Treating hyperhidrosis

Hyperhidrosiscan be challenging to treat and it may take a while to findthe best treatment for you. Less invasive treatments will usually be recommended first.

Lifestyle changes

Changing your lifestyle cannot cure primary hyperhidrosis (hyperhidrosis with no obvious cause), but it can improve your symptoms and help your confidence.

The advice below may help.

• Avoidtriggers that you know make your sweating worse, such as spicy foods and alcohol.
• Use antiperspirant frequently, rather than deodorant.
• Avoid wearing tight, restrictive clothing and man-made fibres, such as nylon.
• Wearing black or white clothing canminimise signs of sweating.
• Armpit shields can absorb excessive sweat and protect your clothes.
• Wear socks that absorb moisture, such as thick socks made of natural fibres, or special soles or sports socks designed to absorb moisture.
• Avoid wearing socks made out of man-made materials and change your socks at least twice a day if possible.
• Ideally wearshoes made of leather, andtry to alternate between different pairs of shoes every day.

Stronger antiperspirants

Ifa regular antiperspirant doesn'tcontrol your sweating, your GP may prescribeor suggesta stronger one for you.

Antiperspirant containing aluminium chloride is often used to treat hyperhidrosis. This works by plugging the sweat glands. You will need to apply it at night just before you go to sleep and wash it off in the morning.

The most common side effect of aluminium chloride is mild irritation or itching and tingling where it is applied. Using the antiperspirant less frequently can help reduce irritation. Using Emollients (moisturisers) regularly and soap substitutes instead of soap may also help.

Anticholinergics

You may be prescribed a type of medicine called an anticholinergic or antimuscarinic. These work by blocking the effects of a chemical called acetylcholine, which the nervous system uses to activate the sweat glands.

Anticholinergics are available as tablets or solutions that are applied to affected areas. They're not widely used to treat hyperhidrosis and most types are not licensed to treat it, but some people find them helpful.

Propantheline bromide is an anticholinergic medicine licensed for treating hyperhidrosis. However, anticholinergic medicines unlicensed for hyperhidrosis such as oxybutynin and glycopyrronium bromide can also be prescribed if your doctor feels they might help.

Possible side effects of anticholinergics include a dry mouth , blurred vision, stomach cramps, constipation and difficulty passing urine.

Referral to a dermatologist

If lifestyle changes and treatment don't work, your GP may refer you to a dermatologist (a specialist in treating skin conditions) for further treatment, such as iontophoresis, botulinum toxin or surgery.

Iontophoresis

Iontophoresismay help if you have excessive sweating that affects your hands or feet. It can also be used to treat armpits, although this is usually less effective.

Iontophoresis involves treating affected areas of skin with a weak electric current passed through water or a wet pad. This is thought to help block the sweat glands.

If your hands and feet need treating, you place them in a bowl of water and a weak electric current is passed through the water. If your armpits need treating, a wet contact pad is placed against each armpit and a current is passed through the pad.

The treatment is not painful but the electric current can cause mild, short-lived discomfort and skin irritation.

Each session of iontophoresis lasts between 20 and 30 minutes, and you will usually need to have two to four sessions a week. Your symptoms should begin to improve after a week or two, after which further treatment will be required at one to four week intervals, depending on how severe your symptoms are.

Iontophoresis is often very effective, although you may need to make regular visits to your local hospitals dermatology clinic to receive treatment.

Alternatively, iontophoresis kits that you can use at home may be recommended, with prices in the range of 250-500.

Botulinum toxin injections

Botulinum toxin can be injected into the skin in areas of the body affected by hyperhidrosis. This helps reduce sweating in these areas by blocking the signals from the brain to the sweat glands.

Around 15-20 injections are given in the affected areas of the body, such as the armpits, hands, feet or face. The procedure usually takes about 30-45 minutes in total.

The effect of the injections usually lasts for several months, after which time the treatment can be repeated if necessary.

Potential side effects ofbotulinum toxin injections include:

• pain, redness or itching where the injections are given
• nausea, headaches and hot flushes after the injections are given
• another part of your body sweating more to make up for treated area known as compensatory sweating
• muscle weakness around the treatment area

Most of these side effects are short-lived or will resolve as the effect of the injections wears off.

Availability of botulinum toxin on the NHS can vary widely depending on your clinical commissioning group (CCG), and you may only be able to get it privately. Costs for private treatment depend on the part of the body being treated. For example, injecting the forehead can cost around 150, while treating both armpits could cost up to 450 or more.

Surgery and other procedures

In a few cases where hyperhidrosis is particularly severe and treatmenthasn't been successful, surgery may be recommended.

Endoscopic thoracic sympathectomy (ETS)

Endoscopic thoracic sympathectomy (ETS) is the most widely used type of surgery to treat hyperhidrosis. It's usually used in cases affecting the palms or armpits.

Small incisions are made in the side of the chest and the nerves that control sweating in the affected area are cut or clipped. This means signals can no longer pass along them to the sweat glands. The operation is carried out under general anaesthetic and done on both sides of the body.

The National Institute for Health and Care Excellence (NICE) recommends that ETS can be used to treat excessive sweating of the palms or underarms. However, before the procedure is performed, your clinician should explain:

• ETScarries a risk of serious complications (see below)
• it's very common for excessive compensatory sweating to occur after the procedure, which causes some people to regret the procedure
• the procedure is not always successful at reducing sweating

For this reason, only people with severe hyperhidrosis which hasn't responded to treatment should be considered.

Read the full NICE guidelines on endoscopic thoracic sympathectomy for primary hyperhidrosis of the upper limb .

Side effects and complications of ETS can also include:

• sweating of the face and neck after eating food this is known as gustatory sweating and may affect up to half of people who have the procedure
• bleeding into the chest during surgery
• air becoming trapped inside the chest (pneumothorax), which can cause chest pain and breathing difficulties
• damage to the nervous system that causesthe upper eyelid on one side of the body to droop (Horner's syndrome) this may be permanent

Removing or destroying sweat glands

Excessive sweating under the arms may occasionally be treated with a procedure to remove or destroy the sweat glands in the armpits.

This can be carried out in a number of ways:

• making an incision in the armpit and carefully scraping away (curettage) or cutting out (Shelleys procedure) the sweat glands
• using a probe held above the skin (no incisions are needed), which emits electromagnetic radiation that destroys the sweat glands
• inserting a laser device under the skin through a small incision and using it to destroy the sweat glands

These procedures are generally carried out under local anaesthetic , which means you will be awake but your armpit will be numbed.

These procedures can sometimes be a permanent solution to excessive underarm sweating, although they are only carried out by a small number of practitioners. Availability on the NHS is likely to be very limited and you will probably need to pay for private treatment.

These procedures don't work for everyone and some of them are relatively new, which means there isn't always evidence about their long-term safety and effectiveness.

Treating anxiety

Feelings of anxiety are not directly responsible for causing primary hyperhidrosis, but they can make the situation worse and create a vicious cycle.

You may feel self-conscious, which can trigger anxiety in certain situations, such as when meeting new people or being in a crowded room. The anxiety can make the sweating worse.

If your anxiety is making your sweating worse, a type of talking therapy called cognitive behavioural therapy (CBT) might help. Medication for anxiety is not usually recommended because it can make sweating worse.

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