Hyperhidrosis, commonly referred to as excessive sweating, can be a daily inconvenience. Should your current deodorant fail to meet the mark, there are other solutions ready to be explored.
What is hyperhidrosis?
Sweating acts as your body's natural thermostat, but those living with hyperhidrosis produce excess sweat, irrespective of their bodily heat or environmental conditions.
In Australia, hyperhidrosis affects around 3 out of every 100 individuals, with 70% reporting significant over-sweating in at least one part of their body.
The most prevalent variant of this condition is primary axillary hyperhidrosis, which triggers excessive perspiration in the underarm region. However, hyperhidrosis does not limit itself to one area, often extending to the hands, feet, face, and scalp. It is also not uncommon for individuals to encounter hyperhidrosis in the regions between the breasts, groin, lower back, or even the butt.
What causes excessive sweating (hyperhidrosis)?
Hyperhidrosis is a result of overactivity in eccrine glands, of which there are millions spread across the human body. These glands generate a clear, odour-free sweat that helps maintain body temperature (the smell is due to its reaction to skin bacteria). Hyperactivity in these glands causes sweat production that surpasses the body's needs.
Primary focal hyperhidrosis
Hyperhidrosis comes in two distinct forms. The first, primary focal hyperhidrosis, typically surfaces during childhood or teenage years and manifests as excessive sweating concentrated in a single area. Currently, the underlying medical cause remains unknown. This condition usually affects the underarms, hands (known as palmar hyperhidrosis), feet, and occasionally, the face due to overactive sweat-signalling nerves.
Primary hyperhidrosis is characterized by at least 1 intense sweating episode per week, predominantly during waking hours, and is symmetrically distributed on the body.
While it can be exacerbated by anxiety or high temperatures, it occurs without an obvious trigger. It is frequently a genetic condition, often seen across multiple family members. Although it doesn't pose a direct health risk, it can negatively impact self-confidence, lifestyle quality, and daily functioning.
Secondary generalized hyperhidrosis
The second form, secondary generalized hyperhidrosis, is less common and generally develops later in life. This condition triggers excessive sweating across the whole body and is often a side effect of certain medications.
It can also be caused by pregnancy or menopausal hot flashes. On rare instances, secondary hyperhidrosis might indicate a serious health issue, such as lymphoma or tuberculosis. If you are dealing with generalized hyperhidrosis, it's crucial to seek medical advice to rule out any underlying medical conditions.
The best treatments for hyperhidrosis
Before pursuing any treatment for excessive perspiration, it's crucial to consult with your healthcare provider to exclude any potential underlying health issues. Following this, you can start your journey towards finding a suitable treatment.
Regrettably, hyperhidrosis does not currently have a definitive cure, but several in-clinic procedures can help reduce sweat production.
One such treatment is miraDry, a TGA-approved therapy for hyperhidrosis. It employs thermal energy to specifically target and eliminate overactive sweat glands, making it an attractive option for those living with axillary hyperhidrosis. Besides immediately curtailing sweat production, miraDry, a form of microwave therapy, also decreases hair growth and body odour in the treated regions.
Patients can anticipate a 60 to 70% reduction in sweat, odour, and hair growth after each miraDry treatment. However, outcomes can vary, with some patients witnessing even better results. As sweat glands do not regenerate once destroyed, the results are permanent.
MiraDry boasts a high satisfaction rating, with numerous patients heralding it as a "game-changer." However, some patients have reported little to no change in their sweat levels.
It is worth noting that only 2% of the body's sweat glands reside in your underarms, so you will continue to perspire elsewhere even after miraDry treatment.
Another effective treatment option for excessive perspiration is the use of Botox for hyperhidrosis, which works by temporarily inhibiting the nerves that trigger sweat glands, much like its function in muscle relaxation.
Botox has been TGA-approved to treat hyperhidrosis specifically in the armpits, where it demonstrates the highest efficacy. However, some practitioners also apply it 'off-label' to areas like the hands, feet, and face.
Usually, the procedure involves the injection of 50 units of botulinum toxin into each armpit, after numbing the area with a local anesthetic.
The results, typically last between 3 to 6 months, and in some cases, may last up to a year. If hyperhidrosis has been medically diagnosed and other treatments like prescription antiperspirants have been tried without success, Medicare and private health insurance should cover Botox. Keep in mind, if not covered, the cost of Botox can be expensive, ranging between $15 to $20 per unit.
Topical solutions for excessive sweating (hyperhidrosis)
Thankfully, there are several topical remedies available for managing hyperhidrosis.
Medical-grade antiperspirants, such as Driclor, Dove and Rexona Clinical Protection, contain higher levels of aluminium chloride. This active ingredient functions by blocking the sweat ducts, thereby controlling excessive perspiration. These deodorants are best at addressing mild hyperhidrosis and can be applied to the armpits, scalp, hands, and feet.
Carpe, a recent entrant to the antiperspirant market, offers a range of products specifically designed for the palms, feet, face, chest, armpits, and groin. For optimal results, it should be used twice a day, with full effects typically observable after 4 weeks of consistent use.
Another treatment option is Qbrexza, a prescription wipe for treating axillary hyperhidrosis in individuals aged 9 and older. These wipes contain the active substance glycopyrronium tosylate, which suppresses a neurotransmitter responsible for activating sweat glands.
Clinical trials for Qbrexza have demonstrated a 50% decrease in sweat production following 4 weeks of everyday usage, with side effects less severe than those associated with oral medications. Qbrexza may also be covered by Medicare and private health insurance.
Some users of Qbrexza have reported side effects such as dry mouth, headaches, and changes in urine output. Caution is advised if you reside in an area with consistently high temperatures due to the medication's potential risks.
Other hyperhidrosis treatments
Iontophoresis is a home-based treatment that requires users to immerse their hands or feet in a pan filled with tap water. A low-voltage electrical current is then passed through, causing a temporary "shock" to the sweat glands, thereby reducing sweat production for between 6 hours and a week.
To achieve the best results, it is recommended to undergo iontophoresis every alternate day, 6 to 10 sessions in total, each lasting around 20 to 40 minutes. After a series of treatments, as many as 80% of patients experience a dramatic reduction in sweat for the treated region. Upon seeing positive results, the treatment can be repeated as needed to sustain these effects. Nevertheless, given its time-intensive nature and the potential discomfort, this option may not appeal to everyone.
In severe cases, when other treatments fail to provide relief, sweat gland removal surgery may be considered as a last resort. This procedure involves the surgical extraction of sweat glands from the underarms through a process of excision, curettage, liposuction, or laser vaporization. While the patient remains conscious during the procedure, the area is numbed beforehand to ensure a pain-free experience.
Another surgical option is sympathectomy, mainly employed for treating the hands. This operation involves interrupting nerve signals that stimulate the sweat glands. The procedure is carried out in a surgical theatre, wherein the surgeon severs or destroys specific nerves identified using a tiny surgical camera inserted into the patient's chest, just below the armpits. A major surgery, sympathectomy necessitates the temporary collapse of the patient's lung to allow for nerve interruption.
Sources & Studies
Pariser, DM, Hebert, AA, Drew, J, Quiring, J, Gopalan, R & Glaser, DA 2018, ‘Topical Glycopyrronium Tosylate for the Treatment of Primary Axillary Hyperhidrosis: Patient-Reported Outcomes from the ATMOS-1 and ATMOS-2 Phase III Randomized Controlled Trials’, American Journal of Clinical Dermatology, vol. 20, no. 1, pp. 135–145, viewed 27 July 2023, <https://link.springer.com/article/10.1007/s40257-018-0395-0>.