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Treatments and drugs
By Mayo Clinic staffYour doctor may recommend one of the following treatments for hyperhidrosis:
- Prescription antiperspirant. If over-the-counter antiperspirants don't help, your doctor may prescribe aluminum chloride (Drysol, Xerac). This prescription antiperspirant is used to treat light to moderate hyperhidrosis. For best results, apply the antiperspirant at night to the areas most prone to sweating; make sure the areas are completely dry before applying. You may notice symptoms improve within a week. Prescription antiperspirants are strong solutions that can cause red, swollen and itchy skin. To prevent irritation, wash the medication off in the morning. To ease skin irritation, your doctor may recommend a hydrocortisone cream.
- Anticholinergic drugs. If you have generalized sweating, your doctor may prescribe an anticholinergic drug, such as glycopyrrolate (Robinul, Robinul Forte). Anticholinergics work by blocking the actions of acetylcholine, a chemical messenger in your body that helps to stimulate your sweat glands. Signs and symptoms generally improve in about two weeks. But because acetylcholine acts on several structures in your body, not just your sweat glands, it can have various side effects. While generally mild, they may include dry mouth, constipation, blurry vision, urinary retention, loss of taste, dizziness and confusion. If you experience diarrhea, rash or hives, or difficulty breathing or swallowing, seek prompt medical help, as these may signal a more serious problem.
- Iontophoresis. In this procedure, a dermatologist uses a battery-powered device to deliver a low level of electrical current to the hands or feet, and sometimes the armpits, while the person's body is immersed in water. This is thought to temporarily block sweat glands. Treatments last about 15 to 30 minutes and are often performed once a day for a couple of weeks, followed by less frequent maintenance therapy. Iontophoresis is generally safe and eventually maintenance therapy can be done at home.
- OnabotulinumtoxinA (Botox). Researchers have discovered that Botox injections, also used to help smooth facial wrinkles, are an effective way to treat severe hyperhidrosis by blocking the nerves that trigger the sweat glands. Botox isn't a cure-all, however. It may take several injections to achieve the desired results, the treatment can be painful, and the results last only about four months. Side effects, such as hand muscle weakness, when injected into the palms, and headache, are possible but uncommon.
- Surgery. In rare cases, surgery may be an option. If excessive sweating occurs just in your armpits, removing the sweat glands may help. Another procedure involves cutting the nerves that carry the messages from the sympathetic nerves to the sweat glands. The surgery can be performed using a procedure known as endoscopic thoracic sympathectomy (ETS). It requires just three small incisions for a video camera and small surgical instruments. Although the operation is delicate, it typically requires only a day in the hospital and produces minimal scarring. After the surgery, sweating on the hands permanently stops. But sometimes after ETS, increased compensatory sweating can occur elsewhere on your body, such as your back or the back of your legs.
References
- Hyperhidrosis. American Academy of Dermatology. http://www.aad.org/public/publications/pamphlets/common_hyperhidrosis.html. Accessed May 10, 2010.
- Smith CC. Idiopathic hyperhidrosis. http://www.uptodate.com. Accessed May 10, 2010.
- Hyperhidrosis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec10/ch118/ch118c.html. Accessed May 10, 2010.
- Hyperhidrosis treatments: Antiperspirants. International Hyperhidrosis Society. http://www.sweathelp.org/English/PFF_Treatment_Antiperspirants.asp. Accessed May 10, 2010.
- Hyperhidrosis treatments: Iontophoresis. http://www.sweathelp.org/English/PFF_Treatment_Iontophoresis.asp. Accessed May 10, 2010.
- Eisenach JH, et al. Hyperhidrosis: Evolving therapies for a well-established phenomenon. Mayo Clinic Proceedings. 2005;805:657.
- Hyperhidrosis treatments: Everyday solutions. http://www.sweathelp.org/English/PFF_Treatment_Solutions.asp. Accessed May 10, 2010.
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