What are the other treatment options for primary focal hyperhidrosis?
If lifestyle advice and antiperspirant treatments do not work, your doctor may suggest that they refer you to see a skin specialist (dermatologist). The specialist may suggest one of the following treatments.
This is a treatment that uses electrical stimulation. It is used mainly to treat sweating of the palms and/or soles. It can also be used to treat armpit sweating. It works well in most cases. Treatment involves putting the affected areas (usually hands and/or feet) into a small container filled with water. A small electrical current is then passed through the water, from a special machine. It is not dangerous but may cause some discomfort or a pins and needles feeling. The exact way this helps to treat sweating is not known. It may help to block the sweat glands in some way.
You will usually need 3-4 treatment sessions per week. Each treatment session lasts 20-40 minutes. Most people see an improvement after 6-10 sessions. A maintenance treatment is then usually required once every 1-4 weeks to keep symptoms away. If the treatment does not work with tap water, a medicine called glycopyrronium bromide is sometimes added to the water.
Iontophoresis does not work in every case. Also, some people develop side-effects from the treatment, such as a dry or sore mouth and throat, and dizziness, for up to 24 hours after each treatment episode.
You should not have iontophoresis if you are pregnant, or have a metal implant, such as a pin to fix a bone break (fracture), or if you have a pacemaker.
Botulinum toxin injections
Botulinum toxin injections are an option that usually works well for armpit sweating. Treatment consists of many small injections just under the skin in the affected areas. The botulinum toxin stops the nerves in the skin that control the sweat glands from working. Botulinum toxin is not licensed to treat sweating of the palms and face. This is because there is a risk that the injections may stop some of the nearby small muscles of the hands or face from working.
The downside of botulinum toxin is that the effect usually wears off after 4-12 months. Therefore, to keep working, the treatment needs repeating when the effect wears off.
Propantheline is a medicine that can be used if you have excessive sweating that happens soon after eating or drinking. Other medicines may be effective but at the moment there isn't any strong evidence to recommend any particular medicine for excessive sweating.
What about surgery?
An operation is an option for people who have not been helped much by other treatments, or if other treatments cause unacceptable side-effects or problems.
For armpit sweating
One option is to remove the sweat glands in the armpit. There are various techniques. One technique is to remove the sweat glands from the underside of the skin through a small hole cut in the skin (called suction curettage).
A recent innovation has been to use a laser to destroy the sweat glands in the armpit - laser sweat ablation (LSA). This may result in less scarring than other surgical techniques.
For palm sweating
One option is to have an operation to cut some of the nerves that run down the side of the spinal cord. These nerves control the sweat glands in the hands. The operation is called endoscopic thoracoscopic sympathectomy. It is done by keyhole surgery, using a special telescope to locate the nerve, and then to cut the nerve. Most people are pleased with the result of the operation. However, a complication that may occur following this operation is a compensatory increase in sweating in other parts of the body (such as in the chest or groin).
Surgery is not usually done for sweating of the soles. Although cutting the nerves next to the spinal cord in the lower back region may cure the problem of sweating, there is a high risk of this also affecting sexual function.
Further reading and references
Grabell DA, Hebert AA; Current and Emerging Medical Therapies for Primary Hyperhidrosis. Dermatol Ther (Heidelb). 2017 Mar7(1):25-36. doi: 10.1007/s13555-016-0148-z. Epub 2016 Oct 27.
Hyperhidrosis; NICE CKS, July 2013 (UK access only)
Endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limb; NICE Interventional Procedure Guidance, May 2014
Benson RA, Palin R, Holt PJ, et al; Diagnosis and management of hyperhidrosis. BMJ. 2013 Nov 25347:f6800. doi: 10.1136/bmj.f6800.
Ibrahim O, Kakar R, Bolotin D, et al; The comparative effectiveness of suction-curettage and onabotulinumtoxin-A injections for the treatment of primary focal axillary hyperhidrosis: a randomized control trial. J Am Acad Dermatol. 2013 Jul69(1):88-95. doi: 10.1016/j.jaad.2013.02.013. Epub 2013 Apr 13.
I am 63 and for the last 22 years have suffered with excessive sweating on my head and face, which seems to be getting worse. This is uncomfortable and embarrassing. If I do anything even slightly...gill22568
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