Treatments for excessive sweating, a condition known as hyperhidrosis

Sweating is a normal and essential function to regulate body temperature but for up to 3% of the population, it becomes excessive causing functional problems in our day-to-day activities.

Excessive sweating or hyperhidrosis most commonly affects the palms, soles of the feet and armpits or axillae.

Today, I will concentrate on the treatment options for excessive sweating in the armpits.

It is thought to be caused by over activity of the nerves supplying the sweat glands.

It is most commonly a primary problem but could be secondary or as a consequence to something else like, for example, menopause, diabetes, or an over-active thyroid gland.

The impact on daily living can be profound both socially and psychologically. The coinciding anxiety about this condition only makes it worse.

Prolonged excessive sweating could cause localised skin irritation and dermatitis.

Symptoms to diagnose hyperhidrosis are: 

• Onset under 25 years of age
• More than six months duration and at least one episode per week
• Sweating independent of temperature and not under conscious control
• Sweating in a common site, ie, hands, feet or armpits and both sides involved
• Sweating more than once per week interfering with daily activities
• No sweating at night
• A positive family history

General lifestyle measures can help. These include, weight control, good hygiene, loose fitting clothing, and avoiding stimulants such as caffeine, tobacco, and alcohol.

Some antiperspirants containing aluminium hydrochloride work for hyperhidrosis. These start at a low strength of 10-20% but may increase to 35%.

They may cause a little stinging, itch or irritation to the skin when applied initially.

In some cases prescribed medication may work but side effects may include a dry mouth, headache, blurred vision, or urinary problems.

Botulinum toxin, commonly known as Botox is a neurotoxin and is most known for its cosmetic use to reduce wrinkles on the face.

It works by blocking the release of a chemical, acetylcholine at the nerve ending. This means the nerves supplying the sweat glands cannot work.

Studies have shown this to be up to 87% effective in reducing sweating. It lasts approximately six months but this is variable.

There are no major side effects except a little pain at the injection site and some local irritation.

The toxin takes about three to seven days to work fully. Treatment involves approximately 20 injections to the hair bearing skin of each armpit.

Surgery is a possibility. This theoretically could be cutting out the sweat glands. More major surgery would involve clipping or cutting nerves in the chest. S

ide effects need to be considered. Compensatory sweating — sweating elsewhere — is commonly seen following surgery.

Laser treatments are emerging, showing promising results. Microwave thermolysis is also a new treatment option where microwaves target the sweat glands and thermolyse or heat treats them so the glands cannot function.

Microneedles are being looked at as a device that could potentially deliver treatment through the skin — a bit like an advanced type of skin patch.

Further studies into the cost and efficacy of these new treatment options are necessary to see if they are viable for the clinical setting.

Case study

“I suffered from hyperhidrosis since the age of 13. It affected my confidence and I found it debilitating for both my personal life and my career. I had to work around the sweating every day,” says a 46-year-old female patient of Dr Lynch.

“Often that meant buying three of the same tops so that I could get through an event without people taking too much notice. I learned from TV that botulinum toxin was a treatment option and found Dr Lynch.

“I was at a stage where I would have taken 100 injections to make things better.

“The treatment was quick and easy with no side effects. Within a week, I didn’t know myself.

"For the first time in decades, I had the freedom to do things for myself — personally and for my career — without having to worry about the sweating.

“This was a life altering treatment for me. Six months post injections I am still not sweating.”

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