Treatment of Hyperhidrosis

Hyperhidrosis is the name given for excessive and uncontrollable sweating. Sweat is produced by the eccrine sweat glands. They are distributed over the entire body but are most numerous on the palms and soles (with about 700 glands per square centimeter).

General measures

• Wear loose-fitting, stain-resistant, sweat-proof garments

• Change clothing and footwear when damp

• Socks containing silver or copper reduce infection and odor

• Use absorbent insoles in shoes and replace them frequently

• Use a non-soap cleanser

• Apply cornstarch powder after bathing

• Avoid caffeinated food and drinks

• Discontinue any medication which may be causing hyperhidrosis

• Apply antiperspirant

Topical antiperspirants

• Deodorants are fragrances or antiseptics to disguise unpleasant smells; on their own, they do not reduce perspiration

• Antiperspirants contain 10–25% aluminum salts to reduce sweating; “clinical strength” aluminum zirconium salts are more effective than aluminum chloride

• Topical anticholinergics such as glycopyrrolate and oxybutynin gel have been successful in reducing sweating; cloths containing glycopyrrolate (Qbrexza™) were approved by the FDA in July 2018 for axillary hyperhidrosis in adults and children 9 years of age and older

Oral anticholinergic drugs

• Available drugs, Oxybutynin 2.5–7.5 mg daily, Glycopyrrolate 1-2 mg orally twice a day

• They can cause dry mouth, and less often, blurred vision, constipation, dizziness, palpitations, and other side effects

• Oral anticholinergics may interact with other medications

Botulinum toxin injections

• Botulinum toxin injections are approved for hyperhidrosis affecting the armpits

• The injections reduce or stop sweating for three to six months

• Botulinum toxins are used off-license for localized hyperhidrosis in other sites such as palms

• Topical botulinum toxin gel is under investigation for hyperhidrosis

Iontophoresis

• Iontophoresis is used for hyperhidrosis of the palms, soles, and armpits

• The affected area is immersed in water, or, with a more significant effect, glycopyrronium solution

• A gentle electrical current is passed across the skin surface for 10–20 minutes

The outlook for hyperhidrosis

Localized primary hyperhidrosis tends to improve with age. The outlook for secondary localized or generalized hyperhidrosis depends on the cause.

Future treatments

Several research projects are underway to find safer and more effective treatments for hyperhidrosis. These include:

• Topical anticholinergic

• Combination of oxybutynin and pilocarpine (to counteract the adverse effects of the anticholinergic, oxybutynin)

Citation: Oakley, A. (2015, July 1). Hyperhidrosis. DermNet. Retrieved July 26, 2023, from https://dermnetnz.org/topics/hyperhidrosis

Written by Danielle Berg, APRN

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