Hyperhidrosis

Hyperhidrosis Blog

It is your turn to stand before the audience and give the presentation.  All eyes are on you as you make your way to the front of the room.  You have prepared for this moment well, and you have mastered the subject.  Although you are confident, you can feel your heart start to race a little and that strange “butterflies” in the stomach feeling.  Your hands are even a little sweaty, and you may just experience a little sweat under your arms.  Sweating before a big crowd or presentation is normal.  It is part of our human fight or flight reaction to stress.  For most of us, these symptoms subside once the stressor is removed. 

There is a group of people, however, that are plagued with unwelcome sweating at inappropriate times.  These individuals may be sitting in an air-conditioned room where everyone else feels quite comfortable, yet these individuals are sweating unprovoked.  We call this type of sweating hyperhidrosis.  This translates to sweating more than normal.  Hyperhidrosis is a medical diagnosis.  While it may sometimes be caused by hormonal abnormalities such as thyroid problems, it is often seen without cause.  In either case, hyperhidrosis can cause rashes, skin breakdown, and psychosocial problems.  Hyperhidrosis affects individuals profoundly and can impair an individual’s quality of life.  It is for this reason that patients come to the board-certified dermatologists at Associated Skin Care Specialists seeking help. 

I have been helping patients with hyperhidrosis for over 20 years.  I approach management following step therapy, starting from the simplest treatments and advancing up the ladder as needed.  The first thing I do is obtain a complete medical history to assure there are no treatable causes for the hyperhidrosis.  Assuming that patients are otherwise healthy, I begin treatment with topical 20% aluminum chloride solution (commonly known by the brandname DrySol). 

If Drysol fails to control the sweating or causes excessive skin irritation, I will try anticholinergic therapy which is available as either the pill glycopyrrolate (brand name Robinul Forte) or the newer topical Qbrexa wipes.  Anticholinergic therapy uses the primary side effect of this class of medications to decrease sweating.  In the oral form, it can be very helpful for treating multiple sites (e.g. hands, soles, underarms) with a single pill taken 2-3 times daily as needed.  If anticholinergic therapy fails or causes too much discomfort with dry mouth or dry eyes, we advance to the next option.

Iontopheresis is a medical device for home use that can be purchased over the internet.  I recommend the Drionic brand.  This device works by directing a mild electrical current through tap water to the skin of the affected area.  This essentially stuns the sweat glands and temporarily decreases sweating for a period of time.  Individuals using this device will need treatment typically three times per week.  While some patients have success with this, it can prove tedious to perform the treatments frequently.

The next treatment option is chemodenervation with botulinum toxin (Botox).  Botox provides durable relief of sweating for 3-6 months in a given treatment area.  Treatment is performed by injecting small amounts of Botox in a grid pattern over the affected area.  While the injections sting slightly, overall the treatment is well-tolerated.  Botox works by blocking the message in the nerves and muscles that control sweat expressed onto the skin.  Treatment of the palms, soles, or underarms can be accomplished in about 10 minutes per area.  Botox is very safe.  While most often connected with cosmetic treatments, it has been used for many medical treatments -- including muscle spasms in children with cerebral palsy -- for over thirty years.  Botox for hyperhidrosis has been a very powerful and successful treatment for my patients.  The drawbacks to Botox are cost if not covered by insurance and the fact that it is not permanent. 

miraDry treatment for hyperhidrosis was introduced in 2011.  This treatment is a game changer.  It is the only permanent treatment approved by the FDA for underarm sweating.  miraDry treatment works by selectively targeting the sweat glands in the underarms with heat.  The heat is so powerful that it destroys the sweat glands.  The treatment is administered in my Eden Prairie office by my miraDry technician.  The underarm is anesthetized prior to the treatment.  While swelling and numbness can occur in the treatment area initially, these symptoms subside soon.  Correction of sweating is seen almost immediately.  For patients with hyperhidrosis, 2 treatments spaced approximately 4-6 weeks apart are the most beneficial.  Typically, no further treatment is then required.  At present, miraDry is only indicated for treatment of the underarms.  In addition to treating hyperhidrosis, many patients opt to treat with miraDry to avoid the daily use of antiperspirants or to treat unwanted underarm odor and hair.  Soon we hope to have additional applicators for the device to treat palms, soles, or other areas.

Finally, for historic interest only, I mention three surgical options for hyperhidrosis.  First, surgically removing the skin from the underarms was done.  This worked for some but created a larger surgical scar.  Furthermore, this surgery could not be performed on the hands and feet.  Second, liposuction has been done in the underarms.  By removing fat from the underarms, the sweat glands are damaged which decreases sweating.  The results of this surgery were often unpredictable.  Again, this procedure does not apply to the hands and feet.  Finally, neurosurgeons can perform a sympathectomy.  This is the surgical cutting of the nerves that innervate the underarm and hand sweat glands.  This surgery is done under general anesthesia and involves collapsing the lung to access the nerves.  Aside from the risk of surgery, patients often experience increased sweating in new areas following surgery.  This is called compensatory hyperhidrosis.  Given the great success of the earlier treatments discussed, all of these surgical options have fallen to the wayside. 

Since my residency at the University of Minnesota, I have enjoyed treating patients with hyperhidrosis.  While I realize I am not curing cancer, the improvement I see in these patient’s lives is profound.  It is an honor to impact my patient’s daily lives in this way.  If you or someone you know struggles with hyperhidrosis, please schedule a consultation to discuss the best personal treatment plan.

Author

Jane Lisko, MD Dr. Lisko is a board-certified dermatologist. She has practiced at Associated Skin Care Specialists, PA in Eden Prairie, MN, and Fridley, MN, since 2001. Dr. Lisko specializes in skin cancer diagnosis and surgery, cosmetic dermatology, and laser surgery. She is married to Dr. Jeff Lisko, a gastroenterologist. Together they have four sons. When not working or spending time with her family, Dr. Lisko enjoys traveling, reading, exercising on her Peloton bike, and playing golf (poorly but with a smile!)