Alternatives to surgery:
For decades, attempts at countering excessive sweating through alternative methods have been made. Conservative solutions, such as BOTOX®, lotions, oral medications, electronic devices, acupuncture, anti-anxiety medications, beta blockers, biofeedback, and herbal medicines have had little or no effect on the problem. The only highly effective and permanent solution has been surgery. Also to learn more about conservative methods to treat focal hyperhidrosis please see Dr. Reisfeld’s published paper in Thoracic Surgery Clinics – 2008 Volume 18.
That said, surgery should not be resorted to without attempting some of these alternative methods. Those patients who suffer only from axillary hyperhidrosis (armpit sweating) should try medicated antiperspirants such as Drysol, Maxim, Odaban as seen below.
In fact, many insurance companies demand that alternatives be tried before surgery is concluded upon.
Most patients who undergo surgery have already attempted to use the conservative methods and resort to ETS as a final and permanent solution. In this surgery, the sympathetic chain, responsible for excessive sweating, is interrupted or excised.
Local Lotion - Drysol
The most commonly used lotion is an aluminum hydrochloride known as Drysol (manufactured by Person & Covey, Inc.- Glendale, CA). In Europe Odaban is the equivalent. In most states, Drysol is available through prescription and in some, it can be purchased over the counter. The aim of the lotion is to cause dryness of the hands. Unfortunately, most patients do not feel any relief due to the fact that the application of any lotion causes more wetness. Long term usage can cause cracking of the skin but without actually decreasing sweating. Maxim is another product on the market with a somewhat higher pH level, causing less irritation. Maxim can be purchased online. When all drawbacks are taken under consideration, lotions are the first step in attempting alternative methods to surgery. The question of aluminum toxicity which is asked quite frequently is not easily answered. There is no known clinical studies which measure toxicity after long-term use of these compounds.
An another type of topical agents (lotions) are those lotions that contain anticholinergic agents. Those did not show any high rate of success due to the need of very large concentration necessary to have a local effect on the peripheral nerves that innervate the eccrine glands (sweat glands). High concentration of this medication can cause some system side effects. In cases of facial hyperhidrosis the topical application of glycopyrrolate (an anticholinergic agent) in a 0.5% solution can produce some relieving results. This coincides with Dr. Reisfeld's belief that facial hyperhidrosis should be treated with conservative modalities rather than surgery.
Other topical agents such as aldehyde agents, formaldehyde and glutaraldehyd have limited use in the treatment of hyperhidrosis due to the fact that they can cause severe allergic reaction and severe skin irritation.
Because of the ease of obtaining the above products every patient is recommended to try alternative methods before a decision about surgery is made. If the focal hyperhidrosis can be managed with alternative methods it is better than surgery.
To learn more about Drysol please visit our drysol page.
In the past, some insurance companies have demanded that patients try BOTOX® (manufactured by Allergan - Irvine, CA) as treatment for Hyperhidrosis before embarking on the surgical procedure known as endoscopic thoracic sympathectomy (ETS). Although the FDA has approved the use of BOTOX® for axillary sweating or excessive sweating under the arms, it has NOT been approved for the treatment of sweaty palms or feet (Hyperhidrosis). It is somewhat disturbing that the demand that BOTOX® be used for the treatment of sweaty hands and feet comes from insurance companies without proper knowledge of the scientific data surrounding hyperhidrosis. In the cases that BOTOX® is used for treatment of any Hyperhidrosis, it is only a temporary solution. At times, the use of BOTOX® to treat Palmar Hyperhidrosis can be painful. (There are methods for avoiding this pain, such as regional or general anesthesia, and therefore patients should arrange for the BOTOX® treatment to be administered by the appropriate physician.) Finally, it is an expensive procedure, and as it is only temporary, it must be conducted on a regular basis to be continuously effective.
Millions of people receive BOTOX® injections for various purposes without any side effects. However, BOTOX® is officially a toxin and the suggestion that the drug be used as treatment can be challenged on this basis, along with the above factors.
To learn more about BOTOX® and its relation to hyperhidrosis please visit our Botox page.
Oral Anti Hyperhidrosis Medications: (Anti Cholinergic Agents)
For years, physicians have treated hyperhidrosis with a group of medications that were used to treat peptic ulcer problems. Those medications work by inhibiting a certain neurotransmitter (a chemical substance) that interferes with some receptors that have a role in the production of sweat. The name of this neurotransmitter is acetylcholine. Learn more about this neurotransmitter on our acetylcholine page. In these medications, such as Robinul, Ditropan, and Propantheline, success is very limited and some patients discontinue use due to side effects such as dry mouth and blurry vision.
Recently a medical paper from Brazil reported initial success with Ditropan which is one of the anticholinergic agents. The final analysis is yet to be determined because medications can lose effectiveness over time and with increasing doses the side effects such as blurry vision and dry mouth can be overwhelming. Never the less Dr. Reisfeld believes that this drug should be offered as a good initial step for the treatment of excessive hand sweating. If this particular treatment or any other conservative measures do not give any relief then the surgical options are always available for consideration.
Most reviews of treatment for hyperhidrosis with oral-systemic agents give little space to this form of treatment because with the long term therapy required at the doses necessary to stop sweating, most patients find the side effects intolerable.
Other systemic agents have been used for hyperhidrosis including amitriptyline, clonazepam, beta blockers and calcium channel blockers and indomethacin were attempted before the 1990's for patients with generalized hyperhidrosis. A variety of case reports have been published showing benefits of certain oral medications including clonidine for the treatment of cranio facial hyperhidrosis. There are also some other case reports using oxybutinin for the treatment of severe upper body sweating. All of those of are single case reports with no clinical importance. Nearly all the reviews that talk about oral medications were written after failure of topical treatment, iontophoresis and even BOTOX. The success rate was extremely low.
Drionic (manufactured by General Medical Co. – Los Angeles, CA) is an electric machine that uses iontophoresis as a means of slowing sweat production. Hands are placed in a tub like container full of water and weak electric currents run through the water. It requires steady use – at least three to five times a week - and can be purchased online. Success is reported to be very limited. It is now possible to rent Drionic machines on a weekly basis. Learn more on our in depth Iontophoresis page.
Percutaneus (through the skin) or x-ray guided techniques:
There are reported cases and clinical trials of x-ray guided injections of absolute alcohol in order to achieve the same sympathectomy effect given by surgical methods. Even though initial success was reported the long-term data is not as promising as the initial findings. There is an inherent risk that the flow of the injected material does not limit itself to only the point of where it was injected and hence can cause collateral damage. It is also true that in cases of chemical lumbar sympathectomy that were done for plantar hyperhidrosis the effect is temporary and because of the possible migration of the alcohol injected there were reported cases of collateral damage to other systems.
Acupuncture, Biofeedback, Anti-anxiety medications, Beta blockers and Herbal Medicines
All of the above methods have been tried by some patients. No success has been so far reported.
Combination Hyperhidrosis Treatments
Some circulating personal opinions are talking about using a combination of conservative treatment modalities to treat hyperhidrosis. In this situation people were talking about adding anticholinergic medications to the liquid used in the iontophoresis machine or usage of oral and topical lotions at the same time. Unfortunately up until now no such controlled studies were done so it leaves the patient and his treating physician to try these options. This might be time consuming but could be attempted anyway.
Even though the alternative methods do not enjoy a high degree of success it is imperative for patients to try some of those methods before any decision is made to go with a surgical approach is made.
Do you have any sweat related questions that were not answered here? Would
you like to speak with Dr. Reisfeld to answer those questions? To learn more
about what we can do for you, contact The Center for Hyperhidrosis by contacting our office.