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The diagnosis and treatment of excessive sweating depends on the type of hyperhidrosis and the area affected:
- Most patients with generalized idiopathic hyperhidrosis (which affects large areas of the body) can be treated with oral medications.
- Those with secondary generalized hyperhidrosis (caused by a medical condition) should be evaluated by a dermatologist.
- A number of treatment methods are used to treat primary focal hyperhidrosis, which occurs on specific areas of the body, including the hands, feet, armpits and face. These treatments are described below.
Many patients should try conservative therapies (medications or topical agents) first before considering surgery. Your doctor will determine what is the best treatment method for you based on the type of hyperhidrosis you suffer from, your age, and your general medical condition.
Some of these methods are covered by health insurance plans, some are not. Check with your individual policy and/or carrier to understand what benefits you are entitled to receive.
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 some patients cannot tolerate the dry mouth and drowsiness associated with it. Other side effects include dilated pupils, constipation, urinary retention and heart palpitations.
- Robinul® (generic name: glycopyrrolate) is sometimes effective but may cause dry mouth, dry throat, dilated pupils, constipation, urinary retention and heart palpitations.
- Beta-blockers (Inderal) have systemic anti-sympathetic effects that are helpful in decreasing the body's sympathetic response. They've 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 doesn't 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.
- Glutaraldehyde applied two to four days a week is effective in treating palm sweating (plantar hyperhidrosis). But it can cause severe browning of the skin and stain clothing. It may also be expensive.
- Topical agents containing aluminum chloride (hexahydrate) with ethyl alcohol (Drysol, CertainDri, Maxim, Odaban and Driclor) are the most widely used for patients with mild to moderate armpit sweating (axillary hyperhidrosis). They contain a much higher concentration of aluminum chloride than what is used in regular antiperspirants. Patients apply the medication to the affected areas of the skin and leave it on for six hours at night for about one week. The medication obstructs the sweat gland pores. Axillary irritation can occur. Short-term results are satisfactory, but the medication doesn't have long-term results.
Endoscopic thoracic sympathectomy (ETS) is a minimally invasive surgical procedure used to treat hyperhidrosis. It's the most successful treatment for excessive sweating of the hands, as well as an effective option for patients who have excessive armpit sweating or facial sweating/blushing. Learn more about ETS surgery for hyperhidrosis.
Botox injections work best for armpit sweating (axillary hyperhidrosis), but not palm sweating, facial hyperhidrosis or facial blushing. Botox is derived from Botulinum Toxin Type A. The toxin is highly deadly, but Botox is manufactured under strict laboratory conditions. Botox blocks the neurotransmission from the sympathetic nerves to the skin to the sweat glands and reduces excessive sweating in the areas where it has been injected by a dermatologist. This treatment lasts only between four to six months, so treatments must be repeated.
This treatment involves placing the hands or feet (whichever area is affected) in two pails of water that contain a conductor. A device (brand names Drionic®, Idrostar, MD-1A) applies a low electric current to the feet. As the current passes through each hand or foot, minerals in the water clog the sweat glands, limiting the amount of sweat released. Each session lasts 20 minutes and is repeated four to six times a week. Frequent treatments are necessary. Some people have experienced good results with this treatment, while others see no effect.
Sweat Gland Removal Surgery
Very severe armpit sweating (axillary hyperhidrosis) may need to be treated with permanent surgical removal of the sweat glands by a plastic surgeon. Either a traditional surgical procedure, or a minimally invasive one called suction curettage, which is a modified form of liposuction, may be used.
Suction curettage is an outpatient procedure during which a plastic surgeon removes the sweat glands using quick suction and scraping (curettage). The surgery takes about 60 to 90 minutes, and patients return home later that day. Some patients return to work the next day. More than 95 percent of patients report less discomfort and permanent dryness. Patients may experience scarring or compensatory sweating (excessive sweating of back, torso and legs) after having this type of sweat gland removal surgery.
- Weight loss can help, since hyperhidrosis can be aggravated by obesity. However, most people with hyperhidrosis don't sweat excessively due to obesity.
- Some patients who have sweaty feet (plantar hyperhidrosis) use talc or baby powder to absorb the sweat, but powder is messy and can cause a coating of white on the feet.
- Complementary therapies, such as relaxation techniques, hypnosis and biofeedback, offer limited success for sweaty palms.