"For complex conditions, you need to be mindful that just because something isn't working, that doesn't mean it doesn't work; it just might not be enough. You might have to compound multiple treatments to get it under control," Adam Friedman, MD, professor of dermatology at George Washington School of Medicine and Health Sciences, tells Health.
For those with sweating in multiple parts of the body, several treatments may be needed.
"Many people have multiple areas of sweating, oftentimes hands and feet go together. Some of my patients have underarms, hand, and feet. The groin and buttocks are not uncommon either, as well as under the breasts or back," Dee Anna Glaser, MD, dermatologist at SLUCare Physician Group in St. Louis, tells Health.
Here is a breakdown of common treatments and which type of hyperhidrosis they are used for.
hyperhidrosis treatment (IHS).
For that reason, Dr. Friedman tells his patients to apply antiperspirants to their underarms at night to block any sweating that might occur (even though excessive nighttime sweating is uncommon, as this 2021 review posted by the US National Library of Medicine points out). For mild hyperhidrosis, he recommends using an antiperspirant every night for three weeks and then decreasing to three times a week.
He warns that some higher-strength over-the-counter and prescription antiperspirants can cause itching and burning if used incorrectly. To avoid skin irritation, Dr. Friedman suggests that people wipe off antiperspirants first thing in the morning. However, talk to your doctor about the best plan for you.
Topical wipes for underarms
In 2018, the US Food and Drug Administration (FDA) approved a topical treatment for primary axillary hyperhidrosis: Qbrexza (glycopyrronium) is a prescription "anticholinergic" medicine, a type of drug that blocks the nerve signal that is going to the sweat gland to activate sweating, explains Dr. Friedman.
"When used properly, Qbrexza cloths are quite effective and approved down to age 9," says Dr. Glaser.
Botox for underarms, hand, feet, face, groin, and more
Botox (onabotulinumtoxinA) is FDA-approved to treat severe primary axillary hyperhidrosis when topical treatments are not effective. OnabotulinumtoxinA can temporarily block the release of the chemical that initiates the body's sweat glands, says Dr. Friedman
The IHS states, "By blocking, or interrupting, this chemical messenger, botulinum toxin 'turns off' sweating at the area where it has been injected. Botox injections are very shallow, meaning that the medicine is injected just below the surface of the skin, where it remains."
Botox is not approved for use on other parts of the body for excessive sweating, however, dermatologists may do so with caution in severe cases when no other treatment is working. For instance, Dr. Freidman says using Botox in the hands can be difficult because the skin on the palms is thick, making it hard for medicine to penetrate. "Also, there are lot of nerve endings in the fingers and hands and Botox injections can hurt there," he says.
Additionally, if the injections are done incorrectly, they can cause muscle wasting in those areas.
"You need documentation has failed a clinical strength anti-perspirant before insurance will pay for Botox," says Dr. Friedman.
"Most patients need the Botox injections every 4 to 6 months. It works well and many patients will also use a topical option too," he says.
Laser for underarms
Most studies involving laser treatment for underarm sweating are merely case reports, which are uncontrolled and involve few patients, the IHS points out. Therefore, there's no definitive proof of the effectiveness of laser treatment for hyperhidrosis. However, some doctors do offer it.
Laser procedures typically takes less than an hour to complete. During the procedure, doctors use lasers to target and destroy sweat glands in the underarm via small incisions, says IHS.
Iontophoresis for hands and feet
This procedure has been used since the 1940s to treat hyperhidrosis of the feet and hands, and typically involves weekly treatments, says IHS.
According to the American Academy of Dermatology (AAD), an iontophoresis device is a machine that generates a low-voltage current. It works by temporarily shutting down sweat glands. You'll immerse your hands or feet in a pan of shallow through which the current passes. For other body parts requiring treatment, patches that connect to the machine may be placed on your skin, says IHS.
After seeing your dermatologist for initial treatments, the procedure may be performed at home.
Iontophoresis can provide long-term benefits, the IHS notes. Side effects may include dry or irritated skin or discomfort during treatment, the AAD points out.
miraDry for underarms
This FDA-approved treatment for axillary hyperhidrosis uses a handheld device to direct microwave energy to the skin where sweat glands are located. The heat it generates eliminates or damages sweat glands in the underarm, says the IHS.
The effects are almost immediate, the society notes. While one treatment is sometimes enough, some people benefit from a second procedure three months after the first.
Oral medications for underarms, hand, feet, face, groin, and more
Prescription medications taken by mouth can help stop the sweat glands from producing sweat.
Anticholinergics, a class of medicines including glycopyrrolate, oxybutynin, benztropine, propantheline, are the most common oral medications used for hyperhidrosis. However, these drugs have not been studied in controlled clinical trials specifically for hyperhidrosis. They are FDA-approved for other medical conditions, so doctors use them "off-label," says the IHS.
"For example, the most common medication we give orally would be oxybutynin, which stops sweating as a side effect, but is FDA-approved to treat bladder problems, so it dries out your mouth and eyes and can constipate you," says Dr. Glaser.
Beta blockers (propranolol) and benzodiazepines are other oral medications used to treat excessive sweating that occurs from specific anxiety-inducing situations like giving a presentation. These medications "block" the physical manifestations of anxiety, says the IHS.
Surgery for underarms
The following procedures, per the IHS, are performed to treat axillary hyperhidrosis:
- Excision: cutting out sweat glands.
- Curettage: scraping out sweat glands.
- Liposuction: suctioning out sweat glands.
In some cases, your doctor may use a combination of these surgeries. It's important to note that these treatments remove or damage sweat glands, so they can have permanent effects, the society points out. Additionally, doctors might not know how effective the surgeries are because sweat glands are very small and often undetectable with instruments.
Another surgery to know about: endoscopic thoracic sympathectomy (ETS). It involves inserting a camera under the armpit so the surgeon can cut or destroy the nerve paths on the spinal column that are connected to the overactive sweat glands. ETS surgery is rarely performed on underarms and hands and should be considered with caution as a last resort when all other treatments fail and a person's ability to live out their life is affected by their hyperhidrosis, says the IHS.
"We don't recommend it anymore. You are tearing out the nerve roots that are sending information to those sweat glands. What we find is you get [compensatory] hyperhidrosis, meaning the areas you were concerned about get better, but other places start to sweat excessively. It also isn't that effective for hand disease, which it was meant to be used for," says Dr. Friedman.
Per IHS, ETS is not reversible and can cause compensatory hyperhidrosis anywhere from 6 months to 10 years after the procedure is performed. ETS can also cause extreme hypotension, arrhythmia, and heat intolerance.
Dr. Glaser notes that some surgeons considered clipping the nerve instead of cutting it off.
"The surgery was a good idea, but it didn't pan out. Some patients might be happy with it, but I have patients who wear diapers now because they are sweating so profusely from their groin and they wish they never had the surgery," she says.
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