How to Stop Sweating & Hyperhidrosis

 Treatment Options for Excessive Sweating

There are many effective methods to decrease or even cure excessive sweating. Treatment will depend factors such as the site (hands, underarms, feet, or face) and your past successes or failures. 97% of excessive perspiration cases can be treated, no matter how severe. In many cases a team approach is the best solution, combining medical treatments by specialists, as well as behavioural methods by psychologists.

Antiperspirants

Facts

  • Antiperspirants remain as first line treatment for excessive sweating
  • Patients with mild forms of hyperhidrosis will benefit, however if your condition is moderate to severe, antiperspirants may cause skin irritation or may not work
  • Antiperspirants such as Driclor work by blocking the sweat duct
  • Correct application of strong antiperspirants will reduce skin irritation

Antiperspirants remain as the first step in treating excessive sweating. They work by blocking the sweat pore and reducing sweat output. Antiperspirants can be used on many parts of the body including the face, hands, feet and for underarm sweating. Stronger antiperspirants such as Driclor contain Aluminium Chloride. Correct application can minimise skin irritation, and maximise the effects.

Antiperspirants work best for mild forms of excessive sweating, however can be used in combination with Botox, Iontophoresis and other remedies to reduce sweating.

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Botox

  • Botox is a safe treatment for excessive sweating
  • Best used for underarm sweating
  • One treatment last 6 months on average
  • For underarm sweating, 95% of patients will have a good response

For the use of severe underarm sweating, Botox injections are subsidised on Medicare and the PBS (Specialist indication). Botox can be combined with antiperspirants, tablets and Cognitive Behavioural Therapy for optimal results.

Botox is a safe and effective method to treat certain types of excessive sweating. Botox works by blocking nerves and chemical signals that activate the sweat glands. Botox  has a proven safety record of over 15 years, and has recently been approved by Medicare and the PBS for the treatment of severe underarm sweating.

One treatment lasts 6 months on average, and apart from mild stinging during the procedure, it is free of side effects. The treatment is successful in over 95% of cases and takes only a few minutes to perform.

Botox can also treat excessive sweating of the hands, feet, face, and scalp, however this is an off label indication. Most specialists will advise against using Botox for the hands, as muscle weakness can be a side effect. Additionally, Botox to the hands only lasts 3-4 months, and is NOT subsidised by Medicare. It also requires twice the number of ‘Botox units’ to be effective in this area.

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Cognitive Behavioural Therapy for Hyperhidrosis

  • CBT is performed by a trained and qualified psychologist
  • This method of sweat conditioning can decrease negative thoughts and behaviour
  • CBT can improvise relaxation techniques and address emotional triggers for sweating
  • CBT can be used with medical treatment for optimal control of sweating disorders

Cognitive behavioural therapy (CBT) challenges the sufferer’s beliefs as to how other people view sweating. For example, CBT may challenge the sufferer’s beliefs about how visible the sweating is. For instance, perspiration often feels worse than it looks. Your psychologist may be able to provide you with video feedback of how you appear in  feared social/performance situations.

CBT would also involve getting the sufferer to confront the situations where they fear sweating. If the person’s anxiety about excessive perspiration decreases so will the sweating.  Attention training may also be part of your treatment. If you can focus on your attention better on what is going on around you, rather than being self focussed on your :physical symptoms, negative thoughts and behaviour, you may sweat less. Psychological treatment may also involve learning relaxation techniques.

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Tablets

  • Tablets and medications can both treat and cause sweating
  • Tablets that cause sweating include cough and flu tablets, antidepressive medications and caffeine containing compounds
  • Anti sweating tablets can reduce perspiration of the hands, feet, underarms and face
  • Anti sweating tablets can have side effects such as excessive tiredness, dry mouth, and blurred vision
  • Tablets are not a cure for excessive perspiration, but can be useful in the short term
  • As these tablets are on prescription, you should consult a doctor or specialist who is experienced in the treatment of sweat disorders

Several types of prescription tablets can help with profuse sweating. They work by blocking the chemicals that activate sweat glands. The most effective family of drugs are called ‘anticholinergics’. Tablets maybe useful in treating sweaty hands, feet, and generalised sweating, however side effects such as dry mouth and blurred vision are commonly encountered.

Specialists can use a special technique to deliver anticholinergic drugs to localised areas of sweating – for example the hands and feet. This is called iontophoresis, and can minimise the side effects of tablets.

Some tablets may also be the cause of profuse sweating, these tablets include pseudoephedrine, geranium, caffeine tablets and certain antidepressive medications.

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Natural treatments

  •  Natural treatments may work in some patients who suffer from excessive sweating
  •  Natural substances include St John’s Wort, Sage and Nat Mur
  • Unlike prescription tablets, natural treatments have little if no side effects
  •  Natural therapies can be combined with medical treatments such as compounded creams and iontophoresis
  • Natural treatments combined with Cognitive Behavioural Therapy can be helpful

Some patients seem to respond to natural treatments for excessive sweating. Unlike prescription tablets, in general, natural treatments taken in moderation have little or no side effects, and can be effective in 5% of cases.

Natural remedies for sweating include St John’s Wort, Sage tablets, Nat mur, Argentum and Chamomile tea.

More on natural treatments for sweating

Iontophoresis for hyperhidrosis

  • Iontophoresis can be used to treat sweaty hands and feet
  • Treatment time varies between 10-20 minutes per area
  • Patients will need to repeat ionto every 2-14 days
  • Glycopyrrolate ionto has a success rate of over 80%
  • Treatments are safe with no long term side effects
  • Procedures should be performed in a center specialising in sweat treatments

Iontophoresis can be combined with creams, tablets and cognitive behavioural therapy for best results.

Iontophoresis can be an excellent method of sweat reduction for hands and feet. It works by using electricity to block sweat glands, and thereby decreasing sweat output.

Iontophoresis can be used in various combinations to treat the hands and feet. Iontophoresis can be performed with plain tap water, salty tap water or a special form of inotphoresis called glyco ionto. Treatment sessions vary between 10 -20 minutes per hand- foot. Tap water iontophoresis has a success rate of 30-50% for treating sweaty hands, whilst glycopyrrolate iontophoresis has a success rate approaching 80%.

Iontophoresis can also be combined with antiperspirants, tablets and Cognitive Behavioural Therapy for superior results.

More on iontophoresis treatments for excessive sweating

Surgery for excessive sweating

Facts on surgery

  • This is a minimally invasive but highly specialised procedure
  • This form of surgery is conduced by a vascular surgeon who understands sweating
  • Endoscopic thoracic sympathectomy (ETS) involves cutting the nerves behind the chest wall

Patients should consider non- surgical methods to treat profuse sweating before considering ETS. Permanent side effects such as rebound or compensatory sweating can be seen in up to 50% of cases.

Endoscopic thoracic sympathectomy or ETS is a highly specialised procedure performed by a skilled Vascular Surgeon. ETS can be used to treat sweaty hands, facial sweating and underarm sweating. It can also reduce flushing and blushing. This procedure has a high success rate, and can ‘cure’ 80-90% of patients, HOWEVER it also has a significant chance of compensatory or rebound sweating. This ‘compensatory sweating’ may occur in up to 50% of patients. The most commonly affected areas of rebound sweating include the chest, abdomen and lower back areas. It is not possible to predict the location of rebound sweating.

ETS can also be associated with bleeding, collapse lung, and Horner’s syndrome – eyelid droop due to nerve damage.

Most experts would agree that ETS is last line treatment of sweating, and patients should explore all other treatments first. Patients should also have a detailed discussion with a surgeon who performs this procedure to discuss the risks in more detail.

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Creams, lotions and sprays

  • Special compounded creams, lotions and sprays can reduce sweating
  • Creams can be useful for excessive hand sweating and areas such as the face
  • The concentration of the ‘active agent’ can be tailored for each patient
  • Creams have less side effects compared to tablets
  • Glycopyrrolate forms the base of anti-sweating creams

Specialist dermatologists can compound special creams that can help reduce profuse sweating. The active ingredient of creams is a drug called glycopyrrolate. This drug blocks the nerve impulses that produce sweat. The advantage of creams over tablets, is that creams are associated with lesser side effects, and the concentration can be tailored according to the site of sweating and the level of skin irritation. Creams, lotions and sprays are best used for excessive sweating of the hands, feet, face and in ‘compensatory sweating’.

Side effects of anti sweating creams include skin irritation, dry mouth syndrome, and tiredness. If side effects occur, we can reduce the concentration of active ingredients.

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Specialist Perspective on the management of excessive sweating

Dr Davin S. Lim
Consultant Dermatologist
Sweat Free Group

Hyperhidrosis or excessive sweating, is a common condition that effects up to 4% of the population. Commonly affected areas are the underarms and hands, however any area of the body can be involved. Treatments are tailored according to the location and severity of sweating. A team approach will give patients the best outcome. As a dermatologist my treatment options are limited to creams, tablets, iontophoresis and Botox injections, however if there is a degree of psychological input, then treatments such as cognitive behavioural therapy may assist in the control of sweating.

Most experts wound agree that ETS surgery is the last option for severe sweating, as this can carry irreversible and unpredictable risks, however if patients fail to respond to medical and psychological assistance, this treatment maybe a viable last option.

It is important to stress that the best treatment for excessive sweating is a tailored program, with a team of doctors and psychologists – this provides suffers with the best possible outcomes.

This article published on Jun 20, 2012. View related Articles

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