By Maryann Mikhail, MD
Sweating is necessary because it prevents the body from overheating. People who have hyperhidrosis, however, sweat for no apparent reason, even when the body does not need cooling. Many people who have hyperhidrosis sweat predominantly from one or two areas of the body, usually the hands, feet, head, or underarms. This excessive sweating can interfere with everyday activities. Sweat from the underarms often soaks through and ruins clothing. Hand sweating makes it difficult to turn a doorknob, use a computer or shake hands while foot sweating can limit the types of shoes a person can wear. In addition, since the skin is often wet, skin infections can develop.
At Spring Street Dermatology, we understand the embarrassment and anxiety associated with hyperhidrosis and are here to help. Depending on the individual patient, location and severity of the sweating, we can formulate a treatment plan that may include one or more of the following:
Drysol (aluminum chloride): The first line treatment for underarms, hands and feet is usually a topical antiperspirant, such as Drysol (aluminum chloride). This medication is applied to the affected areas in the evenings. The most common side effect is irritation at the application site.
Glycopyrrolate: Glycopyrrolate is an oral medication that works as an anticholinergic, meaning it blocks the chemical messenger that triggers the sweat glands to produce sweat. It is mostly prescribed to patients that have excess sweating all over or who do not respond to localized treatment. Since the chemical messenger that triggers sweat also has other important functions, side effects to this treatment include dry mouth, constipation, impaired taste, blurry vision, urinary retention and heart palpitations.
Botox (botulinum toxin): If topical treatment does not work or is not tolerated, Botox can be injected into the skin to temporarily halt the production of sweat by the sweat glands. Results start to be noticeable 2-4 days after injection and can last 3-6 months. Side effects include compensatory hyperhidrosis, which means more sweating in other areas and weakness of underlying muscles, especially in sensitive areas like the face or hands. There are also reports of patients developing antibodies to Botox that can decrease its efficacy over time.
Iontophoresis: Iontophoresis is a medical device that dramatically reduces palmoplantar (hand and foot) sweating. Patients sit with both hands and/ or feet immersed in shallow trays filled with tap water for 20 minutes while the device sends a small electric current through the water that reaches the sweat glands and blocks their function. Iontophoresis is done 3 times per week until desired results are obtained and then decreased to a maintenance schedule of 1 time per week or less.
Miradry: Miradry is the only noninvasive, FDA- cleared treatment for underarm sweat. It delivers precisely controlled electromagnetic energy beneath the underarm skin to the specific area where sweat glands are located, resulting in destruction of the sweat glands. Since the sweat glands under the arms make up only 2% of total human sweat glands, eliminating them does not have effects on the body’s ability to cool itself nor on sweating elsewhere. The procedure is done comfortably under local anesthesia and takes approximately an hour. There may be some swelling, soreness, tingling and numbness immediately after the procedure, which generally resolve within a few days to a few weeks. Most patients experience an 80% reduction in sweating after one treatment. Since the sweat glands do not regenerate, once those glands are destroyed, they are gone for good – this means long lasting results!
Hyperhidrosis can be effectively treated and controlled by a wide range of modalities. Contact Spring Street Dermatology at 212-431-4749 to set up a consultation and discuss your options.