Hyperhidrosis

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What is it?

  • Excessive sweating – over production of eccrine glands that creates a weak salt solution.  Can be primary or secondary.

  • Primary –starts in childhood or adolescence, and may persist lifelong typically involves armpits, palms and soles, may have a family history and usually gets better at night. Other triggers are hot weather, exercise, fever, anxiety, spicy food, meds

  • Secondary – less common, may be generalized, can occur during sleep and can be due to a medical condition.

 

Do I need to do any tests as part of the diagnosis?

  • In most cases the answer is NO as this tends to be a clinical diagnosis

  • Occasionally your doctor may order some baseline bloodwork including blood sugars or thyroid tests if a medical cause is suspected.

 

What are the treatment options available?

  • General measures include:
    •    Wear loose-fitting, stain resistant, sweat proof clothing
    •    Change clothing and footwear when damp
    •    Socks containing silver or copper reduce infection and odour
    •    Use absorbent insoles in shoes and replace frequently
    •    Use a non-soap cleanser (Cetaphil or CeraVe)
    •    Apply corn starch powder after bathing
    •    Avoid caffeinated food and drink
    •    Discontinue any drug that may be causing hyperhidrosis
    •    Apply antiperspirant
        

 

1. Antiperspirants

Available as a cream, aerosol spray, stick, roll-on, wipe, and powder.  They are best applied when skin is dry, after a cool shower just before sleep.  Contain aluminium salts to reduce sweating by blocking the sweat glands.  They typically last about 6-8 hours for most people.  Common products include Drysol mild (6.25%), Drysol regular (12%) and Drysol extra strength (20%) and can be found in the pharmacy or online.   Common side effects include irritation, burning, tingling and prickling sensation.

2. Glycopyrrolate pads

Prescription cloths containing glycopyrronium tosylate were approved in July 2018 for axillary hyperhidrosis in adults and children 9 years of age and older.   Only to be used on armpits so hands should be washed thoroughly after use.   Possible side effects include dry mouth; dilation of the pupils; sore throat; skin redness, burning/stinging or itching in underarm area; headache; problems with urination; blurred vision; nasal, throat, eye, and skin dryness; and constipation. 

3. Botox injections

Tiny injections into the skin usually every 3-6 months.   Reduces sweating in more than 75% of people by “paralyzing” the ability of sweat gland to produce sweat.   Side effects include minor pain with injections, swelling and possible bruising.

 

4. Iontophoresis

Electric powered device (purchased online) where the affected areas are immersed in water and a current is passed across the skin for 10-20 minutes to disrupt sweat production. Repeated daily for several weeks and then used as maintenance treatment - Costs typically 200-1000$ for a home device.
Side effects include skin irritation, discomfort, redness and dryness.

 

5. Medications 

Anticholinergics such as oxybutynin and glycopyrrolate that “dry up” body secretions including sweat.
They can cause dry mouth, and less often, blurred vision, constipation, dizziness, palpitations and other side effects. Should not be used if have glaucoma or urinary retention.

 

6. Lasers and Surgery 

  • Nd:Yag laser – selectively heats underarms and destroys sweat glands

  • Tumescent liposuction (“sucking out” sweat glands)

  • Subcutaneous curettage (“scraping out” sweat glands)

  • Sympathectomy – severing a nerve that runs along your spine –sometimes leads to sweating in a different location afterwards.