Excessive facial sweating and/or facial blushing usually occurs during mild social situations that would not normally cause these conditions. It usually starts after puberty. Facial hyperhidrosis is caused by a hyperactive sympathetic nervous system, which is located in the chest cavity. Sympathetic facial blushing caused by hyperhidrosis differs from rosacea, another condition that causes facial redness. Rosacea is a skin condition characterized by blemished skin and constant redness around the cheeks. Sympathetic blushing is marked by facial redness brought on during certain social or functional situations. Sympathetic blushing comes on in short bursts of facial redness. Frequently, patients who experience excessive sweating of the palms also suffer from facial sweating and/or facial blushing. Because facial sweating may be as a result of an adrenal dysfunction or overproduction of adrenaline-like materials, your doctor may suggest a medical evaluation to rule out other medical conditions. Most people diagnosed with facial sweating an/or facial blushing try medications before considering surgery.
There are no medications for the specific treatment of primary hyperhidrosis. However, the condition can be treated with some success with systemic anticholinergics. Ditropan® (generic name: oxybutynin) is one that has been the most promising, but the dry mouth and drowsiness associated with it cannot be tolerated by some patients. Robinul® (generic name: glycopyrrolate) is sometimes effective but also causes dry mouth or a dry throat. These two medications also can cause dilated pupils, constipation, urinary retention, and heart palpitation.
Beta-blockers (Inderal) have systemic anti-sympathetic effects that are helpful in decreasing the body's sympathetic response. They have been useful in some cases of stress-related hyperhidrosis. They also decrease palpitation and tremors and are mostly useful when taken two hours before a stressful situation.
Anti-depressants (Zoloft®) and anti-anxiety medications (Xanax) can be effective. Depression does not cause hyperhidrosis, but hyperhidrosis can cause depression.
Probanthine® (generic name: propantheline bromide), which is often used to treat high blood pressure and some arrhythmias), causes a systemic decrease in sympathetic response. It should only be administered after a patient undergoes a thorough physical examination.
Botox is derived from Botulinum Toxin Type A. Injections of Botox are not effective in treating facial sweating and blushing.
Topical agents, such as Drysol (or other brands of aluminum chloride with ethyl alcohol) or Odaban are generally not effective for facial sweating or blushing.
If conservative methods fail, our team may recommend a surgical procedure called endoscopic thoracic sympathectomy (or ETS) for patients with facial sweating and/or facial blushing. Our team is highly skilled in performing ETS.
Facial sweating and/or facial blushing is considered a medical condition with serious physical and psychological complications when not treated. Therefore, ETS is usually covered by health insurance because it is considered a medical necessity not a cosmetic procedure. However, your policy may require you to try more conservative methods first. You should check with your individual health insurance coverage to determine your benefits.