Excessive Sweating Nonsurgical Options:
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Medical treatment of primary hyperhidrosis is often successful for most patients with mild and moderate symptoms. Unfortunately, patients with the full blown clinical picture and those with the most severe symptoms rarely find that conservative medical treatment is sufficient to control their disorder. It is strongly recommended that all patients try the conservative medical options and reach their own conclusions prior to seeking the ETS.
Aluminum Chloride with Ethyl Alcohol (Drysol):
Aluminum chloride with ethyl alcohol (Drysol), obtained from your physician, is usually the first line of treatment for excessive sweating. It is the first agent of choice for hyperhidrosis of the hands, armpits, and feet. Treatment consists of applying the medication onto the skin and leaving it on for six to eight hours. The skin must be dry upon application. If the skin is moist, severe skin irritation may occur. After applying Drysol®, the patient must wait 24 to 48 hours before shaving the treated skin. The application should be applied at nighttime and should be washed off completely the following morning before the onset of daytime sweating. Early on, about half of patients will develop some degree of skin irritation. It is important that the application directions be followed closely. Another technique advocated by many dermatologists is to first apply the medication to the hands, armpits, or feet and then wrap the affected body part in plastic wrap. This has been effective for many people. The treatment may have to be repeated as required. Drysol® is most effective for patients who have sweating of mild to moderate severity. In one large series it was found to be initially effective in 64 out of 65 patients. Drysol can be very effective in helping patients control the sweating of their hands, armpits and feet. Unfortunately, the long-term experience has been less rewarding. The inability to tolerate the irritation and lack of a sustained response are the main reasons for long-term failure. In a another study, researchers found that over the long run, non-surgical treatment including Drysol® failed to control symptoms in 26 out of 38 patients. They eventually opted for ETS.
Tanning Agents - Gluataraldehyde:
This is usually obtained from a chemical company and not from a pharmacy. It can be very effective but its side effects may override the benefits. It is applied to the bottom of the feet in concentrations of 2% to 10% and will leave the feet looking very brown. Application is necessary two to four days a week. It can also have the side effect of sensitizing the feet. Many patients, however, have benefited with this treatment.
Iontophoresis (Drionics Unit):
This instrument, which has helped many, is designed for application to the hands and the feet. It is an AC or battery-powered unit that can be easily transported by the patient. The hands or feet are immersed into a pan of water. Two electrode pads are connected to a current and 20 ma is applied. Frequent treatments are usually necessary to control sweating. The classic treatment is do the therapy for one hour every other day for every other week. This will not cure the hyperhidrosis but will control it as long as the treatments continue. Many patients have benefited from this treatment.
There are several good studies that have documented symptom reduction after biofeedback therapy. The success rate depends on the administrator. It may be beneficial to seek help from a professional who specializes in this treatment modality.
Psychotherapy can be extremely beneficial to the patient who has to deal with the numerous emotional effects inherent from severe sweating and facial blush. In some cases, psychotherapy may actually reduce the sweating to some extent. Therapy can be very effective in understanding the stimuli that trigger attacks of abnormal sweating. While anxiety and insecurity may diminish after maximal therapy, the patient may still have hyperhidrosis. Since the pathological sweating and facial blush are due largely to an underlying genetic predisposition, the patient with hyperhidrosis was born to have pathological sweating or blushing. It is important to stress that psychotherapy is definitely helpful and the patient should be encouraged to seek this kind of psychiatric or psychological treatment as an adjunct to ETS.
Robinul® administered IV is commonly used by anesthesiologists prior to general anesthesia to decrease secretions from the mouth and airways. This is helpful in reducing the risk of saliva spilling into the major airway and lungs before a breathing tube is inserted. It not only dries the mouth, but the entire body. Perspiration may be markedly diminished. It can also be prescribed for patients with hyperhidrosis. It is most effective for patients that have strong emotional triggers to their sweating. Patients often use it before a stressful event such as public speaking or meeting new clients. The side effects of Robinul Forte® (oral form) include a dry "cotton mouth" and its use should be avoided in hot environments because it diminishes normal sweating.
Propranolol (Indural®) is an excellent treatment option for stress-induced hyperhidrosis. In many cases, the sweating occurs only during stressful times. These patients do not sweat when reading a novel, newspaper or while watching a movie. Since Indural® is a beta blocker that tends to dull the fight or flight response, it may be effective for some people who have hyperhidrosis that is encouraged by the stress of making presentations or any social situations that may be anxiety provoking. Musicians prior to a concert have used it, attorneys during a trial, public speakers, and by neurosurgeons and cardiovascular surgeons before a highly skilled and technical procedure. It tends to even out emotional, vocal or mechanical tremors. Indural® taken one hour before a stressful event may be helpful in preventing or reducing hyperhidrosis.
Antidepressants and Anti-anxiety agents:
Antidepressants and anti-anxiety agents may be useful in certain situations. These agents, however, have their own side effects. They should be administered by physicians who are familiar with these medications and ideally by someone who has experienced in caring for patients with this syndrome. Talking about this disorder and working with an experienced therapist is often invaluable in coping with the problem.
Propantheline Bromide (Pro-Banthine):
Pro-Banthine® has been shown to work in many cases of hyperhidrosis. The medication works by doing a "pharmacologial sympathectomy" and is normally used in treating patients with high blood pressure. This medication should be administered under the careful guidance of a physician.More information on Surgical Treatments
More information on Hyperhidrosis
The information on this web page is courtesy of Dr. Garza
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