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What are the treatments for Hyperhidrosis?

There are two categories of hyperhidrosis treatment, non-surgical (alternative treatments) and surgical.

There are various non surgical treatments for hyperhidrosis including the following. Keep in mind the success rate for these is extremely limited:

Alternative Treatments:

  • Lotions and or Antiperspirants
  • Oral Prescriptions
    • Anticholinergic Group
    • Sedatives and anti anxiety medications
  • Electronic Devices
  • Combination Hyperhidrosis Treatments
  • Acupuncture and Biofeedback

Surgical Treatments:

  • ETS
  • ELS
  • Axillary
    • Miradry
    • Laser

Alternative Treatments to Hyperhidrosis

Lotions and or Antiperspirants
Currently on the market there are a few chemical compounds (lotions) that are used to try and eliminate hyperhidrosis of the hands, armpits and feet. Those lotions are basically metallic compounds containing aluminum salts which is a combination of chloride attached to aluminum particles. The lotion is supposed to block the sweat pores in the affected areas. Those lotions come in different concentrations. Concentrations below 20% can be bought over the counter and those with 20% and higher can be obtained with a prescription from a doctor. The most well known prescription is Drysol and the non prescription are known as Certain Dry, Sweat Block, etc. In europe different preparations are used especially Odaban.

The usage of these lotions can be limited due to the acidic content of those items which can cause discomfort, pain, blisters and redness. It really depends on the tolerance level of each individual. Overall the success rate is extremely low. Specifically control of the armpit area tends to be more successful than treatment for the hands and feet.

Compound pharmacies around the country can produce lotions that contain additional ingredients than those mentioned above with the addition of anticholinergic agents. The success rate is very limited since no large scale studies have been done.

Oral Prescription Anti Hyperhidrosis Medications
Anticholinergic Agents
Another very popular alternative treatment is the usage of oral medications. Most of the oral medications are not actually primarily intended for hyperhidrosis. This group of medications is called anticholinergic agents. The active ingredient in this type of medication is a chemical structure that is supposed to negate that the body produces in order to release sweat. This group of medications was used initially to treat gastrointestinal disorders. The problem is that the longer term usage of these medications is limited because the body develops a tolerance to it over time. Also some side effects such as blurry vision and dry mouth can limit its use. Overall the success rate with this type of medication is very limited if at all.

Sedatives and Anti Anxiety Medications
There is a wrong perception in the medical community that hyperhidrosis is caused by anxiety and personality issues. This perception is false but at the same time many patients do get some anti anxiety medications and mood changing medications. Those type of medications again do not have a measurable success rate and at the same time can cause more damage than good to the patients due to addiction. Alcohol and recreational marijuana may create temporary relief for hyperhidrosis but is not recommended for long term usage due to obvious reasons.

Electronic Devices
In the medical literature electronic devices to treat hyperhidrosis are known as iontophoretic devices. The most well known of these devices are the Drionic machine and the MD Fischer device. There are also several do it yourself device creation instructions available online. To achieve success these devices have to be used repeated long periods of time which can be painful, time consuming and with low success rates. Altogether the success rate is low but it is a modality that one can try. These devices can be rented or purchased.

BOTOX Treatment
Botox injections to affected areas of hyperhidrosis is another attempted modality to treat hyperhidrosis. The Botox preparation which is made from certain bacteria and the basic physiological action is the interference of the Botox toxin with the chemical structure in the body that triggers sweating. It is an expensive treatment with a very low success rate in the treatment of palmar or plantar hyperhidrosis. It has the highest success rate with the treatment for isolated axillary hyperhidrosis The combination of the cost, pain and very limited success rates eliminated the actual use for palmar and plantar hyperhidrosis. For some commercial reasons there are doctors who recommend it’s use (For example dermatologists). The validity of their claims should be questioned. Also the use of Botox injected to the palms or the feet which is associated with a high level of pain can also cause some temporary muscle paralysis.

Overall Botox is not recommended by hyperhidrosis experts.

Combination Treatments and Acupuncture for Hyperhidrosis
It is an obvious fact that if any illness can be treated or solved with non-invasive methods is preferable to any invasive procedures. In order to achieve that doctors and patients alike are hoping that combination treatment methods will be effective and prevent invasive surgical procedures. So far the combination treatments have not shown any real success rates.

Combination treatments can be a mixture of holistic approaches, lotions, pills, acupuncture, certain dietary products and psychological or behavior modification approaches. Over the web there are a plethora of information sources many of which are not based on peer reviewed medical sources. It is wishful thinking that those will work and any patient is welcome to try those but at the end of the day as far as we know now only the surgical approach is the one with the most prolonged solution for excessive hands and feet sweating.

Obviously the surgical approach is associated with some minimal risks and side effects. A careful and a total discussion should be carried out between patients and the doctor about those side effects.

Surgical Treatments for Hyperhidrosis

Endoscopic Thoracic Sympathectomy – For Excessive Hand Sweating
From the early days of the surgical treatment for palmar hyperhidrosis (hand sweating) there was tremendous progress from different open approaches (large incisions) to modern day endoscopic approaches (minimally invasive). Since the late 1980’s there was great progress made with regard to the optic surgical instruments which enabled surgeons to perform surgeries through small incisions, on an outpatient basis with a very speedy recovery. The same happened with thoracic sympathectomy and here not only the technical issues improved but also our understanding of what should be done to those patients.

To learn more view our Palmar Hyperhidrosis page.

Endoscopic Lumbar Sympathectomy (ELS) – For Excessive Foot Sweating
In the early years ETS had limited success with the resolution of excessive foot sweating (plantar hyperhidrosis) which usually comes together with palmar hyperhidrosis. At a younger age sweaty feet might not be considered as much of a problem as compared to excessive hand sweating. This is based on the fact that physiologically the sweat glands in the feet mature later in life. Obviously as more ETS cases are done around the world the question of what to do with sweaty feet came about. In the mid nineties some pioneering work was done which allowed the development of ELS. With ELS the surgical approach is to eliminate sympathetic innervation to the feet region of the body. This procedure carries with it a high success rate for elimination of sweaty feet in the range of 98%. ELS is usually done for patients in whom ETS did not improve their feet sweating or to patients that have a combination of hand and feet sweating but their main presentation is excessive feet sweating.

To learn more view our Plantar Hyperhidrosis page.

Axillary Hyperhidrosis – Armpit Sweating
Isolated cases of armpit sweating without any hand or feet sweating are quite common. It is very difficult to know percentage wise the exact number because it is a very subjective issue. Having said that there are cases with obvious of excessive armpit sweating. There are numerous methods to treat it starting with aluminum chloride preparations in different strengths. Those have limited success but they warrant a definite attempt to use them. The market is full of different preparation aluminum chloride preparations. Botox injections do have some limited value but it might be costly. Over the last few years different energy producing methods were introduced starting with ultrasound machines, laser instruments, or heatwave methods. Again here the lack of very precise follow-up methods does not allow us to give a definite recommendation for any of the above mentioned treatment methods.

How much do these surgeries cost?
When it comes to cost the major contributing factors are:

  • Clinical Evaluation with the Doctor
  • Type of Insurance – Level of coverage
  • Previous Treatments
  • No Insurance

Clinical Evaluation:
Before any steps are taken it is extremely important for the patient to discuss their specific condition. In that discussion questions will be asked by the surgeon about age, health condition, height and weight, previous treatments used and other relevant details. Only after this clinical evaluation is done in person or over the phone should the actual surgery be discussed including cost.

Type of insurance:
In the US today insurance issues are constantly evolving. Unlike Europe or other countries that have socialized medicine (single payer system) where patients can get the operation without any financial considerations, in the US things are very different. We have different types of coverage (indemnity, HMOs, PPOs, Cash). In order to answer the question about the cost the surgeon’s office will need all the information that the patient can provide in order to start the process of verification and ultimately the level of coverage. Unfortunately it is a long process but a necessary one.

Previous Treatment:
Any previous treatments that the patient has tried are important when discussing the individual cases with the insurance company.

What if I do not have insurance?
For those without insurance who want to pay for the operation with their own money should call the surgeon’s office and discuss it with the staff.

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