HH/excessive sweating treatment options



Dr. Benjamin Barankin Dermatologist, Medical Director and Founder, Toronto Dermatology Centre





Why we are sweating?

    • Sweating is important for our health, providing pheromones for sexual attraction, and thermoregulation so we don’t overheat in hot weather or with exercise, and so we can grip and grab better with our hands.


    • Hands & feet sweating, sometimes called “emotional” and can be due to stress or anxiety which is odor-free. 


  • The smell of sweat occurs when skin bacteria overgrow and feed on excess moisture, typically in the armpits and groin, but also the chest.

Hyperhidrosis (HH) and Diagnosis

    • Hyperhidrosis (HH)/Excessive sweating is sweating beyond what the body uses for homeostatic temperature regulation.


    • The Diagnosis relies almost entirely on complete patient history and supporting physical examination. 


    • Additional testing in the form of lab work or specialized sweating tests is rarely required. 


    • Physical examination is generally cursory or minimal. Visual inspection should reveal glistening of skin and/or frank sweating despite the patient being at rest. 


    • Your dermatologist may in some cases perform a starch-iodine test to help determine the location or extent of sweating.


  • Laboratory tests are not required to make a diagnosis of primary HH. They only serve to rule out and work-up potential secondary causes of sweating such as a thyroid problem or rarely tuberculosis. 


Hyperhidrosis (HH) Management

The Management of HH is focused on two approaches non-surgical or surgical.

The appropriate treatment will differ for each patient and will depend on the location of focal HH, the severity, and patient tolerance. 

Nonsurgical management

Most patients should begin with non-surgical treatments. The non-surgical or conservative treatments can be broadly categorized into topical antiperspirants, specifically clinical strength DRYSOL®, iontophoresis, oral medications, botulinum toxin (BTX) injections, or a combination of these. Here we review them shortly and go through the advantages and disadvantages of each treatment.

1. Antiperspirants

The advantages are ease of application, high efficacy and safety, and low co

The disadvantage is that for some patients, topical antiperspirants only provide temporary, short-acting relief from sweating

2. Clinical strength DRYSOL®

Drysol™ is a tried and true treatment for hyperhidrosis that all patients should try.

Effective products such as DRYSOL®, contain aluminum chloride, which is work by physically obstructing the pore of the sweat gland and/or by causing atrophy of the secretory cells.

Drysol™ passed the Human Repeat Insult Patch Test (HRIPD) test and meets The Canadian Dermatology Association’s Skin Health Program criteria. 

Drysol™ does not contain specific ingredients that can cause irritation and negative reactions to the skin.*

3. Iontophoresis

Iontophoresis is the introduction of ions through the skin by the application of an electrical current. 

Treatment involves placing the hands or feet in the water, through which an electrical current of 15–20 mA is passed for 20–30 min, three to four times per week. Long-term maintenance therapy is required. 

Side effects are uncommon and are limited to skin irritation. Its use is contraindicated in pregnant patients, who have a pacemaker, defibrillator, or metal surgical implants. 

4. Oral medications

A wide variety of oral medications have been prescribed for the management of HH, with the commonly used agents being anticholinergic medications such as glycopyrrolate or oxybutynin.  

Although the majority of patients will typically respond to anticholinergics, their utility is limited by the intolerable side effects that tend to develop at the doses required to reduce sweating. 

The anticholinergic side effects specifically include dry mouth, blurred vision, urinary retention, constipation, sedation, orthostatic hypotension, and tachycardia.

5. Botulinum toxin

The Canadian Hyperhidrosis Advisory Committee recommends BTX as second-line therapy for mild axillary, palmar, plantar, and craniofacial HH, and as one of the options for first-line therapy for severe axillary, palmar, plantar, or craniofacial HH.

BTX effectively inhibits eccrine gland activity by interfering with the nerve to sweat gland communication, and thus there is reduced sweat production.


Contraindications for BTX are uncommon but include hypersensitivity to albumin, peripheral motor neuropathies, and neuromuscular junction disorders. Aminoglycosides, penicillamines, quinine, and calcium channel blockers may potentiate the effects of BTX and concomitant use should be avoided.

Surgical management

HH surgical management involves either interruption of the sympathetic supply tothe upper limb (sympathectomy) or locally cutting out the sweat glands in the armpits.

Complications resulting from armpit gland removal or liposuction curettage, including skin damage, huge bruising, scarring, and reduced arm movement, as well as a lower overall success rate, have limited its role in more recent years.


It’s important to choose the right treatment option to help with your HH condition or excessive sweating and allow you to get on with your daily activities and lifestyle.


Next up: We’ll review Hyperhidrosis stigma, silent disorder, and treatments


To learn more and download the e-coupon, visit www.drysol.ca

Join and follow #drysolidarity to break the excessive sweating stigma

* https://dermatology.ca/industry/industry-recognition-programs/shp/

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