What is hyperhidrosis?
The main purpose of sweating is the regulation of body temperature. Sweat transfers heat from within the body outwards through the skin, released through evaporation into the air. Hyperhidrosis is defined as excessive sweat production that exceeds the body’s thermoregulatory needs. This condition affects 4.8% of the U.S. population and it is widely under-treated, often because of lack of awareness.
Hyperhidrosis is classified into two types: primary and secondary. Secondary hyperhidrosis is caused by an inciting medical or physiological condition. Causes can include
- Infections (TB, malaria, HIV)
- Endocrine or metabolic disorders (hyperthyroidism, adrenal dysfunction)
In secondary hyperhidrosis, sweating is widespread. It occurs during sleep and tends to have onset at age 25 and up.
Secondary hyperhidrosis accounts for only a small fraction of cases of hyperhidrosis. 93% of cases are classified as primary hyperhidrosis. Primary hyperhidrosis is not caused by an underlying health issue, but rather by excessive neurological stimulation of sweat glands. It typically begins in patients age 14-23 and is often limited to specific body sites such as the axillae, palms, soles and sometimes craniofacial areas. It can be either intermittent or continuous and occurs only when patients are awake.
Although the vast majority of cases of hyperhidrosis are considered primary, this is considered a diagnosis of exclusion and should only be made after secondary hyperhidrosis has been excluded. This can usually be done by discussing the patient’s specific circumstances, and usually doesn’t required any lab tests.
Hyperhidrosis Affecting Your Daily Life
Hyperhidrosis can affect daily activities, social interactions and work function. It can cause embarrassment, low self-esteem, and interfere with social and intimate relationships. In one study, 32% of affected people described it as unbearable and causing constant disruption to their life. 63% of people with hyperhidrosis feel unhappy or depressed.
There are a variety of treatment strategies for hyperhidrosis:
- Topical agents
- Oral medication
- Microwave ablation
The first topical agent is Aluminum chloride hexahydrate, sold under the trade name Drysol. This treatment blocks sweat gland openings and is applied either once daily or once every other day. The biggest advantage is that it’s inexpensive, but the disadvantage is that it can cause skin irritation.
Another useful topical medication is glycopyrronium cloths, sold under the trade name QBREXZA. The cloths contain a medication that blocks communication between nerves and sweat glands. Although this treatment lacks the irritation that may accompany aluminum chloride, it is very expensive and poor coverage by insurance plans.
Here we see the difference in how antiperspirants function versus how qbrexza functions.
Oral medications can be used for hyperhidrosis. They block signaling between sweat glands and the nerves that control them. This is similar to the mechanism of qbrexza, except these medications work everywhere, not just on a limited application area. The most commonly used oral medication for hyperhidrosis is glycopyrrolate. Oral treatment is a good option for people with multiple affected areas. The downside is that sometimes they can have side effects such as dry mouth or nausea.
Botox is a great option for treating hyperhidrosis. It’s highly effective, usually covered by insurance, and each treatment lasts from 4mo to as long as 1yr, depending on the patient.
Iontophoresis is a treatment that uses electric current to occlude sweat glands. It’s mostly used for hyperhidrosis of the hands. The hands are placed in trays of water and a current is applied using an external device. Treatments are performed every other day for 3 weeks, then once weekly for maintenance. The advantage of this is that it is drug free and can be self-administered at home. The disadvantage is that each treatment takes 20 minutes and the device must be purchased by the patient at an out of pocket cost of usually $700.
This photo shows the use of a medical device called MiraDry. MiraDry uses microwaves to permanently destroy axillary sweat glands. The advantage of this treatment is that it’s permanent. The disadvantage is that it is uncomfortable, takes about an hour, and is costly. A typical cost might be $2500 for one session, with possible need for a second session.
There are surgical options as well, including liposuction and neurosurgery. Neurosurgery is mostly used for hyperhidrosis of the hands. The advantage is that the result is permanent. The disadvantage is that after surgery about 20% of people develop what’s known as compensatory hyperhidrosis, which is excessive sweating of other parts of the body.
If you are interested in learning more about hyperhidrosis, visit the website of the International Hyperhidrosis Society www.SweatHelp.org. For a personalized consultation about individual symptoms and treatment options, contact Windsor Dermatology today.