ANTIPERSPIRANTS
Usually recommended as the first therapeutic measure. The most effective agent appears to be alluminum chloride (20-25%) in 70-90% alcohol, applied in the evening 2-3 times/week. Generally, this treatment is sufficient in cases with light to moderate hyperhidrosis but has to repeated regularly.
IONTOPHORESIS
Can be tried if antiperspirants have not lead to the desired result. This method consists in applying low intensity electric current (15-18 mA), supplied by a D/C generator, to the palms and/or soles immersed in an electrolyte solution. The procedure has to be repeated regularly, initially in 20' sessions several times/week, gradually stretching out the interval between treatments to 1-2 weeks. The results vary: many patients, suffering from light or moderate hyperhiderosis, are happy with the method, some may consider it too time-consuming or inefficient, and comparably expensive. It is difficult to apply in axillary, and impossible to use in diffuse hyperhidrosis of the face or the trunk/thigh region.
Equipment, specifically designed for the treatment of hyperhidrosis at home or in the physician's office, is commercially available from different suppliers.
DRUGS
There are no specific drugs available against profuse sweating. Psychotropic (mostly sedative) and/or anticholinergic drugs are often tested but show usually too many side-effects before any noticeable result can be achieved. Hence, they are, as a rule, not recommended. In those few cases who suffer from profuse sweating on the trunk (but not the extremities), a low dose of anticholinergic agent can slightly alleviate the symptoms without rendering life unsupportable from side-effects (dry mouth, accomodation difficulties of the eyes, etc), but a dosage necessary to normalize the amount of sweating will rarely be tolerated.
BOTULINUM TOXIN
A family of toxins produced by a bacteria known as Clostridium botulinum. This toxin is one of the most lethal poisons known, interfering with the effect of the transmitter substance acethylcholine at the synapses (the contact point of a nerve ending with another nerve cell or a muscle) and leading to progressive paralysis of all muscles in the body, including the respiratory muscles. In extremely low doses, botulinus toxin has been adopted in cases with localized muscle hyperactivity (lid spasms, torticollis, etc), resulting in a reduction in transmitting impulses to the muscle. Initial reports have been published regarding the use of botulinum toxin in hyperhidrosis. It seems to work adequately in axillary hyperhidrosis, lasting for 6-12 months depending on the dosage (0.5-1.0 Units/cm2;). A drawback are the costs of this treatment which has to be repeated at regular intervals, but the side-effects seem to be negligible if dosages are kept low.
SURGERY
Excision of the axillary sweat glands
Patients with axillary hyperhidrosis who are unresponsive to medical therapy can be effectively treated by excision of the axillary sweat glands. If sweating extends beyond the hairy portion of the axilla, several skin incisions may be needed, sometimes resulting in formation of hypertrophic and/or constrictive scars.
Sympathectomy
- The principle of sympathectomy is to interrupt the nerve tracks and nodes (ganglia) which transmit the signals to the sweat glands. Basically, this can be achieved for all locations in the body, but only the nerve nodes responsible for the sweat glands of the palms and the face are accessible without the need for a major surgical procedure. Today, the treatment of choice for moderate to severe palmar and facial hyperhidrosis (but also axillary, especially if combined with palmar sweating), consists in a surgical procedure known as Endoscopic Thoracic Sympathectomy. This minimal-invasive endoscopic technique has been developed in recent years in a few hospitals in Europe, superseeding Conventional Thoracic Sympathectomy, a very traumatic procedure performed in the past. The endoscopic technique is very safe, if performed by a surgeon experienced in this type of procedure, and leads to definitive cure in nearly 100% of patients, leaving only a minimal scar in the armpit.
- Individuals with combined hyperhidrosis of the palms and soles have a good chance to improve the sweating of their feet after an operation aiming to suppress sweating of the hands. Isolated plantar hyperhidrosis can, however, only cured by Lumbar Sympathectomy, an open abdominal procedure.
- Diffuse hyperhidrosis of the trunk or general sweating of the whole body cannot be treated by surgery.
OTHER TREATMENT OPTIONS
"Alternative Medicine"
In the experience of the author, many patients, disappointed by the treatment offered by their doctors, have tried different methods of alternative therapy including homoeopathy, massage, acupuncture and phytotherapeutic drugs, in almost all cases without noticeable improvement.
Hypnosis
There are no systematic studies on this method. Few patiens have tried it, reporting poor results on palmar hyperhidrosis.
Psychotherapy
Very limited effect in the absolut majority of patients. Psychological problems are in most cases a consequence of hyperhidrosis, not the cause. Hence, psychiatric or psychopharmacologic therapy cannot cure this disorder, at most it may help the patient to accept living with the problem.
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