• The disease
• Diagnosis
• Treatment options

 
There are a number of potential options to control hyperhidrosis, with the least aggressive (local treatments) tried before the more invasive methods (surgery):

• Antiperspirants: antiperspirants such as aluminum salts (the most common) can be very effective for controlling excess perspiration, especially in axillary hyperhidrosis. They form a “protein buffer” at the end of the sweat pathway provoking a chemical reaction that absorbs the moisture and reduces the wetness under the arms. The acidity produced by the reaction also helps to control bacterial and fungal flora, but can irritate the skin (application of the aluminum chloride on dry skin is recommended).
• Iontophoresis: the patients hands are immersed in water and an electrical current is delivered. The iontophoresis stabilizes the cells in the sweat glands. This treatment is available in some dermatology clinics and in hospitals (special devices are available but not reimbursed by social security in France). It should be repeated two to three times a week for one month, and then approximately once a month after that to maintain the results.
• Botulinum toxin Type A injections: botulinum toxin is very effective for hyperhidrosis and quickly improves quality of life for patients. Injections of the toxin into the skin block contraction in the myoepithelial cells (these are muscle cells that have contracting properties) that surround the sweat glands and prevent them from emptying. A Minor test is conducted to pinpoint the areas affected by hyperhidrosis and the injections are made at various points, with 1 cm between them (see Fig. 3). They are relatively painless under the arms, but the palms are far more difficult to inject and will require anesthesia. The effect of the injections can last anywhere from 4 to 25 months.
• Surgery: There are two types of surgery for hyperhidrosis, which are reserved for severe cases that have not responded to treatment with botulinum toxin. Thoracic sympathectomy involves cutting the sympathetic nerve at the thorax to completely stop sweating in the upper half of the body. However, various embarrassing side effects, such as compensatory hyperhidrosis (sweating in other areas after the surgery), can be even more uncomfortable than the initial hyperhidrosis. For axillary hyperhidrosis, the surgeon may remove the sweat glands. Complications from this type of surgery are rare, but it does leave a large scar for life.