Hyperhidrosis
Treatment
Several treatment options are available for primary hyperhidrosis. Your doctor will work with you to find the least invasive treatment options that relieve symptoms. Surgery is reserved for patients with severe symptoms who haven't found relief from other treatments.
Treatment for secondary hyperhidrosis focuses on diagnosing and treating the underlying health condition causing the sweating.
Topical medications
For light-to-moderate hyperhidrosis, your doctor will likely recommend applying a nonprescription, over-the-counter, clinical strength antiperspirant on problem areas as an initial treatment. Options that work well might include Certain Dri, Secret Clinical Strength, Degree Clinical Protections and 5 Day.
Prescription antiperspirants with aluminum chloride are the next step. Typically, prescription antiperspirants (Drysol, Xerac) are applied to dry skin before bedtime. Covering the affected areas during sleep can be helpful. Six to eight hours later, the antiperspirant should be washed off. Prescription antiperspirants may cause red, swollen and itchy skin.
Iontophoresis
In this procedure, your doctor will show you how to use a battery-powered device to deliver a low current of electricity to the hands or feet, and sometimes the armpits, through water-saturated wool pads. Iontophoresis treatment alters the outer layers of skin to prevent sweat from coming to the surface.
The treatment, which can be mild to moderately painful, needs to be performed two times a day for three to four weeks. This intense treatment can decrease sweating for several weeks. Then you'll need to repeat the process. Devices are available so you can do this procedure at home. You shouldn't use this treatment if you are pregnant or have a pacemaker.
Although iontophoresis is quite safe, it may be no more effective than a topical antiperspirant.
Oral Medications
Several oral medications can help control hyperhidrosis.
Anticholinergics (such as glycopyrrolate) block nerve impulses to sweat glands.
Carbonic anhydrase inhibitors (such as topiramate) inhibit sweating.
Clonidine reduces nerve stimuli, thereby reducing sweat output.
Older types of antidepressants, such as amitriptyline, can reduce sweating and also can help patients cope with hyperhidrosis. Possible side effects are dry mouth, blurred vision and difficulty with urination. Anti-anxiety medications are an option for patients whose excessive sweating is primarily due to stress-induced anxiety. But they usually aren't effective.
Botulinum Toxin (Botox)
Botulinum toxin (Botox) treatment temporarily blocks the nerves that trigger your sweat glands. The U.S. Food and Drug Administration approved Botox for axillary (underarm) hyperhidrosis in 2004.
At Mayo Clinic, dermatologists administer Botox. Your doctor could inject up to 20 small doses of Botox in a treatment session. Often, the injection sites are determined using diagnostic sweat tests. To ease pain caused by the injections, your doctor will use anesthetic techniques that might include oral or intravenous sedation medication or topical creams.
Typically, you should see improvements in two to four days. The benefit usually lasts four to six months. Then, the treatment needs to be repeated. Botox is used most successfully for underarm hyperhidrosis but it can be used for sweaty palms. Less often, it's considered for facial sweating because of the risk that it might weaken facial muscles.
Surgery
If you have severe hyperhidrosis and other treatments haven't worked, surgery may be an option. Mayo Clinic surgeons are among the most experienced anywhere in providing minimally invasive surgical treatment for hyperhidrosis. Two approaches involve interrupting the nerve signal triggering excessive sweating. The other approach is to remove some sweat glands. Learn more about hyperhidrosis surgery.
