There are a number of treatment options for primary, focal hyperhidrosis. Treatment for secondary hyperhidrosis should be directed towards correction, if possible, of the underlying causes.
For primary hyperhidrosis, it is best to start with simple methods and then, if they fail, progress to more aggressive treatments.
Initially, one should consider antiperspirants, either over-the-counter (OTC) (e.g. Secret Clinical Strength) or by a doctor’s prescription (e.g. Hydrosal Professional). Deodorants merely deal with odor, not with the underlying perspiration problem. A combination of antiperspirants and deodorants may be a good starting treatment. Twice daily treatment is often helpful. Obviously, these treatments are only suitable for the armpit area.
For treatment of the hands and feet, iontophoresis may offer help. This 20 minute, painless treatment uses a water bath of electrolytes and chemicals in which a mild electric current is passed. The electric current forces the minerals and ions to plug up the sweat ducts. Usually, every other day treatment for six to ten treatments is required. Improvement may last for several weeks, at which time additional treatment is required. This treatment machine may be prescribed for home use.
Emotions also play a large role in sweating. Some natural therapies such as relaxation techniques, yoga, biofeedback, and psychotherapy are capable of breaking up the self-perpetuating cycle of heightened emotions leading to sweating which leads to anxiety about the sweating itself which leads to even more sweating. These techniques require multiple sessions and are not totally effective or reliable.
Botulinum toxin (e.g. Botox, Dysport) injections have been successfully used for all areas – armpits, hands, feet, and face. There is mild discomfort during the injections which can be helped with numbing creams and ice packs. Since Botox works to block the nerve stimulation of the sweat glands, it works on both types of sweat glands to produce significant dryness. The improvements are apparent within days and oftentimes last for 4 – 12 months or longer – it is extremely variable. While there is no doubt that these injections are very helpful, the long-term cost of the treatments may be prohibitive.
Another treatment is with anticholinergic, anti-anxiety, anti-depressant, and other medications (such as Robinul, Inderal, Clonidine, etc). These are pills that affect a portion of the nervous system. They help to decrease anxiety and sweating over the entire body but by doing so, will affect the body’s natural ability to cool itself. Long-term use is not recommended due to the significant side effects of the medication.
When all else fails, surgery becomes an option. There are two alternatives: surgical sympathectomy and suction curettage. How do they work?
Sympathectomy is an operation, performed under general anesthesia in a hospital, which cuts the sympathetic nerves to the armpit and palm areas. It is performed using minimal incisions and is known as ETS or endoscopic thoracic sympathectomy. Once this is performed, there is no way to reverse the operation. The operation interrupts the nerve stimulation to the sweat glands. Unfortunately, there is oftentimes post-operative compensatory sweating, in which the body switches the excess sweating to other areas of the body – and which may be worse than the original problem. This can occur even years after the original surgery.
A new and relatively simple surgical procedure for hyperhidrosis of the armpits (“Sweat Lipo” surgery) has been recently been developed and perfected by Dr. Jacobs. It is performed in a 45-minute operation under sedation and local anesthesia on an out-patient basis in our fully accredited (by The Joint Commission) hospital-type office operating room suite. The procedure uses specialized, sharp instruments designed by Dr. Jacobs to perform a direct removal of the sweat glands of the armpit areas. Technically, it is called suction curettage, although it goes by the easily remembered term “Sweat Lipo.” Details of the operation are described below.