How is hyperhidrosis treated?
There is currently no cure for hyperhidrosis, but fortunately there are many treatments available.
Antiperspirants
Deodorants and antiperspirants are terms often used interchangeably, but they are not the same. Deodorants help prevent and conceal body odour, but do not have any “anti-sweat” properties. Antiperspirants, on the other hand, have properties (aluminum salts) that can temporarily halt the production of sweat. They come in different formulations such as gels, creams, sticks, powders, and wipes. The main active ingredient in antiperspirants is aluminum salts, generally in 12%-25% concentrations.
Antiperspirants are applied directly to the skin (topical application). The purpose of the antiperspirant is to decrease the volume of sweating by creating “plugs” in the underarm (or region it is applied to). These plugs are made of aluminum salts, which dissolve into the skin with the help of perspiration. Essentially, the aluminum mixes with the sweat on your skin, dissolving the aluminum that is then absorbed into your pores, which creates “plugs”. These plugs are temporary (generally lasting up to 24 hours) and are washed away over time.
Iontophoresis
Tap water iontophoresis is often considered a first or second-line treatment option for hyperhidrosis, and is generally prescribed and/or recommended for those who traditional antiperspirants don’t work. It is a non-invasive, drug-free, and needle-free treatment that is generally done at home with a small, portable medical device.
Tap water iontophoresis for the treatment of palmar (hand) and plantar (foot) hyperhidrosis can be traced back at least as far back as the 1940s. Since its introduction, it has undergone significant technological advancements and developments and now with the help of devices like Dermadry, treatment can be done at home.
This technology works by directing a mild current through the skin, neutralizing the connection between the nerves and sweat glands. Iontophoresis treatment is done with a medical device, which is plugged into a power source that produces an electrical current that travels via tap water (the conductor), reaching the conductive electrodes that are submerged in water and touching the skin. A protective barrier, such as a towel or sponge is used to make treatment more comfortable by protecting the skin from coming into direct contact with the electrodes. In nearly all cases, this dramatically reduces excessive sweating.
Iontophoresis is a non-invasive (doesn’t penetrate the skin), drug-free, and needle-free way to treat hyperhidrosis. Many doctors recommend and prescribe iontophoresis to those who have no luck with traditional antiperspirants. It is a safe and effective method to treat hyperhidrosis with limited minor side effects, such as temporary skin irritation and reddening.
To learn more about iontophoresis as a treatment option, visit our dedicated
iontophoresis page.
Microwave Thermolysis
Microwave thermolysis (also known commercially as Miradry) is a way to permanently treat excessive sweating of the underarms only. It uses thermal energy to permanently eliminate sweat glands in the underarm region.
The procedure is done with a non-invasive handheld device that delivers electromagnetic energy beneath the underarm skin resulting in thermolysis (decomposition by heat) of the sweat glands. Microwaves target the layer where the sweat glands are, therefore not burning the surface of the skin. It can also help eliminate body odour emanating from the underarm region (bromhidrosis) and underarm hair permanently. It can require several treatments (generally 2, sometimes up to 3) and is a costly procedure.
Laser Therapy
Laser treatment exists for underarm sweating (axillary hyperhidrosis). The treatment is done with a targeted high heat laser that destroys the sweat glands.
Prior to the procedure, tiny incisions are made on the surface of the skin, in order to facilitate the laser penetrating the skin. The device emits a highly targeted laser beam that can precisely heat and destroy the overactive sweat glands in the underarm region. The heat from the laser seals off blood vessels and reduces the risk of infection in the treatment area. Local anesthesia is used during the procedure, and some side-effects include swelling, bruising and numbness. There is not much research on the effectiveness of laser therapy for hyperhidrosis, however it is thought to significantly reduce sweating in the underarm region by permanently destroying the overactive sweat glands. Most patients require 1-2 treatment sessions. The second treatment is often done to target the sweat glands that have not been destroyed during the first session.
The procedure is costly and has limited availability. As it is only offered in select dermatologists’ offices, those seeking laser treatment may struggle to find a clinic in their area that offers the treatment. Laser therapy is also only available for excessive underarm sweating. Not all laser therapy is the same, so consult your dermatologist to discover your options.
Laser Therapy
Laser treatment exists for underarm sweating (axillary hyperhidrosis). The treatment is done with a targeted high heat laser that destroys the sweat glands.
Prior to the procedure, tiny incisions are made on the surface of the skin, in order to facilitate the laser penetrating the skin. The device emits a highly targeted laser beam that can precisely heat and destroy the overactive sweat glands in the underarm region. The heat from the laser seals off blood vessels and reduces the risk of infection in the treatment area. Local anesthesia is used during the procedure, and some side-effects include swelling, bruising and numbness. There is not much research on the effectiveness of laser therapy for hyperhidrosis, however it is thought to significantly reduce sweating in the underarm region by permanently destroying the overactive sweat glands. Most patients require 1-2 treatment sessions. The second treatment is often done to target the sweat glands that have not been destroyed during the first session.
The procedure is costly and has limited availability. As it is only offered in select dermatologists’ offices, those seeking laser treatment may struggle to find a clinic in their area that offers the treatment. Laser therapy is also only available for excessive underarm sweating. Not all laser therapy is the same, so consult your dermatologist to discover your options.
Botulinum Toxin Injections
Botulinum toxin (also commercially known as Botox) injections for hyperhidrosis are a common treatment option for the condition. It is a less common use of the substance that is known for its use in cosmetic procedures, such as to reduce the appearance of wrinkles. Currently, the FDA has only approved Botox for the treatment of primary axillary (underarm) hyperhidrosis, however many specialists will use it “off-label” to treat other areas of the body. It is not always recommended for hands as it can cause temporary pain and weakness in the hands, nor the feet as they are too sensitive. It is most effective for the underarm region, and is also commonly used to treat the forehead and scalp regions.
Botulinum toxin (Botox) is a drug made from a toxin produced by the bacterium Clostridium botulinum. It is a neurotoxin, which affects the structure or function of the nervous system. It's the same toxin that causes a life-threatening type of food poisoning called botulism. Doctors use it in small doses to treat health problems, such as hyperhidrosis.
Botulinum toxin injections alter the function of neurotransmitters, which are chemicals found in the body that are responsible for making the body react in certain ways (i.e. sweating when it’s hot). The injections block the nerves responsible for activating your sweat glands in the treatment area.
Methenamine
Methenamine is a chemical used topically on the skin to treat excessive sweating, generally of the hands. This is commonly used by and marketed to rock climbers, as this cream builds a strong, thick callus on the skin. It makes the skin dry and rough, which is perfect for climbing. Some who suffer from hyperhidrosis have turned to creams with the active ingredient methenamine to help keep their hands dry. The cream comes under many brand names, the most popular being Antihydral.
Methenamine is applied to your skin, and once it encounters the acid pH level on your skin, it reacts by producing formaldehyde and ammonia, which dries out the skin and builds a thick callus with consistent exposure. Formaldehyde is a known carcinogen that works as a potent antiperspirant. Pure formaldehyde is never to be used on the skin due to its links to cancer.
Systemic Drugs
The most commonly used medications for managing excessive sweating are anticholinergics. These include medicines such as glycopyrrolate, oxybutynin, benztropine, propantheline, among others. Anticholinergics are drugs that block the action of acetylcholine, a neurotransmitter that transfers signals between certain cells to affect how your body functions.
The work by blocking the chemical messenger acetylcholine as it attempts to travel to receptors on the sweat glands that are responsible for triggering sweating.
Because anticholinergic medications work systemically, they cannot target one area of the body, unlike other hyperhidrosis treatments. That means that they decrease sweating and moisture all over the body, even where sweating is not a problem, this can cause a range of unwanted side-effects.
Surgeries
Note: We strongly advise against surgeries for hyperhidrosis, due to the risks and side-effects they pose.
Endoscopic thoracic sympathectomy (ETS) is a highly risky procedure that is only reserved for the most severe cases of palmar (hand) hyperhidrosis. Similarly, endoscopic lumbar sympathectomy (ELS) is used to treat the most severe cases of plantar (foot) hyperhidrosis, however it is not as common.
While ETS and ELS are highly advised against due to the inherent risks they pose and the unwanted side-effects, other less risky surgeries exist for underarm sweating. These are "local surgeries", so generally the patient does not have to go under full anesthesia. The surgeries include excision, liposuction, and curettage.
During ETS surgery, a surgeon will attempt to interrupt the transmission of nerve signals from the spinal column to the sweat glands to stop the sweating. The patient is under general anesthesia when the procedure is done, as the surgeon must temporarily collapse a lung in order to destroy the nerve paths associated with the overactive sweat glands. It is generally done to treat severe cases of palmar hyperhidrosis, when no other treatment options have worked.
This is a permanent procedure, no successful reversals have ever been done. The procedure is highly risky and generally results in compensatory sweating all over the body, which is often even more excessive than the sweating the patient was experiencing before. While some patients may experience dryness in their hands, they will be sweating excessively everywhere else on their body, which can be even more life-altering than palmar hyperhidrosis.
Some of the most serious side-effects include compensatory sweating, gustatory sweating, Horner’s syndrome, neuritis and neuralgia, brachial plexus Injury, extreme hypotension, heat intolerance, and arrhythmia. Additionally the risks associated with surgery and undergoing anesthesia must also be considered.
For a more in-depth look at the treatment options click
here.