TREATMENTS FOR HYPERHIDROSIS
Alternatives for patients seeking control of antiperspirants are to use products with a higher degree of aluminum. The way aluminum works is that it blocks the patient’s pores. With some patients, however, they could have a lot of irritation to it, aside from other theoretical risks, such as cancer as discussed before.
TREATING HYPERHIDROSIS WITH BOTOX OR DYSPORT
One of the effective ways to treating patients with hyperhidrosis under the arms, or axillary hyperhidrosis, or under the feet is the use of a neuromodulator, such as Botox or Dysport. The way these neuromodulators work is that they inactivate both the sweat gland and the gland that makes smell. They are called the Apocrine (smell) and Eccrine (sweat) glands. The Apocrine gland is located in the armpit area (mainly in the hair follicle) as well as certain areas of the body. The rest of the body, such as the hands and feet are comprised of the Eccrine gland.
Patients typically respond well to this treatment. Because the neuromodulator is treating glands and not muscles, the botox treatment tends to last longer, with some patients having results last up to one year.
TREATING HYPERHIDROSIS NON-INVASIVELY
For a more permanent solution, patients can look at options which include Iontophoresis, also known as MiraDry, or Radio Frequency. Iontophoresis (MiraDry) is only FDA approved for armpits. In our practice, we use radio frequency for many of our patients and have found results that are near permanent. The way this works is that use multilevel heating with Fractora, which we have found to be effective in treating patients for both Eccrine, Apocrine, and improving areas. The side benefit of this method that we noticed that underarm hairs are improved.
Hand, feet, and groin sweating can also be an issue for patients. This can also be treated with Botox or, for a more durable solution, can be treated with radiofrequency. MiraDry is not FDA approved and is not used off label in these locations as of yet. They are currently working on the adapter.
TREATING HYPERHIDROSIS WITH SURGERY
The final way of treating Hyperhidrosis is with surgery. Surgery is invasive and could involve cutting nerves and possible surgery near the spine. While this used to be the standard of care, this is no longer the standard and is often too invasive. So, patients with abnormal sweating are turning to botox or more permanent solution, such as radiofrequency or MiraDry.
A simple way to test for the problematic area caused by hyperhidrosis is the Starch-Iodine Test. First, a solution of 3.5% iodine in alcohol is swabbed onto the cleaned, shaved area and let dry. Then a light coating of store bought cornstarch is brushed evenly onto the area. After about ten minutes, a bluish-black area in which indicates a positive test result of the affected area for the Starch-Iodine Test. In some cases, this result is noticeable almost immediately. In others, the patient may need to be stimulated to produce sweat by vigorous, stressful means, especially if the patient was administered medication beforehand.
Products Used to Treat Excessive Sweating:
Antiperspirants: Products here range in effectiveness. Aluminum Chloride is the ingredient used in most products. Some of these products can cause irritation in select patients. It typically takes around 3-5 days to see any benefits. Examples of these products include: Certain Dri and Xerac.
How to use: Apply to affected area when dry. Can occlude with plastic overnight. Wash material off in morning.
Prescription strength Antiperspirants: Contains aluminum chloride hexahydrate. Products containing this include Drysol (20% aluminum chloride hexahydrate).
How to use: Most patients use this consecutively until effective and then maintain its use once a week. It works by creating aluminium salts to block sweat ducts.
Aluminum Chloride Gel: Aldehydes such as Cidex can be used to treat palms and soles but these products can be irritating to skin and have a short lasting effect. Side effect is local irritation.
Iontophoresis : Passing electricity through skin using tap water for 10-20 minutes per session 2-3 x per week. Many patients can purchase this device through a prescription. Newer devices include anticholinergic iontophoresis which has been shown to be more effective than tap water iontophoresis.
Oral Medications : A group of medications called anticholinergics which can reduce sweating. Limited by effecting the entire body and can include mouth dryness, mood changes, irritablity, blurred vision, insomnia, and drowsiness. The drugs used include Oxybutynin and glycopyrolate. Tolerated by very limited number of people.
Botox: Botox: has an FDA approved application for hyperhidrosis. Typically requires 25 units per armpit. Lasts between four to six months. A comparision between aluminium chloride (Drysol) versus Botox showed botox to be more effective treatment.
Surgical Procedures : Thoracic sympathectomy involves cutting the sympathetic chain along the spinal column. Although the benefits have been reported in over 80% of patients, the side effect profile is long and includes compensatory sweating, recurrence of sweating (nerve regeneration), Horner’s syndrome, lowered heart rate.