Excessive Sweating (Hyperhidrosis)

What Is Hyperhidrosis?

Hyperhidrosis, or excessive sweating, is a common disorder which produces a lot of unhappiness. An estimated 2-3% of Americans suffer from excessive sweating of the underarms (axillary hyperhidrosis) or of the palms and soles of the feet (palmoplantar hyperhidrosis). Underarm problems tend to start in late adolescence, while palm and sole sweating often begins earlier, around the age 13 (on the average). Untreated, these problems may continue throughout life.

Sweating is embarrassing, it stains clothes, ruins romance, and complicates business and social interactions. Severe cases can have serious practical consequences as well, making it hard for people who suffer from it to hold a pen, grip a car steering wheel, or shake hands.

What Is the Cause of Hyperhidrosis?

Although neurologic, metabolic, and other systemic diseases can sometimes cause hyperhidrosis, most cases occur in people who are otherwise healthy. Heat and emotions may trigger hyperhidrosis in some, but many who suffer from hyperhidrosis sweat nearly all their waking hours, regardless of their mood or the weather.

What is the Treatment for Hyperhidrosis?

Through a systematic evaluation of causes and triggers of hyperhidrosis, followed by a judicious, stepwise approach to treatment, many people with this annoying disorder can achieve good results and improved quality of life.

The approach to treating excessive sweating generally proceeds as follows:

• Over-the-counter antiperspirants -- usually tried first because they are readily available. Antiperspirants containing aluminum chloride (for example, Certain-Dri) may be more effective when other antiperspirants have failed
• Prescription strength antiperspirants -- those containing aluminum chloride hexahydrate
• Iontophoresis -- a device which passes direct electricity through the skin using tap water
• Oral medications -- ones called anticholinergics, which reduce sweating
• Botox (botulinum toxin) -- recently approved in the U.S. by the FDA for treating excessive axillary (underarm) sweating
• Surgery -- cervical sympathectomy, as a last resort

Aluminum Chloride Hexahydrate and Excessive Sweating

When regular antiperspirants fail to treat excessive sweating, most doctors start by recommending aluminum chloride hexahydrate (Drysol), a prescription-strength version of aluminum chloride. It is applied just before bedtime seven to 10 nights in a row, then roughly once a week thereafter to maintain improvement. This treatment works reasonably well for many patients whose problem is excessive underarm sweating, but is not satisfactory for most of those with palm and sole sweating.

The main side effect with Drysol is irritation, which can sometimes, but not always, be overcome by reducing the frequency of use or applying anti-inflammatory drugs, such as lotions containing a corticosteroid.

Iontophoresis for Excessive Sweating

Iontophoresis was introduced over 50 years ago as a treatment for excessive sweating. Its exact mechanism of action is still unclear, although it probably works by plugging up the sweat duct. The procedure uses water to conduct an electric current to the skin which combats production of sweat. Current is applied typically for 10-20 minutes per session, initially with two to three sessions per week followed by a maintenance program of treatments at one- to three-week intervals, depending upon the patient's response. Iontophoresis treatments sound potentially painful but, in fact, they are not.

Patients purchase devices for this treatment through a doctor’s prescription. Medical insurers sometimes cover the cost.