skin disorders
Excessive Sweating
Treatment of Excessive Sweating
Aluminum chloridesolution applied to the skin Glycopyrroniumtosylate towelettes Anticholinergic drugs taken by mouth Clonidinetaken by mouth Tap-water iontophoresis Botulinum toxin type A injections Microwave-based device Surgical procedures A prescription-strengthaluminum chloridesolutionapplied to the skin is stronger than a commercial antiperspirant and is often needed to treat excessive sweating, particularly of the palms, soles, armpits, or genital area. At night, the person first dries the sweaty area and then applies the solution. In the morning, the person washes the area. At the start of treatment, the person must apply the solution several times until the sweating is controlled. Then an application once or twice a week is sufficient to maintain relief for as long as necessary. The solution should not be applied to inflamed, broken, wet, or recently shaved skin. Sometimes doctors also give the person an anticholinergic drug to take by mouth (see below), which can cause anticholinergic side effects. Cloth towelettes premoistened withglycopyrroniumtosylatecan be used to reduce excessive sweating under the arms in people 9 years of age and older. Once a day, people take only one towelette and use it to wipe each underarm once.Glycopyrroniumtosylate can cause anticholinergic effects (see below). away. However, these drugs can cause side effects called anticholinergic effects. Anticholinergic effects can include blurred vision, dry mouth, and difficulty urinating. These side effects may lead people to stop using anticholinergic drugs ( see Anticholinergic: What Does It Mean? ). Clonidinetaken by mouth may help some people. It is used most often to treat high blood pressure, but it also decreases sweating by blocking the effects of the sympathetic division, the part of the autonomic nervous system that can rapidly respond to stress. Tap-water iontophoresis,a process in which a weak electrical current is applied to the sweaty areas (typically palms or soles) for 10 to 20 minutes, is sometimes used. This routine is done daily for 1 week and then repeated weekly or about twice per month. Botulinum toxin type Acan be injected directly into the armpits, palms, or forehead to inactivate the nerves that trigger sweating. It prevents sweating for about 5 months depending on the dose. These injections are effective but can cause muscle weakness and headache, are painful, and are expensive. Also, treatment must be repeated 2 to 3 times per year. Because the U.S. Food and Drug Administration (FDA) has approved botulinum toxin type A only for excessively sweaty armpits, its use at other sites may not be covered by insurance. A special microwave-based deviceuses thermal (heat) energy to create heat and permanently destroy sweat glands. People may benefit from two treatments at least 3 months apart. to control severe sweating may be tried if other treatments are not effective. Excessive sweating limited to the armpits is sometimes treated by removing the sweat glands via surgery or liposuction. Excessive sweating limited to the palms can be treated by a procedure called endoscopic transthoracic sympathectomy, in which the nerves near the spinal column in the chest leading to the sweat glands are cut. However, surgery can cause permanent complications such as phantom sweating (a sensation of sweating, but no sweat exists), compensatory sweating (increased sweating in untreated parts of the body), gustatory sweating, nerve pain, and Horner Syndrome . Compensatory hyperhidrosis is most common after endoscopic transthoracic sympathectomy, develops in up to 80% of people, and can be disabling and far worse than the original problem. Sometimes hyperhidrosis can lead to body odor ( Body Odor ), which can be treated by cleansing twice daily with soap and water or, if this is ineffective, with other measures used to treat bromhidrosis. 