Q&A: Treatment options exist for ‘significant problem’ of hyperhidrosis

Hyperhidrosis is a condition that affects nearly 5% of people, although many go undiagnosed.

Since Hyperhidrosis Awareness Month recently wrapped up in November, Healio spoke with Rutledge Forney, MD, FAAD, a medical, surgical and cosmetic dermatologist from Atlanta, to find out more about this uncommon condition.

Healio: What is hyperhidrosis?

Forney: Sweating excessively, anywhere on the body. There is no specific definition of how much sweating is excessive; It is the perception of the person sweating.

Healio: What is the difference between primary and secondary hyperhidrosis?

Forney: Primary hyperhidrosis is not caused by anything and typically affects the palms, soles, underarms and occasionally the face. It may have a genetic basis and is thought to be related to overactive stimulation of specific sweat glands in these areas known as eccrine glands. Secondary hyperhidrosis is caused by something and, therefore, may be stopped by treating the underlying disorder or stopping the drug that may trigger the sweating. Diseases such as diabetes, thyroid dysfunction, some cancers and diseases of the nervous system, as well as drugs such as some pain relievers and antidepressants, can cause secondary hyperhidrosis.

Healio: How does hyperhidrosis affect an individual’s personal and professional life?

Forney: Excessive sweating for any reason is a significant problem. It is embarrassing, destroys clothes, and causes the “sweater” to change behavior to accommodate the condition. Avoiding holding or shaking hands and wearing multiple layers of clothing are two common coping mechanisms.

Healio: What ways can hyperhidrosis affect a patient’s mental health?

Forney: It can result in social isolation. Psychologically, excessive sweating makes people feel socially awkward and may result in avoiding any activity where the sweating will be obvious. Sports, dancing, handicrafts with others such as quilting bees, and public speaking are a few of the activities people with hyperhidrosis will avoid.

Healio: What are the current treatment options for patients with hyperhidrosis?

Forney: For secondary hyperhidrosis, addressing the underlying cause is key. Many of the treatments for primary hyperhidrosis will help people with secondary hyperhidrosis. We follow a treatment hierarchy based on likely insurance coverage, minimal risk and maximal effectiveness. Topical medications are the first line, followed by pills, followed by surgery. All of these may be covered by insurance. Botox injections every 9 months and miraDry (1315 Capital) treatment can give significant relief with minimum side effects but are typically not covered by insurance.

Healio: Which patients would be surgical candidates?

Forney: Surgery is an option for underarm excessive sweating after all other options are exhausted. There are no surgical options for hand and foot sweating.

Reference:

• Hyperhidrosis awareness month #knowsweat 2022. https://www.sweathelp.org/sweat-help-home/hyperhidrosis-awareness-2022.html. Accessed Nov. 29, 2022.