Treatment Options for Hyperhidrosis (Excessive Sweating)

Hyperhidrosis is a medical term used to describe the condition of excessive and uncontrollable sweating. This condition can affect anyone at any age. Hyperhidrosis can be either localized (affected areas include armpits, soles, palms, or face) or generalized (the entire body is affected). The further subdivision includes whether the condition is primary or secondary.

Primary hyperhidrosis results from a malfunction in the hypothalamic thermoregulatory centre in the brain. It is transmitted through the sympathetic nervous system into the eccrine sweat glands. Excessive sweating attacks can be triggered by exercising, fever, hot weather, anxiety, and spicy food. Usually, the sweating attacks decrease at night and remain absent during sleep. In primary hyperhidrosis, armpits, soles, or palms are affected symmetrically. The condition may be persistent throughout the entire lifespan or may improve with age.

In comparison with primary hyperhidrosis, secondary hyperhidrosis is less common. It is not symmetrical. Excessive sweating attacks occur at night and even during sleep. These attacks can be triggered by various medical conditions such as stroke, peripheral nerve damage, brain tumour, neuropathy, chronic anxiety disorder, and spinal nerve damage. Obesity, menopause, diabetes, respiratory failure, overactive thyroid, cardiovascular disorders, Parkinson disease, and Hodgkin lymphoma can also trigger secondary generalized hyperhidrosis. Drugs such as caffeine, alcohol, tricyclic antidepressants, opioids, and nicotinamide can likewise cause secondary generalized hyperhidrosis.

Numerous treatment options exist for hyperhidrosis, as well as lifestyle measures that help to maintain the condition and minimise its negative impact on daily activities. General measures include avoiding consumption of caffeinated food and beverages, using a non-soap cleanser, and applying antiperspirant. Wearing loose-fitting, stain-resistant, and sweat-proof clothing is also recommended. It is necessary to change clothes and footwear once they become damp. Socks that contain silver or copper tend to decrease odour and the risk of infection.

Antiperspirants are effective in reducing sweating due to their composition of 10 to 25 percent aluminium salts. They are available as creams, sticks, aerosol sprays, roll-ons, and powders. These products are recommended to be applied on dry skin after a cool shower before bedtime. Usage ranges from once a week to daily applications.

Oral medications can be prescribed for the treatment of hyperhidrosis. Effective oral anticholinergic drugs include oxybutynin, benztropine, and glycopyrrolate; however, these can cause dry mouth. Other side effects include dizziness, blurred vision, and constipation. Individuals with glaucoma or urinary retention are not recommended to take these drugs. Elderly patients are advised to take these medications with extreme caution because of the higher risk of negative side effects, including dementia.

Beta-blocker medications block the physical effects of anxiety attacks, which in turn helps to reduce excessive sweating.

Botulinum toxin injections are an approved treatment option for hyperhidrosis. Botulinum toxin decreases sweating or stops it entirely by blocking the sympathetic nerve fibres responsible for controlling sweat glands. Tiny injections are administered on the affected area at approximately 1 cm intervals. When pain tolerance is low, particularly on the palms, a local anaesthetic may be used. The effect lasts for 3 to 6 months.

Another treatment option for hyperhidrosis is fractional radiofrequency. Radiofrequency thermotherapy (RFTT) is administered through a device with electrodes or microneedles in order to generate thermal energy. This is achieved using electromagnetic radiation, which produces an electric current. Once the current meets resistance within the tissue, it produces heat. Heat denatures protein activity and permanently destroys sweat glands. Fractional radiofrequency causes less discomfort during the procedure.