Treatment of Hyperhidrosis

Medical:

• Local
• Topicals
• Metal salts:
• Aluminum chloride solutions (eg: Drysol®, certain dry etc)
• Zerconium salts (not used now due to reported granuloma formation in local areas)
• Mechanism of action:
• causing plugging of the distal sweat gland ducts (acrosyngium)
• Effectiveness:
• Concentration dependent (20% or above needed)
• pH dependent (the lower the better, but lower pH also more irritating to the skin)
• minimally to moderately effective
• Side effects:
• Short term:
• Itching, stinging, erythema, other iritation
• Long term:
• Miliaria very rare
• Cost for Drysol®:
• C$20-30 per bottle, can cost hundreds per year
• Acids and aldehydes:
• Works by denaturing proteins, thus temporarily closing the sweat gland ducts
• Mildly effective
• Stains skin
• Contact hypersensitivity
• Local anaethetics:
• Blocks the nerve conduction
• Not widely used
• Not very effective
• May cause contact hypersensitivity
• Anticholinergics
• Not commonly used
• Some find useful as an adjunct to inotophoresis
• Tap-water Iontophoresis (TWI)
• Galvanic devices more effective than drionic devices
• Mostly indicated for palmar and plantar hyperhidrosis
• Mechanism of action unknown:
• Effectiveness:
• About 50-75% patients find TWI effective
• Side effective and drawbacks:
• Local dysthesias and burning
• Erythema and urticarias
• Electric stingings
• Electric burns on uncovered skin defects such as small paper cuts
• Needs daily or several times per week treatment
• Can be time consuming
• Cost C$1,200 for each devise
• Systemic:
• Anxielytics (diazepam)
• beta-blockers (Inderal)
• Anticholinergics (glycopyrolate)
• clonidine
• Calcium channel blockers (Diltiazem)
  

  Can be effective for some people, but systemic side effects associated with these medications
  Heat stroke in hot summers a concern for some due to anhidrosis as well
  Relatively inexpensive (may need to phone a pharmacist to get the real cost)

Surgical

• Sweat gland excision
• Only an option for the axillae
• Can be effective, but technique dependent
• Wound healing and scaring a concern
• Recurrence a concern also
• Covered by MSP, but difficult to find surgents who performs this surgery
• Sympathectomy:
• Open-thorax sympathectomy (rarely performed now)
• Thoracoscopic sympathectomy
• Very effective (greater than 90%)
• Operator dependent
• Can be for axillar and palmar
• Not for plantar (technically not feasible)
• Complications:
• Horner`s syndrome as high as 3.8%
• Hemothorax and pneumothorax (0.3% reported)
• Rare cardiac arrest intra-operatively
• Side-effects:
• Compensatory hyperhidrosis in up-to 84% patients
• Gustatory hyperhidrosis (upto 57%)
• Phantom sweating (sensation of sweating but no production of sweat) 48%
• Neuralgia (pain in the sympathectomy affected areas): rare
• Cost: covered by MSP in CanadaÉ
• Private pay can cause hundred to thousands
• Botox injections:
• FDA indicated and HPB approved in Canada for axillary hyperhidrosis
• Blocks acetyl choline release from nerve endings, thus sweat gland not stimulated
• Highly effective (more than 90%)
• Effect is transient (7.8 month average, 40% more than a year)
• Effective for axillae, palms, plantar, face and other localized areas
• Side effects rare for axilae other than local mild discomfort during injection and rare flu like sympotoms
• For hands: nerve blocks with rare median nerve injury risk, intrinsic hand muscle weakness in some people (transient)
• Facial muscle paralysis possible for botox facial hyperhidrosis treatment
• Costly
• Drug alone: C$400 for axillae, 800 for palms and 1600 for plantar surface per treatment