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It is of course normal to sweat, but some of us are plagued with an exaggerated sweat response. Called hyperhidrosis, this distressing condition may affect the palms and soles, as well as underarm areas. Profuse sweating results from even the least amount of heat, or physical or mental activity. Emotional stress may also trigger hyperhidrosis. The hands, feet, and underarms produce a steady stream of moisture (“sweating buckets”) leading to marked self-consciousness in most hyperhidrosis sufferers. Survey data suggests that over one million Americans are negatively impacted by excess sweating.
Hyperhidrosis often begins during puberty and improves with age. Topical therapy with a nonprescription “clinical strength” or “extra strength” antiperspirant should be the first line of therapy. Examples include Certain Dri, Secret Clinical Strength, Dove Invisible Solid, and Degree Invisible Solid. The ideal time for application is at bedtime, as these agents work best when applied to dry skin. Persons not achieving adequate control should try a prescription antiperspirant such as Drysol. These contain aluminum chloride in strengths ranging from 15 to 20 percent. Again, nighttime application to dry skin is crucial for success. A deodorant may be applied in the morning for cosmetic purpose.
Iontophoresis therapy (also called drionics) uses a battery-powered device intended to inhibit excess sweating of the hands, feet, and underarms. The small current induces electrical charges in the sweat glands that decrease sweat production. The treatment is safe but relief is variable, and therapy has to be continued indefinitely. Oral medications such as Ditropan, Robinul, and Probanthine are helpful on occasion, but the occurrence of annoying side effects may limit their use.
Botox or Dysport injected into the palms and soles (and even into the face), is a simple method to alleviate hyperhidrosis. Drawbacks include transient discomfort during injection (multiple sticks are required) as well as cost and duration. Injections need to be repeated every five to seven months. Surgical excision or liposuction may be utilized to remove sweat glands situated within the armpits. A more drastic option is surgical destruction of the nerves that control sweat production (sympathectomy), a procedure usually performed under general anesthesia, which is generally reserved for physically or psychologically incapacitating sweating.