Hyperhidrosis—Don’t Sweat It, Your Dermatologist Can Help

Apr 19

Excessive uncontrollable sweating, called hyperhidrosis, can greatly impact your daily activities in its most severe form. People may experience it in various parts of the body, but it most commonly occurs in the armpits or on the hands and feet. You may find you are soaking through your clothing or giving damp handshakes, making for awkward social interactions.

Good news—hyperhidrosis is treatable. Options range from over-the-counter choices to seeking care from a board-certified dermatologist. So don’t sweat it—there’s help available.

The Game Plan

We recommend trying gentle over-the-counter antiperspirants first and then, if needed, try clinical-strength antiperspirants containing aluminum zirconium trichlorohydrex. These newer products are less irritating and more effective than ever before. Apply nightly for the best results.

Aluminum chloride hexahydrate formulations

If OTC options fail, a dermatologist can provide a prescription, usually containing aluminum chloride hexahydrate, in easy-to-use formulations including wipes, gels, cream, lotion, and roll-ons.

Glycopyrronium wipes

A newer prescription option in wipe form, containing glycopyrronium, works by blocking the sweat receptors and is very effective. It is easy to use by swiping across the affected areas of skin, then tossing it out. It’s important to wash the residue off the hands.

Iontophoresis

If these topical treatments don’t do the trick, your physician may prescribe iontophoresis. It is a long-standing treatment for sweating of the underarms, palms, and soles. A medical device is used to pass mild electrical currents through water onto the skin. The treatment is very safe and results can be long-lasting with maintenance regimens. In some cases, insurance coverage is available for these devices.

Oral medications—anticholinergics

Your dermatologist may prescribe an oral medication if these other treatments fail or if many body areas are involved with excessive sweating. These prescription medications are used effectively off-label to decrease the activation of sweat glands. The category of medication is called anticholinergics and comes with the risk of some side effects. As with everything, you need to weigh the risks and benefits.

Botox injections

Botox injections are FDA approved for hyperhidrosis. Botox works by blocking the chemical signal that activates sweat glands. Results are temporary and treatment is low risk but typically requires repeating every four to 12 months. Due to the escalating costs of Botox, insurance coverage remains a hurdle.

miraDry treatments

Some dermatologists offer miraDry treatments. It is a non-invasive treatment performed in the office. An FDA-approved device delivers controlled electromagnetic energy to cause thermolysis of the sweat glands. The goal is to permanently damage or eliminate the glands. Two to three treatments may be required and this is not covered by insurance.

Endoscopic Thoracic Sympathectomy (ETS)

Finally, as a last resort, ETS is a surgical procedure involving severing the nerve endings responsible for debilitating sweating. The results are permanent but the procedure is done under general anesthesia and comes with the potential for significant risks.