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EXPERT
Dr. Lawrence Osman, MD (Dermatologist) answered

Excessive sweating (or hyperhidrosis) is a relatively common problem that affects about three percent of the population, according to the International Hyperhidrosis Society. People with hyperhidrosis sweat heavily and frequently from the affected area--which may include the armpits, head, palms and soles--whether or not they are anxious or warm. Dealing with the sweat may even interfere with your ability to lead a happy, healthy life.

Fortunately, there are good treatments available.

Antiperspirants:
Antiperspirants work by physically plugging sweat ducts. There are powerful over-the-counter (OTC) antiperspirants, such as Hydrosal Pro and Certain Dri (R) (the cheaper option available in most drugstores), which may be effective enough to help some people with hyperhidrosis. Although most people typically apply antiperspirants in the morning, you should use these products at night on clean and dry skin. Though you may not normally think to do so, you can use these on your palms and soles (not just armpits), if you experience excessive sweating there.

Since these are more effective antiperspirants because they contain high concentrations of the active ingredient, you do have a higher risk of experiencing skin irritation such as red, itchy and flaky skin. Thinner-skinned areas such as the armpits are more susceptible to irritation than the palms and soles.

If those don't work, a dermatologist can prescribe even more powerful antiperspirants, such as Drysol, if needed.

Iontophoresis:
Iontophoresis is a technique using a machine that passes an electric current through water. It's a temporary solution that may be used to treat the armpits, palms and soles when antiperspirants alone are not enough. No one knows exactly how it works, but it's thought to thicken the skin enough to block the sweat ducts. The main side effect is mild, temporary redness in the treated area.

Botox Injections:
Botox (botulinum toxin) works very well to temporarily decrease excessive sweating and can be injected into all commonly affected areas. Botox works by paralyzing the small muscles that propel sweat along the sweat duct, and significantly reduces sweating for six to eight months. Botox is only FDA-approved for treating axillary hyperhidrosis (a.k.a. excessive underarm sweating), but is often used to treat other areas. Adverse reactions noted during the FDA trials included possible bruising (lasting several days) and injection site pain; however, I've found the injections are well tolerated. This procedure may be covered by insurance, but costs about $1000 to treat both underarms if it's not.

Surgery:
Surgical treatment is reserved as a last resort for hyperhidrosis, and the results may be permanent.

Liposuction surgery can be used to physically remove the sweat glands from the underarm area (you may have watched Ramona Singer have one version of this procedure done in an episode of The Real Housewives of New York). As with any surgical procedure, there is a risk of infection or reaction to the anesthesia. This liposuction procedure generally costs several thousand dollars, and is not likely to be covered by insurance.

Another type of technique is endoscopic thoracic surgery (ETS), where the nerves responsible for sweating (located deep inside the chest cavity) are cut. The risks of ETS are much higher than those of liposuction, especially if liposuction is performed using local anesthesia. One of the major drawbacks of ETS is the risk for compensatory sweating, which is when the body reacts by increasing sweating in an area not previously affected, such as the chest or back. Some studies show this may occur in as many as 80% of patients.

 

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