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No Sweat!
No Sweat!

There is help for hyperhidrosis

Jessica looked miserable when I walked into the exam room. “I just can’t shake your hand,” she said with a tear in her eye. “My hands are always damp, but they get dripping wet whenever I’m under stress. I hate to tell you about my perspiration problem, but I really need help. I am getting married next winter and I am afraid my sweating will ruin my day. I know I will stain my beautiful dress and have to skip the receiving line if you can’t help me.”

I let her know that she made a great decision to get medical help, and she came to the right office. Board certified dermatologists are physicians with special training for a wide variety of skin problems. Excess sweating is a common medical problem called hyperhidrosis. Fortunately, dermatologists can help most people with this condition. Hyperhidrosis is generally considered to be more perspiration produced than the body needs to maintain good temperature control. Perspiration is critical to keep our bodies from being overheated, especially if we have been exercising or working hard. Excess perspiration starts after puberty and has been estimated to affect almost three percent of adults in the United States. Unlike Jessica, the majority never mentions the problem to their doctor. Although the condition cannot be cured, we can usually get good control to allow people to participate in the activities they enjoy.

First, we needed to discuss her medical problems, allergies, current medications, and recent blood tests.
Rule out potential disorders
I told Jessica I was delighted that she had given us time to work together before her special event. First, we needed to discuss her medical problems, allergies, current medications, and recent blood tests. Fortunately, Jessica like most people with the perspiration problem was in good health, but sometimes excessive sweating may be a sign of thyroid disorders, diabetes, or hormonal problems. It may also be a bigger problem for people who are above their ideal body weight. Occasionally increased perspiration can run in families. We also needed to do a physical examination to help me understand her problem areas. The most common body areas affected are the armpits, palms, and soles. If necessary, the doctor can paint the skin with iodine and sprinkle with starch. In the areas of excessive sweating, the iodine becomes almost black and the areas of sweat gland concentration can be easily identified.

What are the options?
Before coming to my office, Jessica had tried almost every antiperspirant in the drugstore and a natural crystal product from the health store, but nothing had worked well. She was unaware of the number of different medical treatments for increased perspiration. I wanted to give her an overview of our options. We usually start with a prescription antiperspirant medication called Drysol. The active ingredient, 20 percent aluminum chloride, is available generically. Fortunately, this medication gives about 60 percent of the people adequate control. Unlike the non-prescription products, it is applied to clean, dry skin in the problem areas before going to bed and left on overnight. It is rinsed off in the morning with plain water to reduce irritation. The treatments continue nightly until the amount of perspiration lessens. People can generally skip a night or two before needing another application.

If people need a bit more improvement or want a treatment without chemicals, I ask them to consider a Drionic device. This procedure involves applying a small electrical current to the surface of the skin while it is in contact with water. There are battery operated iontophoresis units for home use. The treatment is repeated several times a week. The mechanism of action is unknown, but the device treatment probably physically blocks the sweat ducts at skin levels. It has been reported that 80 percent or more of the people with hyperhidrosis show improvement with this treatment, and they will continue its use. The units may be purchased on the Internet without a prescription.
I explained that if Jessica did not get adequate improvement with the Drysol or the Drionic, we still had other options. The prescription tablet, Robinul, or generic glycopyrrolate is used off label for excessive perspiration. The medication was originally studied as an intestinal antispasmodic. However, in low doses, it can block excess perspiration. We generally start with one tablet a day. It can be increased in strength or frequency if needed. This pill can cause dry mouth, constipation, and overheating, so it must be used only with careful monitoring. However, many people consider this medication life changing.

Although topical glycopyrrolate wipes are not available in the United States, they are marketed over-the-counter as Secure Wipes in Canada. Many people prefer using this topical product because they can apply it only where it is needed and can avoid the potential systemic side effects of a pill.

Really? Botox can help sweating?
The FDA approves Medical Botox for sweating that has not been responsive to other treatments. It is rather expensive, so most insurance companies require patients to document failure of the more traditional treatments. The Medical Botox is approved for excessive armpit perspiration, but it is also used off label for palms and soles. The treatment is done in the doctor’s office. The medication is injected in small amounts through a tiny needle into the top skin area where the sweat glands are located. Most people find the discomfort minimal, and they can be excessive perspiration free for six months after a single treatment session. Side effects are uncommon and most patients love their results.

Before Medical Botox was available, some patients needed neurosurgical procedures requiring general anesthesia. In these procedures, the surgeon attempts to clip the fibers of the sympathetic nervous system that supplies the area of increased perspiration. One of the side effects of this procedure is increased perspiration in adjacent areas not affected by the surgical procedure. Fortunately, because of the various treatments that I named above, very few people now need this procedure. Other types of surgical procedures that have been used include liposuction and removing the sweat glands in the area of the armpits.

Jessica was amazed that she had so many treatment options. We started first with the Drysol prescription. When she returned in a month, she was a new woman who shook my hand without hesitation. I asked her how the wedding plans were proceeding. Her response with a grin was “No sweat!”

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"No Sweat!"
   authored by:
Dr. Rebecca L. Bushong is both a pharmacist and a board-certified dermatologist. After receiving her BS. in Pharmacy and her Pharm D degree, she returned at age 30 to the Medical School of the University of Kentucky. Following medical school she comp...

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