Hyperhidrosis

Topical aluminum salts are often the first line treatment for hyperhidrosis. They act on the sweat glands by reducing the action of secretory cells and thereby localized sweating. The most common aluminum salt is 20% aluminum chloride. 

Glycopyrronium bromide is a topical medication that blocks the action of acetylcholine (a neurotransmitter) and, thereby, inhibits local sweating.

Oral medications such as oxybutynin block receptors that inhibit the action of acetylcholine. However, it is associated with side effects such as dry mouth, nausea, diarrhea, gastroesophageal refux, headache, dizziness, fushing, blurred vision, urinary retention, tiredness, and constipation.

In iontophoresis, the skin is exposed to a weak electric current that causes ions to pass across the skin surface, which is believed to alter the local pH, block the sweat ducts, or inhibit the sympathetic nervous system that innervates the sweat glands. Iontophoresis may be effective treatment for primary hyperhidrosis of the palms or soles.

BTX is injected into the skin where it blocks the release of acetylcholine from the nerve endings that innervate the sweat glands. It is useful for axillary, palmar and craniofacial hyperhidrosis, with repeated (and costly) injections every 6 months. 

Fractional microneedle radiofrequency devices uses a microneedle that allows for precise delivery of energy in the tissue, which can target and destroy your sweat glands. During this procedure, microneedles are placed 2 to 3.5 mm under the skin, and radiofrequency energy is applied. This therapy results in a decrease in the HDSS score of at least one point in nearly 80% of patients. They have the advantage of minimal skin trauma, ability to reach depths up to 3.5mm and are considered safer compared to laser devices for darker skin type. Examples of these devices include:

• GENIUS
• INFINI

A microwave device delivers heat to the tissue that inducesthermolysis (heat induced destruction) of the sweat glands, which inhibits local sweating. 

Surgery is considered when conservative treatments have failed.

Local surgical techniques include excision, curettage, liposuction, or a combination of these techniques.

Sympathectomy is the treatment of last resort in the management of hyperhidrosis. The most common long-term complication after sympathectomy is compensatory sweating.

• This type of hyperhidrosis is idiopathic, meaning its exact cause is unknown.
• It typically starts during childhood or adolescence and persists throughout adulthood.
• Primary hyperhidrosis often affects specific areas of the body, such as the palms, soles of the feet, underarms, face, or groin.
• It can be triggered by emotional factors (emotional sweating) or occur spontaneously (thermal sweating).

Antiperspirants containing aluminum chloride are often effective for mild to moderate cases of hyperhidrosis by blocking sweat ducts.

Fractional microneedling with radiofrequency (RF) is a minimally invasive  procedure that has shown promise in the treatment of hyperhidrosis, particularly axillary hyperhidrosis (excessive sweating in the underarms). Some advantages of fractional microneedling RF for hyperhidrosis include:

• Minimal Side Effects: Fractional microneedling RF is associated with minimal side effects compared to more invasive procedures. Patients may experience temporary redness, swelling, or mild discomfort at the treatment site, but these typically resolve within a few days.

• Precision Targeting: Fractional microneedling RF allows for precise targeting of the sweat glands in the treated area, minimizing damage to surrounding tissues.

• Minimally Invasive: Compared to surgical interventions such as sympathectomy (surgical interruption of sympathetic nerve signals) or sweat gland removal, fractional microneedling RF is minimally invasive and does not require extensive downtime.

• Stimulates Collagen Production: The microneedles used in the procedure create controlled micro-injuries in the skin, which stimulate the body’s natural healing response and promote collagen production. This can lead to improved skin texture and tone in addition to reducing sweating.

• Long-lasting Results: Fractional microneedling RF has been reported to provide long-lasting results for hyperhidrosis, with many patients experiencing a reduction in sweating for several months to a year or more after treatment.

• Customizable Treatment: The depth of needle penetration and the intensity of RF energy can be adjusted based on the individual patient’s needs, allowing for a customized treatment approach.

Daily management strategies for hyperhidrosis include wearing moisture-wicking clothing, using absorbent materials or pads in affected areas, practicing good hygiene, avoiding triggers such as spicy foods or caffeine, and managing stress through relaxation techniques or therapy.

Botulinum toxin injections (Botox) can provide significant relief from excessive sweating for several months, typically around 4 to 6 months. Repeat injections may be necessary to maintain the effects.

Side effects may vary depending on the treatment but can include skin irritation, dry mouth, blurred vision (with anticholinergics), and compensatory sweating in untreated areas (with sympathectomy).

In severe cases that don’t respond to other treatments, surgical options like sympathectomy (nerve surgery) or surgical removal of sweat glands may be considered, but they carry risks and are usually considered a last resort.