Hyperhidrosis is a condition in which a person experiences excessive sweating in their hands (palmar hyperhidrosis), underarms (axillary), face and/or feet (plantar). Everyone perspires more when they get nervous or excited or when they exercise, but people with hyperhidrosis perspire excessively, often for no apparent reason.
The sympathetic nervous system, which controls involuntary responses such as sweating, blushing, and salivation, fails to regulate sweating in these body areas in people with hyperhidrosis. Consequently, these individuals often experience sweating so severe that it becomes a source of embarrassment, making them reluctant to shake or touch hands. It also can interfere with everyday activities such as writing, driving, taking tests, making presentations or even holding or grasping objects.
The severity of the condition varies from person to person, but in most cases the sweating proves problematic both socially and professionally. The prevalence of hyperhidrosis is not well-documented, but it is estimated to affect up to one percent of the U.S. population. People with hyperhidrosis may even know of a family member with symptoms as well.
The most common non-surgical treatments for this condition include:
- Topical Anti-Perspirants: These include anti-perspirants containing aluminum chloride. Drysol, a topical lotion applied two to four times a day, is usually the first medication tried. It is often very effective for those patients with the mildest symptoms, but it can cause chapping and cracking of the skin.
- Oral Medicines: Anticholinergic medicines, such as Robinul, are used to block certain receivers on nerve receptors at involuntary nerve sites. In people with hyperhidrosis, this leads to decreased sweating. Some psychotropic drugs (drugs that affect mental function), like amitriptyline, have also been prescribed for hyperhidrosis.
- Iontophoresis (Drionics): This treatment option involves applying low-intensity electrical current to the hands or feet while they are immersed in an electrolyte solution. When used daily, it can decrease the problem or even solve it temporarily. However, the procedure is time consuming and can be mildly to moderately painful.
- Botox: This substance, a derivative of the botulism toxin, is injected into the affected area. The success rate is only fair for axillary hyperhidrosis and even less so for palmar symptoms. Although it can sometimes work, its effectiveness wears off after 3 to 4 months. Therefore, the person has to undergo periodic and potentially painful injections.
While these treatments can help many people with hyperhidrosis, they do not work for everyone and their effectiveness can even decrease over time. Moreover, they often don't provide a permanent solution to the problem. Consequently, many people with hyperhidrosis are now considering the minimally invasive surgical treatment known as thoracoscopic sympathectomy, sometimes called endoscopic transthoracic sympathectomy (ETS).