Hyperhidrosis

Diagnosis

Diagnosing hyperhidrosis typically involves a physical examination and an assessment of your symptoms and medical history. To receive a hyperhidrosis diagnosis, you should have experienced excessive sweating for at least six months and answered positively to at least two of the following criteria:

• Sweating occurs on your underarms, palms, soles, or face.
• You experience symmetric sweating on both sides of your body.
• Sweating does not occur at night or is significantly reduced at night.
• Episodes of excessive sweating last for at least one week.
• There is a family history of hyperhidrosis.
• Sweating interferes with your daily activities.
• You are younger than 25 years old.

To determine the underlying cause of hyperhidrosis, healthcare providers may employ various diagnostic tests, including:

• Starch-iodine test: During this test, your healthcare provider applies an iodine solution to the affected, sweaty area and then sprinkles starch over it. The areas with excess sweating will turn dark blue, indicating the presence of sweat.
• Paper test: Special paper is placed on the sweaty area to absorb the sweat. After a certain period, the paper is weighed to measure the amount of sweat produced.
• Blood or imaging tests: These tests may involve taking a blood sample or using imaging techniques to explore potential underlying causes of your symptoms, such as hormonal or neurological issues.

These diagnostic methods can help healthcare providers identify the cause and severity of your hyperhidrosis, allowing them to develop an appropriate treatment plan tailored to your needs.

Treatment

Hyperhidrosis treatment typically begins with addressing the underlying cause, if known. If no specific cause is identified, the focus shifts to managing excessive sweating. If self-care measures prove ineffective, your healthcare provider may recommend various treatments. It’s important to note that even after treatment, symptoms may return.

Medications

• Prescription antiperspirants: Your healthcare provider may prescribe antiperspirants containing aluminum chloride. Apply these to dry skin before bedtime, and wash them off in the morning. Initially, use daily, then reduce to once or twice a week for maintenance. Be cautious to avoid contact with eyes, as these products can cause irritation. Discuss ways to minimize side effects with your provider.
• Prescription creams and wipes: For hyperhidrosis affecting the face and head, glycopyrrolate-containing creams may be recommended. Wipes soaked in glycopyrronium tosylate can help with hands, feet, and underarms. Possible side effects include mild skin irritation and dry mouth.
• Nerve-blocking medications: Certain oral medications can block nerves that stimulate sweat glands, reducing sweating in some individuals. Potential side effects include dry mouth, blurred vision, and bladder issues.
• Antidepressants: Some depression medications can also reduce sweating and may help alleviate anxiety.
• Botulinum toxin injections: This treatment involves injecting botulinum toxin to block nerve signals to sweat glands. Most people experience minimal pain during the procedure, but numbing options may be available. Results may take a few days to become noticeable and typically require repeat treatments every six months. Temporary muscle weakness at the injection site is a possible side effect.

Surgical and other procedures:

• Iontophoresis: A home-based treatment involving soaking hands or feet in water while a device applies a mild electric current to block nerves triggering sweating. It requires regular sessions initially, with potential adjustments for maintenance. Discuss any side effects with your healthcare provider.
• Microwave therapy (miraDry): This therapy employs microwave energy to eliminate sweat glands in the armpits through two sessions, three months apart. Potential side effects include altered skin sensation and discomfort, with long-term effects remaining unknown.
• Sweat gland removal: If excessive sweating is confined to the armpits, sweat glands can be removed through scraping (curettage), suction (liposuction), or a combination of both (suction curettage).
• Nerve surgery (sympathectomy): This surgical procedure involves removing a portion of spinal nerves controlling hand sweating. However, it may lead to compensatory sweating in other areas. Surgery is generally considered only when other treatments prove ineffective. A variation, sympathotomy, interrupts nerve signals without removing the sympathetic nerve, reducing the risk of compensatory sweating. These procedures can be performed under general anesthesia or with local anesthesia and sedation.

Always consult with your healthcare provider to determine the most suitable treatment option for your specific condition and preferences.