Hyperhidrosis: How to Not Sweat It

With temperatures outside soaring, sweating provides a useful way to cool our bodies and lower our temperature. Hyperhidrosis, or sweating that is more than what is required to regulate normal body temperature, is no laughing matter. It affects nearly 5 percent of Americans (more than 15.3 million people) and a much higher percentage in many other countries.

The cause of primary hyperhidrosis is unknown, but it results in over activity of the sympathetic nerves and occurs in limited body areas. Secondary hyperhidrosis is usually due to an underlying medical condition or medications and involves the entire body. More than half the cases of primary hyperhidrosis involve the axillae (armpits), but other commonly affected areas are the palms of the hands, soles of the feet, and the head and scalp.

Although excessive sweating can affect people’s daily activities, impact quality of life, and lead to social isolation, only half of hyperhidrosis sufferers have discussed the condition with their doctors. This may be because they are embarrassed, because they don’t know that effective treatments exist, or even because they don’t know that this is a legitimate medical condition.
First line treatments for excessive sweating are topical application of aluminum chloride hexahydrate (Drysol or Certain Dri) or glycopyrronium (Qbrexza.) These are applied once daily and can be helpful in treating focal areas. Skin irritation may limit their use. We have had great success in many patients using anti-cholinergic systemic medications such as glycopyrrolate and oxybutynin, but side effects include dry mouth, difficulty starting urine flow, or the sensation of incomplete bladder emptying.

For ease of use, I love using Botulinum toxin type A (Botox, Dysport, Xeomin) in my armpits for treatment of axillary hyperhidrosis. I never have to wear deodorant or antiperspirant and have sweat- and odor-free pits for about six to nine months per treatment. The treatments are easy and take about fifteen minutes in my office.

Other treatments include iontophoresis, which uses a mild electrical current through water, but there are two more permanent options. MiraDry uses microwave thermolysis to destroy the underlying sweat (and odor-producing) glands. It is not covered by insurance and costs about $2,000 for a treatment. There is also a surgical treatment that severs the sympathetic nerves that cause sweating, but many patients have compensatory hyperhidrosis in new areas, so this procedure has fallen out of favor.

Whatever the location, you don’t have to suffer alone or in silence. There are treatments available, and many are covered by insurance. At Thacker Dermatology, we are here to help you. If excessive sweating is bothering you, call us today at (229) 469-4383 to discuss what options are available.

Written by: Betsy Perry Backe, MD, FAAD

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