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The term “hyperhidrosis” refers to excessive sweating. It is a relatively common condition and is not serious, but it can greatly impact the patient’s quality of life by interfering with their interpersonal relationships and work environment.

Sweat is produced by a type of sweat gland called “eccrine.” Its function is to regulate body temperature and help humans adapt to their environment. These glands are distributed over almost the entire surface of the skin and their function is regulated by nerve fibers.

Dermatologists usually treat patients with localized hyperhidrosis, i.e., limited to certain areas of the body such as the palms, soles or armpits. But there are patients with generalized hyperhidrosis in whom the sweating pattern is more diffuse. In these patients, an infectious, tumor, hormonal or neurological causative process must be suspected.

The cause of hyperhidrosis is not known but it seems that there is an overstimulation of the glands through nerve impulses. It occurs equally in men and women. It is common for the history to begin in childhood or puberty and for other family members to be affected as well, in addition to worsening with certain emotional stimuli. It usually persists for a few years, but there is a tendency for spontaneous improvement. An unusual evolution or asymmetry in its presentation should lead us to think that there may be a cause of localized hyperhidrosis, but this is not usual.

Although there are several treatments for hyperhidrosis, it is important to emphasize that most of them are temporary, and only surgery could be considered as a definitive treatment.

Main treatments for hyperhidrosis

Metallic salts are widely used. Many of the topical products on the market contain them; one of the most commonly used is aluminum hydrochloride, but it can be irritating. Another option is glycopyrrolate, which is not commercially available and must be prepared in a master formulation.

Iontophoresis

An electric current is created by means of a device that mobilizes ions through the skin. The patient places the extremities to be treated in a container and performs daily sessions lasting several minutes, which can be spaced out as results are observed. It is mainly used in palmar and plantar hyperhidrosis.

Botulinum toxin injection

It produces a nervous blockage which prevents the passage of “information” to the gland and the gland does not receive the stimulus to produce sweat. It’s injected at various points using a syringe and needle into the areas to be treated, typically the armpits and palms. In this latter location, anesthesia is necessary because the injection is very painful. This anesthesia is performed by nerve block. The effect on reducing sweating is noticeable within a few days and lasts around 6 months. Then reinjection is necessary, which is done without observing a decrease in the effect over time.

Oral medication

One of the drugs used is oxybutynin. It prevents the transmission of information between the nerve fiber and the gland. As it is an oral treatment, its effects are also generalized, and sometimes they are more limiting or uncomfortable than hyperhidrosis itself (constipation, blurred vision, dry mouth). But it would be a good option in patients with hyperhidrosis in various locations (plantar and axillary palms, for example).

Laser

Nd:YAG and diode types have been used to cause glandular damage. The results are inconclusive and further studies are needed, but it could be an option in patients in whom local or oral treatments have not been effective and prefer to explore other less invasive modes of treatment before considering surgery.

Microwave

It is performed through a device recently approved in the United States for the treatment of axillary hyperhidrosis. Improvement has been observed not only in hyperhidrosis, but also in bromhidrosis (bad odor).

Surgery

It consists of interrupting the nerve transmission of the sympathetic nervous system and is used in the axillae, palms and craniofacial region. Although I have presented this treatment as definitive, the sweating could reappear years later. The technique can be performed by open surgery or endoscopically through a small incision in the thorax. There is even the possibility of “clipping” the nerve instead of cutting it, thus making the technique reversible. There may be complications of surgery; sometimes excessive dryness results and in addition “compensatory hyperhidrosis” may develop in other locations, which is generally better tolerated than the hyperhidrosis that motivated the treatment.

The most important thing, in any case, is to analyze each situation individually to find the best possible solution.

More information about hyperhidrosis.

Beatriz Fleta Asin.