Hyperhidrosis Treatment

The approach to treating Hyperhidrosis should be guided by consultants, preferable by a dermatologist. Other medical specialists, for example internists, will help to eliminate pathological causes of a secondary Hyperhidrosis.

Psychotherapists and neurologists will treat psychosomatic reasons or nervous influences. Example: A common complaint of patients is that they get nervous because they sweat, then sweat more because they are nervous. A vicious circle …

Visiting a homoeopath might be an alternative to conventional therapies. It can help to treat causes and symptoms of sweating disorders as well.

Apart from the important causal research, sufferes should start to treat the symptoms (= sweating) as soon as possible. Guidance by health professionals is recommended, yet the first steps of treatment are prescription free (over-the-counter remedies).

Treatment – Step by step:

Step-by-step treatment of Hyperhidrosis

A recommended hierarchy to be maintained:
Hyperhidrosis sufferers should always start their treatment with topical antiperspirants (albeit some doctors prefer to start with expensive injections or surgery, guess why …). More than 80 % of people with Hyperhidrosis can reduce their sweating efficiently with aluminium chloride. Only when these affordable remedies seem to fail the next step should be taken.

Conclusion: Before considering a huge operation which could involve unforecastable risks, much simpler procedures may be worth looking into.

A critical view on Hyperhidrosis solutions

Therapy Pros Cons
Deodorants, topical agents; OTC *
none
inefficient
Home remedies, for example tea from sage leafs, baking soda, brewed oak rind, baby powder, rubbing alcohol and others; OTC
cheap, alternative treatment
inefficient (in most cases); partly extensive (time consuming)
Antiperspirants, topical agents, prescription strength; OTC
cheap (approx. 10 to 20 £); non-surgical therapy; topical only; highly efficient; very good successrate; best solution for cranial (facial) sweating; easy usage
harmless skin irritations are possible (easily treatable)
Iontophoresis, technique using a small electric charge; induction through water baths; prescription needed
non-surgical therapy without active agents
only for axillary Hyperhidrosis and sweaty hands/feet; inefficient in many cases; scientifically unexplored effects; extensive (time consuming); expensive home remedy (approx. 500 £ for med. devices); quite harmful for many patients
Medications, mostly pills; prescription needed
effective
negative side effects, medications often contain antipsychotic drugs or agents for the treatment of Parkinson’s disease
Botox® Injections, multible injections of Botulinum toxin with syringes; prescription and precautious anamnesis needed
effective
only for axillary Hyperhidrosis and sweaty hands/feet; surgical intervention; use of toxin; painful anaesthesia; more than 15 injection per hand/sole; effect will only last for 6 month; expensive (approx. 300 £ or more); recurring surgery (2x p.a.)
LSA (Laser sweat ablation), sweat gland removal by laser; prescription and precautious anamnesis needed
effective; minimally invasive (keyhole surgery)
only for axillary Hyperhidrosis; non-reversible; surgical intervention; low risk of compensatory sweating
Liposuction,
Curettage,
Sweat gland removal, by suction; prescription and precautious anamnesis needed
effective
only for axillary Hyperhidrosis; non-reversible; surgical intervention; low risk of compensatory sweating
ESB (endoscopic sympathetic blockade), surgical procedure where certain portions of the sympathetic nerve trunk are temporarily interrupted by clamping; prescription and precautious anamnesis needed
effective;
reversible procedure
surgical intervention; high risk of negative side effects and compensatory sweating, yet reversible (unclamping)
ETS (endoscopic thoracic sympathectomy), surgical procedure where certain portions of the sympathetic nerve trunk are destroyed by cutting or burning (laser); prescription and precautious anamnesis needed
utterly effective
ultima ratio; non-reversible; surgical intervention; high risk of many side effects (e.g. Horner’s syndrome) and severe compensatory sweating

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A closer look on negative side effects and disadvantages:

  • Antiperspirants: harmless skin irritations typically occur shortly after the usage of antiperspirants. They manifest themselves as reddened, itching or stinging skin. A greasy lotion enriched with natural ingredients (for example Aloe vera, liquorice root or refreshing Frescolat® chrystals) will help to calm down dermal irritations. However, these problems are temporary and not dangerous at all.
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  • Iontophoresis is a galvanic ionisation therapy where low voltage is brought to the skin (thereby to the sweat glands) through water baths. It should not be used on people who have very susceptible skin or are sensitive to any ion that is projected for treatment. A strange electrical pain, felt in close-by bones and joints is the most often side effect. Sporadically, skin irritations, even small blisters can occur on the area where the treatment is applied.
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  • Medications often contain antipsychotic drugs or anticholinergics (agents which were originally made for the treatment of Parkinsons’s disease). Such oral or systemic prescription medications will affect the autonomic nervous system. Many people have reported serious side effects, for example unbearable oral dryness (thereby impaired speech, taste, chewing, and swallowing), blurred vision, urinary retention, constipation, heart palpitations, tremors and even localized paralysis.
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  • Botulinum toxin (Botox®) injections are a common, yet expensive and extensive therapy for Hyperhidrosis. The surgical procedure demands 20 or more punctures with a syringe per hand/foot/armpit. The toxic agent is injected directly into the sensitive palm/sole/axillary area, the previous local anesthesia is quite painful for most people. A further disadvantage is the shortened effectiveness (approx. 6 month). Usually, Botox® patients will have to endure the whole procedure twice a year.
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  • Sweat gland removal: This surgical therapy is done by laser (LSA) or by suction (liposuction and subcutaneous curettage). Aside from rather minimal scarring, compensatory Hyperhidrosis can occur. This localised reflex sweating is a serious side effect: As surgery stops sweating in one area of the body, people may wind up with excessive sweating elsewhere.
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  • ESB/ETS: This surgical intervention should always be the ultima ratio. The clamping (ESB, which is reversible) or the final disconnection of the sympathetic nerve trunk is a radical and final surgery with possible, but very serious side effects. The most common rebound is compensatory sweating. Not less than 80 % of patients experience a milder form. For 40 – 60 % of patients it gets annoying. And for 3 – 5 % of patients the rebound perspiration gets beyond all bearing. For example, people who have eliminated their palmar sweating by ESB/ETS could get sweaty soles instead. In worst cases, the sweating found its way to the face (known as cranial sweating). Another odd after-effect is severe sweating whilst eating/digesting a meal (known as gustatory sweating). There are many other (sporadic or seldom) side effects. They should be regarded as a serious threat because the initiating surgery is forever irreversible (except for ESB).
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    Expert’s tip:
    Visit www.no-ets.com for a detailed description of all ETS side effects.

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Hyperhidrosis therapies in words and pictures

iontophoresis galvanic hyperhidrosis therapy

photo above | Iontophoresis treatment of palmar Hyperhidrosis. The patient dips his hands into galvanic baths while the iontophoresis device sends out an electrical current through the water buffer to the pores (and by that to the sweat glands) of the skin. The same method is used for plantar sweating and axillary Hyperhidrosis (by using wet sponges). The possible effects of this solution are scientifically unexplored. Another problem is that patients have to visit the doctor on a daily basis – for years. The device could also be purchased for home usage but it is quite expensive and most health insurance companies do not pay for it.

botox injections plantar hyperhidrosis

photo above | Prepared sole and toes for Botulinum toxin (Botox®) treatment of plantar Hyperhidrosis. Each dot stands for an injection with the syringe. More than 40 punctures are needed for one foot. Problem with this therapy is that the positve effect will only last for approx. 6 month.

esb surgery with laser or sub sonic device

photo above | Removal of the axillary sweatglands. Each dot stands for an insertion of the laser or ultrasonic (as shown) device for subcutaneous elimination of the eccrine glands, either by burning (laser) or shattering (ultrasonic). This keyhole surgery is minimally invasive but the risks are still the same as for every surgical intervention.
ets surgery for hyperhidrotics
photo above | Surgical disconnection of the sympathetic nerve trunk (ETS). Due to the high risks of several documented side effects this non-reversible surgery should always be an ultima ratio.
* OTC = over-the-counter products, prescription free
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