What is Hyperhidrosis?

Hyperhidrosis Defined

Hyperhidrosis is a skin condition where patients experience sweating in excess of what is required to maintain regulation of normal body temperature1. There are many types of hyperhidrosis, but the two most common types are:

  1. axillary hyperhidrosis, which is the excessive sweating of the underarms and usually begins in late adolescence
  2. palmoplantar hyperhidrosis, which is the excessive sweating of the palms and the soles of the feet and could begin in patients as young as 13.

Causes of Hyperhidrosis

Most of the time, hyperhidrosis occurs in patients who are otherwise very healthy. Sometimes neurologic, endocrine (based on the network of glands in the body that produce hormones to keep the body functioning), infectious, or other systemic diseases can be the cause, and other times people experience hyperhidrosis due to heat or emotions. However, most who suffer from hyperhidrosis experience sweating at all hours, regardless of mood or temperature.

Treatments for Hyperhidrosis

Treatments for hyperhidrosis have included over-the-counter antiperspirants, prescription strength antiperspirants, a treatment called Iontophoresis, which uses direct electricity to pass ionized tap water through the skin to temporarily disable the sweat gland, oral medications, Botox®, and now miraDry®.

  1. Over-the-counter antiperspirants usually contain aluminum or another low dose of metal salt and are usually the first attempt at treating hyperhidrosis, since they’re easily accessible.
  2. Prescription strength antiperspirants are usually the next step. Most doctors will recommend a prescription strength version of aluminum chloride called Drysol, which patients apply two to three nights in a row before bedtime and usually once a week thereafter. While this treatment generally works well for underarm hyperhidrosis, it is less effective for the palms of the hands and soles of the feet and can cause irritation.
  3. Iontophoresis has been around for 50 years as a treatment for hyperhidrosis and is thought to work by temporarily blocking the sweat duct using an electric current. The treatments usually begin as frequently as a few times a week for 10-20 minutes per session with a maintenance program to follow based on the patient’s response. The treatments are not painful and are sometimes covered by insurance. This is an ongoing treatment to reduce sweating.
  4. Oral medications include drugs like gycopyrrolate, or Robinul, but are not commonly used because of side effects like dry mouth, dry skin, blurred vision, and urinary retention.
  5. Botox®, which is used cosmetically to treat fine lines and wrinkles, can also treat excessive sweating due to hyperhidrosis by injecting Botox into to the armpit2. The FDA has not approved Botox® for the treatment of hands and feet, and this treatment is not permanent, as it usually lasts for about 3-6 months depending on the amount injected and overtime can become costly.
  6. miraDry® is an effective treatment for hyperhidrosis of underarms3 that we offer at WIFH. Using microwave energy, miraDry® targets and destroys sweat glands. miraDry® treatments can take up to 30 minutes per underarm. Patients sometimes return for a second treatment after three months or more to achieve even better results.
Citations
1. Leung A., Chan P., Choi M., (2008). Hyperhidrosis. International Journal of Dermatology. 1999; Aug; 38(8):561-7. https://www.ncbi.nlm.nih.gov/pubmed/10487442
2. Nawrocki S., Cha J., (2019). The Etiology, Diagnosis and Management of Hyperhidrosis: A Comprehensive Review. Part II. Therapeutic Options. Journal of the American Academy of Dermatology. 2019 Jan 30. pii: S0190-9622(19)30167-7. doi: 10.1016/j.jaad.2018.11.066. https://www.ncbi.nlm.nih.gov/pubmed/30710603
3. Chih-Ho Hong, H., Lupin, M., O’Shaughnessy, K., (2012). Clinical Evaluation of a Microwave Device for Treating Axillary Hyperhidrosis. Therapeutic Options. Dermatologic Surgery. 2012 May; 38(5): 728–735. Published online 2012 Mar 27. doi: 10.1111/j.1524-4725.2012.02375.x. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3489040/
About the Author

Charlotte Kulkin, RN, CNS, FNP-BC

Charlotte Kulkin, RN, CNS, FNP-BC, is a Family Nurse Practitioner licensed by the State of Georgia, and the Georgia Composite Medical Board. Charlotte has more than 30 years of experience in primary care, critical care, and cardiac rehabilitation. She currently serves as WIFH’s miraDry® specialist, performing over 600 miraDry® procedures since 2015.