Excessive Sweating (Hyperhidrosis)
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 temporarily blocking the sweat duct. The procedure uses water to conduct an electric current to the skin a few times each week, for about 10-20 minutes per session, followed by a maintenance program of treatments at 1- to 3-week intervals, depending on the patient's response. Iontophoresis treatments are not painful.
Patients may purchase devices for this treatment through a doctor’s prescription. Medical insurers sometimes cover the cost.
Oral Drugs for Excessive Sweating
Oral anticholinergic drugs such as glycopyrrolate (Robinul) are not commonly used for excessive sweating, because in order to work they often produce side effects like dry mouth and blurred vision.
Botox and Excessive Sweating
Botulinum toxin A (Botox), a nerve toxin that can temporarily paralyze muscle, is often in the news as a cosmetic treatment for wrinkles. But it has actually been used in many areas of medicine for some time, such as in the treatment of muscle spasms and certain types of headaches. Its latest medical niche is the treatment of excessive underarm sweating.
A small amount of Botox is injected with a very fine needle into roughly 25 to 20 spots in each armpit. This may produce approximately six months of relief from sweating. The injections are uncomfortable, but use of a very small injection needle makes them tolerable.
Now that this treatment has received FDA approval for hyperhidrosis, many health insurers are providing coverage for the injections and the Botox itself after other treatments have failed.
Currently, the FDA has not approved Botox for sweating of the palms and soles of the feet, though some physicians are administering it as an off-label use, reportedly with success. Palm injections cause more pain, requiring nerve blocks to numb the hands in order to make the injections comfortable.
Surgery for Excessive Sweating
Thoracic sympathectomy is surgical interruption of the sympathetic nerves responsible for sweating. Sympathectomy is an operation intended to destroy part of the nerve supply to the sweat glands in the skin. The surgeon inserts a special endoscopic instrument into the chest between two ribs just below the armpit. Sympathectomy is both effective and risky. Even with newer endoscopic techniques, the complications can include excessive sweating in other parts of the body and lung and nerve problems. As many of these complications are serious and not reversible, this option is rarely used, and then only as a last resort.