Hyperhidrosis is classified as either focal (primary) or generalised (secondary). Both types can be treated. While the treatment for generalised hyperhidrosis requires the treatment of the underlying cause, treatment for focal is treated with various non-surgical and surgical methods.
The least invasive methods are always recommended first. Only when no significant improvement is achieved does one move on to other measures. Following are the most common treatments used to reduce the symptoms (and even cure) hyperhidrosis.
Topical treatments are always recommended as first line options, and antiperspirants with added aluminium chloride are typically prescribed. Aluminium chloride is most effective for excessive sweating of palms, face, underarms and soles of the feet. It works by blocking sweat ducts and eventually destroying them. It is applied at night and then washed off in the morning.
The pros of antiperspirants are that they are affordable, non-invasive, topical only, and easy to use. The cons include some skin irritation.
When antiperspirants don’t yield sufficient improvements, a technique using gentle electrical current passed through water baths becomes the next option. The procedure is non-surgical and painless. Some tingling is felt and the electricity induction causes the sweat glands to ‘turn off’. For Iontophoresis to be effective, a course of 10-20 minute therapy sessions is required.
The pros of Iontophoresis are that it is non-surgical, non-invasive, and can be done at home. The cons include possible blistering and cracking of treated areas, only suitable for underarms, palms and feet, time consuming, and costly.
Medications and Drugs
Medications are the next measures one can take when antiperspirants and Iontophoresis are proven ineffective. Typically, these are taken orally and contain anti-cholinergic and anti-psychotic drugs which affect the autonomic nervous system. Obtaining medication for hyperhidrosis requires a doctor’s prescription.
The pro of taking oral medication is that it is effective, especially where excessive sweating is on large areas or multiple parts of the body. However, the cons include serious side effects such as extreme dryness in the mouth, drowsiness, visual impairment, heart palpitations, constipation, tremors, and most serious of all, localised paralysis. This makes it unsuitable as a long term solution.
Botox is another effective treatment for hyperhidrosis. Many who have thought they would never find relief have found it through this method. Botulinium toxin is injected into affected areas which results in temporary blockage of sweat-stimulating nerves. The treatment is effective up to 9 months, depending on the area treated. People with axillary, palmar and plantar hyperhidrosis find this procedure most effective.
The pros of botox treatment are its high success rate and long term results. The cons include its high cost, the need for repeat treatments, multiple injections per hand/feet, and possible side effects. Patients report back temporary soreness in the injected area, flu-like symptoms, and weakness in the palms and feet when used in these areas.
Laser Sweat Ablation (LSA)
Although minimally invasive, this next method is the first of the few surgical options to treat excessive sweating. LSA is a procedure that removes sweat glands by using laser through keyhole surgery. However, it is only used for axillary hyperhidrosis.
The pros of LSA are its rate of effectiveness and minimally invasive surgery. The cons, however, are that it is non-reversible, only an option for underarm excessive sweating, and the possible risk of compensatory sweating.
Similar to LSA, this surgical procedure treats axillary hyperhidrosis by removing sweat glands but suction is used instead of laser. The pros and cons to liposuction curettage are also similar to LSA.
Endoscopic Sympathetic Blockade (ESB) and Endoscopic Thoracic Sympathectomy (ETS)
Ultimately, when all else fails, this surgical intervention is the last resort to effective hyperhidrosis treatment. The procedure involves temporarily clamping (ESB) or permanently disconnecting (ETS) certain areas of the sympathetic nerve trunk to inhibit focal sweating. While ESB is reversible, ETS is forever irreversible.
The only pro to ESB and ETS is that it is utterly effective. The cons come in many serious forms including severe negative effects, compensatory sweating, cranial sweating and gustatory sweating.
Of course, as with all other conditions, there are alternative solutions and home remedies that are worth trying. These include homeopathic, acupuncture, hypnosis, psychotherapy, and massage. Although many have found them ineffective, some have indeed seen success.