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Of Sweating and Hyperhidiosis

The Issue

In the U.S. alone, approximately 7.8 million people suffer from hyperhidriosis, a condition characterized by excessive sweating around a general or specific area such as the hands, feet, armpit and groin areas. These areas contain a very high concentration of sweat glands and thus leading to increased perspiration from these areas causing significant problems for affected individuals from both personal and professional perspectives. The condition ruins relationships, stains clothes and creates problems with business and social interactions. Severe cases could have even a more negative impact such as making it difficult for sufferers to hold a pen or grip a steering wheel. In sports, this condition makes it difficult for sufferers to grip a baseball, basketball or football.

What You Need To Know

Although neurologic, endocrine, infectious, and other systemic diseases can sometimes cause hyperhidrosis, more often than not sufferers of this condition are healthy. Triggers such as heat and emotions may cause the on-set of hyperhidrosis in some, but a great number who suffer from hyperhidrosis sweat virtually all their waking hours, regardless of their mood or the weather. Nervousness or excitement can make the situation worse for many sufferers. Certain foods and drinks, nicotine, caffeine, and smells can also trigger hyperhidriosis.

The way in which hyperhidiosis has been treated has generally proceeded as follows:

1. Over-the-counter antiperspirants usually containing aluminum are usually tried first because they are quite accessible. Antiperspirants containing aluminum chloride such as Certain Dri, could be more effective if other antiperspirants have not worked.

2. Prescription antiperspirants containing aluminum chloride hexahydrate (Drysol).

3. Iontophoresis, a system which disseminates ionized tap water through the skin utilizing direct electricity.

4. Oral medications such as Anticholinergics to reduce sweating.

5. Botox (botulinum toxin)-A, was approved in the U.S. by the FDA for treating excessive axillary (underarm) sweating.

6. As a last resort, a procedure called thoracic sympathectomy is sometimes considered.

When regular antiperspirants fail to treat excessive sweating, most doctors start by recommending Drysol, a prescription-strength version of aluminum chloride. Sufferers apply it on the affected area(s) just before bedtime 2 to 3 nights in a row, then usually once a week thereafter to maintain improvement. This treatment works relatively well for many patients whose problem is excessive underarm sweating, but does not work well for most of those with palm and sole sweating.

The primary side effect of Drysol is irritation, which can sometimes, but not always, be prevented by ensuring that the skin is dry before applying and allowing the medicine to dry completely afterwards. Also, reducing the use of lotions containing a corticosteroid could help minimize irritation.

Iontophoresis was introduced more than 50 years ago as a treatment option for excessive sweating. Its exact mechanism of action is still not fully understood, although it is believed to be by the temporary blocking of the sweat duct. The procedure uses water to conduct an electric current to the skin several times a week, for around 10-20 minutes per session, followed by follow-up treatments at 1- to 6-week intervals, depending on the patient’s response and device used.

Oral anticholinergic drugs like glycopyrrolate (Robinul) are not often used for treating hyperhidrosis, because the side effects include dry mouth and blurred vision.

Botulinum toxin A (Botox), a nerve toxin that can temporarily paralyze muscle, is frequently in the news as a cosmetic treatment for wrinkles. One may be surprised that it has actually been used in many areas of medicine for many years including for the treatment of muscle spasms and certain types of headaches. Its latest medical use is for the treatment of excessive underarm sweating.

Though the FDA has not approved Botox for treating sweating pf the palms and feet, they have approved it for use to prevent excessive sweating of the armpits. Treatment involves the injection of a small amount of Botox with a fine needle into around 25 to 20 locations in each armpit which produces six months of relief from sweating. With FDA approval, many insurance companies are now providing coverage for the injections and the Botox itself after other treatment options have failed.

Sympathectomy is an operation that removes a portion of the nerves to the sweat glands in the skin. The surgeon inserts a special endoscope into the chest between two ribs just under the armpit. This procedure may be both effective and risky since even with the latest endoscopic techniques, the complications, which include excessive sweating in other parts of the body, lung and nerve problems, creates an even more serious threat to one’s health. Due to the fact that many of these complications are serious and not reversible, this option is rarely used, and then only as a last resort.

What You Need To Do

As with any health issue, discuss and plan your course of action with your doctor or in the case of athletic departments, the team physician. With that said, Iontophoresis is an option to seriously consider as the technology and success rate continues to rise with limited complications involved.

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