Hyperhidrosis

Types of Hyperhidrosis

There are two types of hyperhidrosis, primary and secondary.

Primary hyperhidrosis is when unwarranted nerve impulses are sent to sweat glands when they are not needed.  The result is sweaty palms, feet, face or armpits in people who are otherwise healthy.  Some think emotional stimuli can trigger the condition, but doctors have not been able to confirm this.

Secondary hyperhidrosis is excessive perspiration brought on by an underlying medical condition, like an infection, heart disease, cancer, menopause, or hyperthyroidism.  This condition can affect the entire body or a single area.

Judging the Severity of Hyperhidrosis

The severity of hyperhidrosis is measured on a scale from one to four, based upon how much the patient feels the condition interferes with daily life.  Here’s how the levels are defined:

1: My sweating is never noticeable and never interferes with my daily activities

2: My sweating is tolerable but sometimes interferes with my daily activities

3: My sweating is barely tolerable and frequently interferes with my daily activities

4: My sweating is intolerable and always interferes with my daily activities.

One third of people with hyperhidrosis define their severity as a Level 4, saying the condition is intolerable. Both 3 and 4 above are considered to be “severe” cases of hyperhidrosis.

A starch iodine test is often used to test for hyperhidrosis.  In the test, an iodine solution is applied to the affected area, followed by dry starch powder.  The powder will turn dark blue or purple in areas where sweating is excessive.  The doctor might apply a filter paper to the area for 60 seconds to determine the rate at which sweat is produced.  This helps them to diagnose the severity of the condition.

Treatments for Hyperhidrosis
There are several treatment options available for hyperhidrosis.  Most patients start by trying the least invasive options, and then proceeding to more elaborate treatments if their symptoms persist.

Topical Medications
The most common treatment for underarm sweating is over-the-counter antiperspirants containing 10% to 15% aluminum chloride hexahydrate.  People who suffer from excessive sweating often choose a clinical-strength over-the-counter antiperspirant, such as Degree Clinical or Secret Clinical Strength.  While these work for some, most patients proceed on to other forms of therapy.

The next step up are prescription antiperspirants containing a higher amount of aluminum chloride hexahydrate, such as Xerac and Drysol, They are applied to the skin at bedtime and washed off in the morning. This is usually done daily for several nights in a row, then once a week thereafter. While effective, these prescription antiperspirants can leave the skin, red, swollen and itchy.

Iontophoresis
Introduced in 1952, this procedure delivers a low current of electricity to the areas suffering from excessive perspiration (typically the feet and hands, but sometimes to the underarms as well) through the use of wool pads saturated with water.  The electrical current alters the outer layers of the skin, preventing sweat from coming to the surface.

There are at-home devices available to perform iontophoresis which makes the process much more convenient. Each treatment lasts 10 to 20 minutes, and can be a little painful and intense. Iontophoresis needs to be performed two times a day for three to four weeks.  When successful, iontophoresis can decrease sweating for several weeks before the process needs to be repeated.

Iontophoresis is considered to be a safe procedure, but it hasn’t been shown to be more effective than topical antiperspirants.  Also, pregnant women and people with pacemakers should avoid iontophoresis. 

Oral Medications
Some patients find success treating their hyperhidrosis with oral medications such as Anticholinergics that block nerve impulses to the sweat glands and clonodine, which reduces nerve stimuli, including those impulses that travel to the sweat glands.  Also, anti-anxiety medication can provide relief to those suffering from anxiety-related hyperhidrosis.

Oral medications can have side effects, such as dry mouth, insomnia, blurred vision and difficulty urinating.  Some sufferers reserve these medications for use before important social or business events, where their excessive sweating is more burdensome than usual.

BOTOX for Hyperhidrosis
In 2004, the FDA approved BOTOX Cosmetic for use in treating for axillary (underarm) hyperhidrosis.  During treatment, the physician injects up to 20 small doses of BOTOX in a grid in the armpit.  A local anesthetic is used to numb the area, making the treatment a comfortable one.

BOTOX is sometimes used for excessive sweating in the hands and feet as well, but these treatments can be extremely painful and require nerve blocks to the area before administrating.

The treatment does a good job of controlling excessive sweating.  Results are usually seen in two to four days and last for about six months, at which time the procedure must be repeated.A 2008 study found BOTOX to be more effective than prescription-strength antiperspirants for moderate to severe hyperhidrosis in the underarm area.

AxiLase Laser Sweat Ablation
AxiLase is the latest way to reduce excessive underarm sweating.  This minimally-invasive treatment uses proven laser technology to bring excessive sweating under control. 

The procedure takes about an hour and the affects are usually immediate. Some experts in the medical community believe the results will last for years or even longer.  After the treatment, patients are usually have a day or two of downtime and then and return to their normal activities.

AxiLase replaces more invasive options such as surgical excision of the sweat glands or endoscopic thoracic sympathectomy, or surgical interruption of the nerves responsible for sweating.