Hyperhidrosis, or excessive sweating, is a common disorder which produces a
lot of unhappiness. An estimated 2%-3% of Americans suffer from excessive
sweating of the underarms (axillary hyperhidrosis) or of the palms and soles of the feet
(palmoplantar hyperhidrosis). Underarm
problems tend to start around puberty, while palm and sole sweating may begin
earlier, often during childhood.
Untreated, these problems may continue
throughout life.
Sweating is embarrassing, it stains clothes, and it complicates
business and social interactions. Severe cases can have serious practical
consequences as well, making it hard for people who suffer from it to hold a
pen, grip a steering wheel, or shake hands.
What is the cause of hyperhidrosis?
Although neurologic, metabolic, and other systemic diseases can sometimes
cause excessive sweating, most cases occur in people who are otherwise healthy.
Heat and emotions may trigger hyperhidrosis in some, but
many who suffer from hyperhidrosis sweat nearly all the time, regardless of their mood or the
weather.
What is the treatment for hyperhidrosis?
Through a systematic evaluation of causes and triggers of excessive sweating,
followed by a judicious, stepwise approach to treatment, many people with this
annoying disorder can achieve good results and improved quality of life.
The approach to treating hyperhidrosis generally proceeds as
follows:
- Over-the-counter antiperspirants:
Home remedies like these are usually tried first because they are readily available. Antiperspirants containing aluminum chloride (for example, Certain-Dri) may be more effective when other antiperspirants have failed. So-called "natural" antiperspirants are often not very helpful.
- Prescription-strength antiperspirants: those containing aluminum chloride hexahydrate
- Iontophoresis: a device which passes direct electricity through the skin using tap water
- Oral medications: from the group of medications known as anticholinergics, which reduce sweating
- Botox (botulinum toxin): approved by the FDA for treating excessive axillary (underarm) sweating
- Surgery: cervical sympathectomy, as a last resort
- Aluminum chloride hexahydrate
When regular antiperspirants fail, as they often do, to remedy hyperhidrosis, most doctors
start by recommending aluminum chloride hexahydrate (Drysol,
various generics), a prescription-strength version of aluminum chloride. It is
applied just before bedtime seven to 10 nights in a row, then roughly once a
week thereafter to maintain improvement. The aluminum salts in this preparation
collect in the sweat ducts and block them. Over time, sweating may diminish to
the point at which little or no further treatment is needed. This method works
reasonably well for many patients whose problem is excessive underarm sweating,
but it's not satisfactory for most of those with palm and sole sweating.
The main side effect with aluminum chloride is irritation, which can sometimes,
but not always, be overcome by reducing the frequency of use or applying
antiinflammatory medications such as lotions containing hydrocortisone.
- Iontophoresis
Iontophoresis
was introduced over 50 years ago as a treatment for excessive
sweating. Its exact mechanism of action is still unclear. The procedure
uses water to conduct an electric current to the skin which combats
production of sweat.
The current is applied typically for 10-20 minutes per session,
initially with two to three sessions per week followed by a maintenance
program of treatments at one- to three-week intervals, depending upon
the patient's response. Iontophoresis treatments sound painful but in
fact are not.
Patients purchase devices for this treatment through a doctor's prescription.
Medical insurers sometimes cover the cost.
- Oral medications
Oral anticholinergic medications such as
glycopyrrolate (Robinul) are not commonly used for this condition, because in order to work they often produce
side effects like dry mouth, insomnia, and blurred vision.
- Botox
Botulinum toxin (Botox), a muscle
poison much in the news as a cosmetic treatment for wrinkles,
has actually been used in many areas of medicine for some time, such as in the
treatment of muscle spasms and certain types of headaches. Its latest medical
use is for treating excessive underarm sweating.
Fifty (50) units of Botox are injected into roughly 20 spots in each armpit.
This may produce approximately six months of relief from sweating. The
injections are uncomfortable, but use of a very small injection needle minimizes
discomfort.
Now that this treatment has received FDA approval, many health insurers are
providing coverage for the injections and the Botox itself, which is quite
costly.
Currently, the FDA has not approved Botox for treating sweating of the palms and
soles of the feet, though some physicians are administering it as an off-label
use, with some success. Drawbacks of using this treatment for the palms and
soles are pain, requiring nerve blocks to numb the hands in order to make the
injections tolerable, and the potential for temporary muscle weakness.
- Surgery
Endoscopic thoracic sympathectomy (ETS) refers to surgical interruption
of the sympathetic nerves responsible for sweating. Sympathectomy is an
operation intended to destroy part of the nerve supply to the sweat
glands in the skin. The surgeon inserts a special endoscopic instrument
into the chest between two ribs just below the armpit. The lung is
briefly deflated to better visualize and destroy the nerves.
Sympathectomy is both effective and risky. Even with newer endoscopic
techniques, complications of the procedure can include excessive
sweating in other parts of the body as well as lung and nerve problems.
As many of these complications are serious and not reversible, this
option is rarely used, and then only as a last resort.
Hyperhidrosis At A Glance
- Hyperhidrosis, or excessive sweating, is a common disorder.
- Axillary hyperhidrosis is excess sweating of the underarms.
- Palmoplantar hyperhidrosis is excess sweating of the palms and soles.
- Hyperhidrosis usually occurs in people who are otherwise healthy.
- The approach to treating hyperhidrosis generally proceeds from OTC antiperspirants to prescription antiperspirants, iontophoresis, oral anticholinergic medications, Botox, and surgery.
No comments:
Post a Comment