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Types of alternative treatments

Alternatives to surgery:
For decades, attempts at countering excessive sweating through alternative methods have been utilized with mixed results. Conservative solutions such as Botox® Cosmetic , lotions, oral medications, electronic devices, acupuncture, anti-anxiety medications, beta blockers, biofeedback, and herbal medicines have had little or no effect on the problem.

The only highly effective and proven solution has been surgery. To learn more about conservative methods to treat focal hyperhidrosis please see Dr. Reisfeld’s published paper in Thoracic Surgery Clinics – 2008 Volume 18. Patients should maintain good records of any alternative treatments they tried as this will be helpful when dealing with your insurance company.

That said, surgery should not be resorted to without attempting some of these alternative methods first. Patients who suffer only from axillary hyperhidrosis (armpit sweating) should try medicated antiperspirants such as Drysol, Maxim, and Odaban.

In fact, many insurance companies demand that alternatives be used first, before resorting to surgical methods.

Most patients who undergo surgery have already tried using conservative methods and resort to ETS as a final and proven surgical solution. As part of this surgical procedure the sympathetic chain, responsible for excessive sweating, is interrupted or excised.

Local Lotion – Drysol

The most commonly used lotion is an aluminum hydrochloride known as Drysol (manufactured by Person & Covey, Inc.- Glendale, CA). In Europe, Odaban is the equivalent. In most states, Drysol is available through prescription, and in some, can also be purchased over the counter. The goal when using this lotion, is to purposefully dry out the user’s hands and reduce excess sweating as a result.

Unfortunately, most patients do not feel any relief due to the fact that the lotion itself adds additional moisture to the skin. Long term usage can cause the skin to crack as well. Maxim is another product on the market with a somewhat higher pH level, which causes less irritation. Maxim can be purchased online.

Lotions represent the first alternative method to surgery that many doctors will try. Many patients have raised concerns surrounding aluminum toxicity when using these types of lotions. However, as of yet, there are no known clinical studies which measure toxicity after long-term use of these compounds.

Another type of topical agent (lotion) are options that contain anticholinergic agents. Unfortunately, these do not show any high rate of success. This is due to the large amount required to have a local effect on the peripheral nerves that innervate the eccrine glands (sweat glands). High concentration of this medication can cause some side effects as well.

In cases of facial hyperhidrosis the topical application of glycopyrrolate (an anticholinergic agent) in a 0.5% solution can produce some relieving results. This coincides with Dr. Reisfeld’s belief that facial hyperhidrosis should be treated with conservative methods, rather than surgery.

Other topical agents such as aldehyde agents, formaldehyde, and glutaraldehyd have limited use in the treatment of hyperhidrosis. This is due to the fact that they can cause severe allergic reactions and severe skin irritation.

The products we’ve discussed thus far are all easily obtained by average consumers. In any case, it is always preferable to treat focal hyperhidrosis with one of these methods, before resorting to surgery.

Drysol

To learn more about Drysol please visit our drysol page.

BOTOX® Cosmetic

In the past, some insurance companies have demanded that patients try BOTOX® Cosmetic (manufactured by Allergan – Irvine, CA) as treatment for Hyperhidrosis before resorting to a surgical procedure known as endoscopic thoracic sympathectomy (ETS). Although the FDA has approved the use of BOTOX® Cosmetic for axillary sweating or excessive sweating under the arms, it has not been approved for the treatment of sweaty palms or feet (Hyperhidrosis).

It is somewhat disturbing that insurance companies demand that BOTOX® Cosmetic be used for the treatment of sweaty hands and feet without the proper scientific knowledge of hyperhidrosis. In cases that BOTOX® Cosmetic is used for treatment of any form of Hyperhidrosis, it represents a temporary solution.

In some cases, the use of BOTOX® Cosmetic to treat Palmar Hyperhidrosis can be painful. There are methods for avoiding this pain, such as regional or general anesthesia. Therefore, patients should arrange for the BOTOX® Cosmetic treatment to be administered by an appropriate physician. Since the treatment is temporary, numerous injections will be required. This can quickly add up, as each injection is a costly procedure.

Millions of people receive BOTOX® Cosmetic injections for various purposes without any side effects. However, BOTOX® Cosmetic is officially classified as a toxin. Based on this, and the factors above, it can be argued that it is not an ideal treatment.

To learn more about BOTOX® Cosmetic and its relation to hyperhidrosis, please visit our BOTOX® Cosmetic page.

Contact Expert Dr. Reisfeld to Learn More

Oral Anti Hyperhidrosis Medications: Anti Cholinergic Agents

For years, physicians have treated hyperhidrosis with a group of medications that were also used to treat peptic ulcer problems. These medications work by inhibiting a certain neurotransmitter (a chemical substance) that also interferes with receptors that play a role in the production of sweat.

The name of this neurotransmitter is acetylcholine. Find out more about this neurotransmitter on our acetylcholine page. In these medications, such as Robinul, Ditropan, and Propantheline, success is very limited and some patients discontinue use due to side effects such as dry mouth and blurry vision.

Recently a medical paper from Brazil reported initial success with Ditropan, which is an anticholinergic agent. The final analysis is yet to be determined, because medications can lose effectiveness over time. Furthermore, increasing doses result in more severe side effects.

Despite this, Dr. Reisfeld believes that this drug should be offered as an initial step in the treatment of excessive hand sweating. If this particular treatment, or any other conservative measure, does not provide results, then surgical options can be considered.

In our experience, there are some patients who will report benefits from Ditropan, which is another anticholinergic agent. As long as the patient reports improvement without any side effects like blurry vision, dry mouth, or memory loss, they can continue using Ditropan.

If the side effects are unbearable, then surgery should be considered. Similarly, if one of the anticholinergic agents shows positive results, but must be stopped as a result of negative side effects, other similar treatments can be used instead.

Treatment for hyperhidrosis with oral-systemic agents has shown that patients experience too many negative side effects. As a result, many do not pursue this option as a long-term solution.

Other systemic agents have been used for hyperhidrosis as well. These include amitriptyline, clonazepam, beta blockers, calcium channel blockers, and indomethacin. These were utilized before the 1990’s for patients with generalized hyperhidrosis.

A variety of case studies have been published showing benefits of certain oral medications. For example, clonidine has been used for the treatment of cranio facial hyperhidrosis. There are also reports that tested oxybutinin for the treatment of severe upper body sweating.

All of these are single case reports with no clinical importance. Nearly all the reviews that tested oral medications were written after topical treatment like iontophoresis and even BOTOX® Cosmetic did not produce results. The success rate was extremely low.

Electronic Devices

Drionic (manufactured by General Medical Co. – Los Angeles, CA) is an electric machine that uses iontophoresis as a means of slowing sweat production. The hands are placed in a tub-like container full of water as weak electric currents pass through the liquid. It requires steady use: at least three to five times a week, and can be purchased online. Success is possible, but limited, based on reports. It is now possible to rent Drionic machines on a weekly basis as well. Learn more on our Iontophoresis page.

Percutaneus (through the skin) or X-ray Guided Techniques:

There are reported cases and clinical trials which used x-ray guided injections of absolute alcohol to achieve the same sympathectomy effect that surgical methods provide. Even though initial success was reported, the long-term data is not as promising as the initial findings.

There is an inherent risk that the injected materials can move beyond the point where they were administered, resulting in collateral damage. It is also true that in cases of chemical lumbar sympathectomy, done for plantar hyperhidrosis, that the effect was temporary. See our Chemical Lumbar Sympathectomy page for more information.

Acupuncture, Biofeedback, Anti-anxiety medications, Beta blockers and Herbal Medicines

All of the above methods have been tried by some patients. As of yet, no wide-spread success has been noted when using these alternative method of treatment.

Combination Hyperhidrosis Treatments

Some circulating personal opinions talk about using a combination of conservative treatment methods to treat hyperhidrosis. In this situation people were adding anticholinergic medications to the liquid used in the iontophoresis machine, or using oral and topical lotions at the same time. Sufficient study is still required to measure the potential success of this methodology. Even so, it should be considered as an option on a patient-by-patient basis.

Psychological / Psychiatric Treatments

Patients who suffer from hyperhidrosis are looking for any medical solutions that might solve their sweating problem. Due to a lack of knowledge among physicians, some patients are labelled as suffering from mental or behavioral disorders. Those patients are sometimes put on psychiatric/psychological medications which offer little to no help at all.

The problem with these types of medication, is the fact that they can create a dependence in the patient, while never addressing the true problem. It is true that patients who suffer from hyperhidrosis will have some social inhibitions, however, these inhibitions can be approached with group therapy, support, and understanding of the problem. The takeaway here, is that patients should always consult physicians who have knowledge of Hyperhidrosis.

There are some very widely used medications and lotions that offer some relief, but it’s usually very little or not at all. These simple methods do not have any addictive characteristics, so it’s always smart to try these simple conservative methods first.

In the past, patients who were treated with psychiactric or psychological medication found that, after ETS surgery, they no longer felt the need to continue taking these drugs. Perhaps the biggest issue of all, is the lack of knowledge when it comes to issues of hyperhidrosis among the medical community. This issue is being addressed, but progress is very slow.

Even though the alternative methods do not enjoy a high degree of success, it is imperative for patients to try some of those methods before any decision is made move forward with surgery.

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