Reduce Excess Sweating
A Dermatologist’s Viewpoint
Excess sweating (hyperhidrosis) can be embarrassing, socially isolating and difficult to hide especially when it affects the hands, face or underarms. Below are six common treatments and my comments based on treating patients for nearly 20 years with this condition.
Some suggest that drinking large quantities of water may in some way inhibit sweating. Unfortunately, in my experience I have had no patient report success. I would like to warn anyone thinking of trying this; excessive water intake can result in low blood sodium levels which can result in nausea, headaches, muscle spasm and other potentially dangerous side effects. So please be careful and try one of the options below.
- Lotions and Roll on Anti Perspirants
This is perhaps the most common topical products recommended. I would definitely suggest trying a number of anti perspirants. The benefits can be variable.
In Australia, products containing aluminium chloride are commonly recommended and some who apply it underarms (axilla) ) find it irritating. I would suggest decreasing the frequency of application to 2-3 times each week and apply to clean, dry skin at night to allow absorption and be effective in the morning. On the palms and soles it is reasonably helpful and fortunately irritation is less of a problem. Glycopyrolate lotion in different concentrations can be prescribed, usually by a dermatologist. This is a reasonable alternative to anti perspirants but will need a script from your doctor or more likely dermatologist. Some patients may notice slight dryness of the mouth.
This is a method which is helpful for the palms and soles. It involves placing your palms/soles in separate trays filled with a solution and allowing a small weak current to pass through. It isn’t uncomfortable and most patients describe a tingle or buzzing sensation. The solution is most commonly glycopyrollate which requires a script to purchase. Patients report benefits which usually lasts 1-2 weeks and this would determine frequency of treatment. Tap water can also be used but more frequent treatment is usually required. Please call our rooms or email us with any questions regarding this treatment or to make an appointment. Ionotophoresis treatment is available at Skinplus Findon. Units can be purchased online but I would suggest trying the treatment first to assess the benefits before buying a very expensive unit which may not help.
- Tablets include Ditropan or Propantheline
These drugs have an anticholinergic effect ie it blocks your nerve receptors accepting a natural chemical acetylcholine. As it is taken by mouth, most patients experience some side effects which is dose dependent. The most common is dry mouth. These drugs are short acting and the side effects limit a higher dose. This is best if the sweating is generalised and I have used it in combination with the next treatment.
- Botulinum Toxin Injections
Works well in 98% of patients with a dramatic improvement within a week of treatment. It involves multiple injections and the benefits last between 4 months to over a year (minority). Some patients have remained sweat free for up to 18 months! In the axilla (armpit) topical anaesthetic is useful to help the sting of the injections. ( Honestly it feels like an Epilady - for those who have used one. ) On the palms – I usually use ice for pain relief or some doctors will use a nerve block. For reasons only known to medicare Australia – a rebate is available for the toxin injected (by specialist such as dermatologists ) for treatment of sweating of the axilla but not if you sweat excessively elsewhere.
In the old days axilla vault excision was used and rarely recommended now due to the scars and also some patients would continue to sweat. Transthoracic sympathectomy or liposuction are two other options. There is a side effect known as compensatory hyperhidrosis ie: excessive sweating develops elsewhere which can occur in up to 1/3 of patients.
I hope the above has been helpful.
NB: These comments are my opinion based on my personal experience treating this condition