Hyperhidrosis - Definition and Overview

Hyperhidrosis is the medical condition of abnormally increased perspiration (sweating) in excess of that required for regulation of body temperature. The excessive perspiration can happen regardless of temperature or emotional state. (See also diaphoresis)

The most commonly affected parts of the body are the hands, feet and axillae but any part of the body surface may be affected. The incidence of hyperhidrosis is estimated at around 1% of the population.

Hyperhidrosis can be classified according to whether it is generalized or localized and on whether it starts early or late in life. Generalized hyperhidrosis suggests that the cause may be neurological, hormonal or secondary to drug use although other conditions such as lymphoma should also be excluded. Localized hyperhidrosis tends to start in early life and may be due to local excessive numbers of sweat glands, over-reactivity of the sympathetic nervous system in that region or other causes.

Treatment

Hyperhidrosis can usually be treated, but achieving a cure is difficult.

1. Surgery (Endoscopic thoracic sympathectomy or ETS): Select nerves or nerve ganglia in the chest are either cut or burned, which completely destroys the ability for them to transmit impulses, or are clamped, which allows for reversal of the procedure. The procedure is usually very affective from the mid-chest upwards; however, as many as 30% of the patients experience compensatory sweating in other parts of the body. Some people find it tolerable while others feel that the compensatory sweating is worse than the sweating experienced before the surgery. There are other risks, such as a less than 1% chance of Horner's syndrome, and other risks common to minimally-invasive surgery. The surgery can be expensive, but can be covered by insurance. Increasingly, because of the risk of compensatory sweating, the use of the procedure is being curtailed.
2. Aluminum chloride (hexahydrate) solution: The most common brands are Drysol®, Maxim® and Odaban®. The products' active ingredient is similar to what is in regular antiperspirants, but is much more effective. The aluminum chloride solution usually takes about a week of nightly use to stop the sweating, with one or two nightly applications a week for maintenance. An aluminum chloride solution can be very effective, however some people cannot tolerate the irritation that it can cause. Also, the solution is usually not effective for palmar (hands) and plantar (feet) hyperhidrosis.
3. Botulinum toxin type A (trademarked as Botox®): Injections of the botulinum toxin are used on an off-label basis to disable the sweat glands. The procedure can be very expensive since few, if any, insurance plans cover it. The effects usually don't last more than three to six months.
4. Iontophoresis: The affected area is placed in a device that has two pales of water with a conductor in each one. The hand or foot acts like a conductor between the positively- and negatively-charged pales. As the low current passes through the hand, the minerals in the water clog the sweat glands, limiting the amount of sweat released. A common brand of tap water iontophoresis device is the Drionic®. Some people have seen great results while others see no effect. However, since the device can be painful to some and a great deal of time is required, no cessation of sweating in some people may be the result of not using the device as required. The device is usually used for the hands and feet, but there has been a device created for the axillae (armpit) area as well.
5. Oral medication: There are several drugs available with varying degree of success. A class of anticholinergic drugs are available that have shown to reduce hyperhidrosis. Ditropan® (generic name: oxybutynin) is one that has been the most promising. For some people, however, the drowsiness and dry-mouth associated with the drug cannot be tolerated. A time release version of the drug is also available, called Ditropan XL®, with purportedly reduced effectiveness. Robinul® (generic name: glycopyrrolate) is another drug used on an off-label basis. The drug seems to be almost as effective as oxybutynin, with similar side-effects. Other less affective anticholinergic agents that have been tried include propantheline bromide (Probanthine®) and benztropine (Cogentin®). A different class of drugs known as beta-blockers has also been tried, but don't seem to be nearly as effective.
6. Weight-Loss: Hyperhidrosis can be aggravated by obesity, so weight-loss can help. However, most people with hyperhidrosis do not sweat excessively due to obesity.
7. Relaxation and meditation: Relaxation techniques have been tried with limited success.
8. Hypnosis: Hypnosis has been used with limited success.