Editing Hyperhidrosis (section)

==Treatment==
Antihydral cream is one of the solutions prescribed for hyperhidrosis for palms.<ref>{{cite news |last1=McColl |first1=Sean |title=My hands, my tools, my rules |url=https://www.cbc.ca/playersvoice/entry/sean-mccoll-my-hands-my-tools-my-rules |work=CBC Sports |date=2 October 2019 }}</ref><ref>{{cite news |first1=David |last1=Wharton |url=https://www.latimes.com/sports/olympics/story/2021-08-04/sport-climbing-rocks-hands-importance-tokyo-olympics |title=When it comes to Olympic sport climbing, hands are the ultimate 'problem' solvers |newspaper=[[Los Angeles Times]] |date=4 August 2021 }}</ref> Topical agents for hyperhidrosis therapy include [[formaldehyde]] lotion and topical anticholinergics. These agents reduce perspiration by [[Denaturation (biochemistry)|denaturing]] [[keratin]], in turn occluding the pores of the [[sweat glands]]. They have a short-lasting effect. Formaldehyde is classified as a probable human [[carcinogen]]. Contact sensitization is increased, especially with formalin. [[Aluminium chlorohydrate]] is used in regular [[antiperspirant]]s. However, hyperhidrosis requires solutions or gels with a much higher concentration. These antiperspirant solutions or hyperhidrosis gels are especially effective for treatment of [[Axilla|axillary]] or underarm regions. It takes three to five days to see improvement. The most common side-effect is [[skin irritation]]. For severe cases of plantar and palmar hyperhidrosis, there has been some success with conservative measures such as higher strength aluminium chloride antiperspirants.<ref name="Reisfeld Berliner 2008">{{cite journal |last1=Reisfeld |first1=Rafael |last2=Berliner |first2=Karen I. |title=Evidence-Based Review of the Nonsurgical Management of Hyperhidrosis |journal=Thoracic Surgery Clinics |date=May 2008 |volume=18 |issue=2 |pages=157–166 |doi=10.1016/j.thorsurg.2008.01.004 |pmid=18557589 }}</ref> Treatment algorithms for hyperhidrosis recommend topical antiperspirants as the first line of therapy for hyperhidrosis. The International Hyperhidrosis Society has published evidence-based treatment guidelines for [[focal hyperhidrosis|focal]] and generalized hyperhidrosis.<ref>{{Cite web |title=Clinical Guidelines |website= International Hyperhidrosis Society |url=https://www.sweathelp.org/treatments-hcp/clinical-guidelines.html |access-date=2024-07-20 |language=en-gb}}</ref>

Prescription medications called [[anticholinergics]], often taken by mouth, are sometimes used in the treatment of both generalized and focal hyperhidrosis.<ref>{{Cite journal|url = http://www.jle.com/fr/revues/ejd/e-docs/current_therapeutic_strategies_for_hyperhidrosis_a_review_100256/article.phtml|title = Current therapeutic strategies for hyperhidrosis: a review.|issue = 3|pages = 219–23|date = May–June 2002|journal = European Journal of Dermatology|volume = 12|publisher = National Institutes of Health|vauthors = Togel B, Greve B, Raulin C|pmid = 11978559}}</ref> Anticholinergics used for hyperhidrosis include [[propantheline]], [[glycopyrronium bromide]] or [[glycopyrrolate]], [[oxybutynin]], [[methantheline]], and [[benzatropine]]. Use of these drugs can be limited, however, by side-effects, including dry mouth, [[urinary retention]], constipation, and visual disturbances such as [[mydriasis]] and [[cycloplegia]]. For people who find their hyperhidrosis is made worse by anxiety-provoking situations ([[public speaking]], stage performances, special events such as weddings, etc.), taking an anticholinergic medicine before the event may help.<ref>{{cite book |last1=Böni |first1=Roland |chapter=Generalized Hyperhidrosis and Its Systemic Treatment |pages=44–47 |pmid=12471697 |chapter-url={{GBurl|64F_NgGegfoC|p=44}} |editor1-last=Kreyden |editor1-first=Oliver Philip |editor2-last=Böni |editor2-first=Roland |editor3-last=Burg |editor3-first=Günter |title=Hyperhidrosis and Botulinum Toxin in Dermatology |series=Current Problems in Dermatology |volume=30 |date=2002 |publisher=Karger Medical and Scientific Publishers |isbn=978-3-8055-7306-1 |doi=10.1159/isbn.978-3-318-00771-8 |url=https://karger.com/books/book/2404 }}</ref> In 2018, the U.S. [[Food and Drug Administration]] (FDA) approved the [[Topical administration|topical]] anticholinergic [[glycopyrronium tosylate]] for the treatment of primary axillary hyperhidrosis.<ref name="Qbrexza FDA label">{{cite web | title=Qbrexza- glycopyrronium cloth | website=DailyMed | date=17 January 2022 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6b985380-1256-4fb3-b89a-6df2c6a6d12e | access-date=2 November 2022}}</ref><ref>{{cite web | title=Drug Approval Package: Qbrexza (glycopyrronium) | website=U.S. [[Food and Drug Administration]] (FDA) | date=20 November 2018 | url=https://www.accessdata.fda.gov/drugsatfda_docs/nda/2018/210361Orig1s000TOC.cfm | archive-url=https://web.archive.org/web/20210411075110/https://www.accessdata.fda.gov/drugsatfda_docs/nda/2018/210361Orig1s000TOC.cfm | url-status=dead | archive-date=April 11, 2021 | access-date=1 November 2022}}</ref>

For peripheral hyperhidrosis, some people have found relief by simply ingesting crushed ice water. Ice water helps to cool excessive body heat during its transport through the blood vessels to the extremities, effectively lowering overall body temperature to normal levels within ten to thirty minutes.<ref>{{cite journal |last1=Brearley |first1=Matt |title=Crushed ice ingestion – a practical strategy for lowering core body temperature |journal=Journal of Military and Veterans Health |date=April 2012 |volume=20 |issue=2 |pages=25–30 |url=https://jmvh.org/wp-content/uploads/2012/12/JMVH_Crushed-Ice.pdf }}</ref>

===Procedures===
Injections of [[botulinum toxin]] type A can be used to block neural control of sweat glands. The effect can last from 3–9 months depending on the site of injections.<ref>{{cite journal |last1=Togel |first1=B |year=2002 |title= Current therapeutic strategies for hyperhidrosis: a review |journal=Eur J Dermatol |volume=12 |issue=3 |pages=219–23 |pmid= 11978559 }}</ref> This use has been approved by the U.S. [[Food and Drug Administration]] (FDA).<ref>{{cite web |url=https://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm174949.htm |archive-url=https://web.archive.org/web/20090805030546/http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm174949.htm |url-status=dead |archive-date=August 5, 2009 |title=Information for Healthcare Professionals: OnabotulinumtoxinA (marketed as Botox/Botox Cosmetic), AbobotulinumtoxinA (marketed as Dysport) and RimabotulinumtoxinB (marketed as Myobloc) |publisher=U.S. Food and Drug Administration}}</ref> The duration of the beneficial effect in primary palmar hyperhidrosis has been found to increase with repetition of the injections.<ref name=":0">{{cite journal|title = Commenting on: "Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis" |doi=10.1016/j.jaad.2014.08.053|volume=72|issue=1|journal=Journal of the American Academy of Dermatology|pages=201|pmid=25497933|vauthors=Comite SL, Smith K|year=2015}}</ref> The Botox injections tend to be painful. Various measures have been tried to minimize the pain, one of which is the application of ice.

This was first demonstrated by Khalaf Bushara and colleagues as the first nonmuscular use of BTX-A in 1993.<ref name="Bushara KO, Park DM. 1437–1438">{{cite journal |last1=Bushara |first1=K O |last2=Park |first2=D M |title=Botulinum toxin and sweating. |journal=Journal of Neurology, Neurosurgery & Psychiatry |date=1 November 1994 |volume=57 |issue=11 |pages=1437–1438 |doi=10.1136/jnnp.57.11.1437 |pmid=7964832 |pmc=1073208 }}</ref> BTX-A has since been approved for the treatment of [[focal hyperhidrosis|severe primary axillary hyperhidrosis]] (excessive underarm sweating of unknown cause), which cannot be managed by topical agents.{{when|date=February 2015}}<ref name="Eisenach JH, Atkinson JL, Fealey RD. 657–666">{{cite journal |last1=Eisenach |first1=John H. |last2=Atkinson |first2=John L.D. |last3=Fealey |first3=Robert D. |title=Hyperhidrosis: Evolving Therapies for a Well-Established Phenomenon |journal=Mayo Clinic Proceedings |date=May 2005 |volume=80 |issue=5 |pages=657–666 |doi=10.4065/80.5.657 |pmid=15887434 |doi-access=free }}</ref><ref>{{cite journal |last1=Felber |first1=Eric S. |title=Botulinum Toxin in Primary Care Medicine |journal=Journal of Osteopathic Medicine |date=October 2006 |volume=106 |issue=10 |pages=609–614 |doi=10.7556/jaoa.2006.106.10.609 |doi-broken-date=2024-11-02 |pmid=17122031 |url=https://www.degruyter.com/document/doi/10.7556/jaoa.2006.106.10.609/html }}</ref>

[[miraDry]], a [[microwave]]-based device, has been tried for excessive underarm perspiration and appears to show promise.<ref name=Ja2013>{{cite journal |last1=Jacob |first1=Carolyn |title=Treatment of hyperhidrosis with microwave technology |journal=Seminars in Cutaneous Medicine and Surgery |date=March 2013 |volume=32 |issue=1 |pages=2–8 |pmid=24049923 |url=https://cdn.mdedge.com/files/s3fs-public/issues/articles/SCMS_Vol_32_No_1_Hyperhidrosis.pdf }}</ref> With this device, rare but serious side effects exist and are reported in the literature, such as paralysis of the upper limbs and [[brachial plexus]].<ref>{{cite journal |last1=Puffer |first1=Ross C. |last2=Bishop |first2=Allen T. |last3=Spinner |first3=Robert J. |last4=Shin |first4=Alexander Y. |title=Bilateral Brachial Plexus Injury After MiraDry Procedure for Axillary Hyperhidrosis |journal=World Neurosurgery |date=April 2019 |volume=124 |pages=370–372 |doi=10.1016/j.wneu.2019.01.093 |pmid=30703585 }}</ref>

Tap water [[iontophoresis]] as a treatment for palmoplantar hyperhidrosis was originally described in the 1950s.<ref>{{cite journal |last1=Kreyden |first1=Oliver P |title=Iontophoresis for palmoplantar hyperhidrosis |journal=Journal of Cosmetic Dermatology |date=December 2004 |volume=3 |issue=4 |pages=211–214 |doi=10.1111/j.1473-2130.2004.00126.x |pmid=17166108 |s2cid=8088671 }}</ref> Studies showed positive results and good safety with tap water iontophoresis.<ref>{{cite journal |last1=Hornberger |first1=John |last2=Grimes |first2=Kevin |last3=Naumann |first3=Markus |last4=Anna Glaser |first4=Dee |last5=Lowe |first5=Nicholas J |last6=Naver |first6=Hans |last7=Ahn |first7=Samuel |last8=Stolman |first8=Lewis P |last9=Multi-Specialty Working Group on the Recognition, Diagnosis, and Treatment of Primary Focal |first9=Hyperhidrosis |title=Recognition, diagnosis, and treatment of primary focal hyperhidrosis |journal=Journal of the American Academy of Dermatology |date=August 2004 |volume=51 |issue=2 |pages=274–286 |doi=10.1016/j.jaad.2003.12.029 |pmid=15280848 }}</ref> One trial found it decreased sweating by about 80%.<ref>{{cite journal |last1=Kurta |first1=Anastasia O. |last2=Glaser |first2=Dee Anna |title=Emerging Nonsurgical Treatments for Hyperhidrosis |journal=Thoracic Surgery Clinics |date=November 2016 |volume=26 |issue=4 |pages=395–402 |doi=10.1016/j.thorsurg.2016.06.003 |pmid=27692197 }}</ref>

===Surgery===
Sweat gland removal or destruction is one surgical option available for axillary hyperhidrosis (excessive underarm perspiration). There are multiple methods for sweat gland removal or destruction, such as sweat gland suction, retrodermal curettage, and axillary liposuction, Vaser, or Laser Sweat Ablation. Sweat gland suction is a technique adapted for liposuction.<ref>{{cite journal |last1=Bieniek |first1=Andrzej |last2=Bialynicki-Birula |first2=Rafal |last3=Baran |first3=Wojciech |last4=Kuniewska |first4=Barbara |last5=Okulewicz-Gojlik |first5=Danuta |last6=Szepietowski |first6=Jacek C. |title=Surgical Treatment of Axillary Hyperhidrosis with Liposuction Equipment: Risks and Benefits |journal=Acta Dermatovenerologica Croatica |date=April 2005 |volume=13 |issue=4 |pages=212–218 |pmid=16356393 |url=https://hrcak.srce.hr/88615 }}</ref>

The other main surgical option is [[endoscopic thoracic sympathectomy]] (ETS), which cuts, burns, or clamps the thoracic ganglion on the main sympathetic chain that runs alongside the spine. Clamping is intended to permit the reversal of the procedure. ETS is generally considered a "safe, reproducible, and effective procedure and most patients are satisfied with the results of the surgery".<ref>{{cite journal |last1=Henteleff |first1=Harry J. |last2=Kalavrouziotis |first2=Dimitri |title=Evidence-Based Review of the Surgical Management of Hyperhidrosis |journal=Thoracic Surgery Clinics |date=May 2008 |volume=18 |issue=2 |pages=209–216 |doi=10.1016/j.thorsurg.2008.01.008 |pmid=18557593 }}</ref> Satisfaction rates above 80% have been reported, and are higher for children.<ref name="Steiner Cohen Kleiner et al 2008">{{cite journal |last1=Steiner |first1=Zvi |last2=Cohen |first2=Zahavi |last3=Kleiner |first3=Oleg |last4=Matar |first4=Ibrahim |last5=Mogilner |first5=Jorge |title=Do children tolerate thoracoscopic sympathectomy better than adults? |journal=Pediatric Surgery International |date=March 2008 |volume=24 |issue=3 |pages=343–347 |doi=10.1007/s00383-007-2073-9 |pmid=17999068 |s2cid=26037254 }}</ref><ref>{{cite journal |last1=Dumont |first1=Pascal |last2=Denoyer |first2=Alexandre |last3=Robin |first3=Patrick |title=Long-Term Results of Thoracoscopic Sympathectomy for Hyperhidrosis |journal=The Annals of Thoracic Surgery |date=November 2004 |volume=78 |issue=5 |pages=1801–1807 |doi=10.1016/j.athoracsur.2004.03.012 |pmid=15511477 }}</ref> The procedure brings relief from excessive hand sweating in about 85–95% of people.<ref>{{cite journal |last1=Prasad |first1=Arun |last2=Ali |first2=Mudasir |last3=Kaul |first3=Sunil |title=Endoscopic thoracic sympathectomy for primary palmar hyperidrosis |journal=Surgical Endoscopy |date=August 2010 |volume=24 |issue=8 |pages=1952–1957 |doi=10.1007/s00464-010-0885-5 |pmid=20112111 |s2cid=14844101 }}</ref> ETS may be helpful in treating axillary hyperhidrosis, facial blushing and facial sweating, but failure rates in people with facial blushing and/or excessive facial sweating are higher and such people may be more likely to experience unwanted side effects.<ref>{{cite journal |last1=Reisfeld |first1=Rafael |title=Sympathectomy for hyperhidrosis: should we place the clamps at T2–T3 or T3–T4? |journal=Clinical Autonomic Research |date=December 2006 |volume=16 |issue=6 |pages=384–389 |doi=10.1007/s10286-006-0374-z |pmid=17083007 |s2cid=24177139 }}</ref>

ETS side-effects have been described as ranging from trivial to devastating.<ref>{{cite journal |last1=Schott |first1=G D |title=Interrupting the sympathetic outflow in causalgia and reflex sympathetic dystrophy |journal=BMJ |date=14 March 1998 |volume=316 |issue=7134 |pages=792–793 |doi=10.1136/bmj.316.7134.792 |pmid=9549444 |pmc=1112764 }}</ref> The most common side-effect of ETS is compensatory sweating (sweating in different areas than prior to the surgery). Major problems with compensatory sweating are seen in 20–80% of people undergoing the surgery.<ref name="Gossot Galetta Pascal et al 2003">{{cite journal |last1=Gossot |first1=Dominique |last2=Galetta |first2=Domenico |last3=Pascal |first3=Antoine |last4=Debrosse |first4=Denis |last5=Caliandro |first5=Raffaele |last6=Girard |first6=Philippe |last7=Stern |first7=Jean-Baptiste |last8=Grunenwald |first8=Dominique |title=Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis |journal=The Annals of Thoracic Surgery |date=April 2003 |volume=75 |issue=4 |pages=1075–1079 |doi=10.1016/s0003-4975(02)04657-x |pmid=12683540 }}</ref><ref name="Yano Kiriyama Fukai et al 2005">{{cite journal |last1=Yano |first1=Motoki |last2=Kiriyama |first2=Masanobu |last3=Fukai |first3=Ichiro |last4=Sasaki |first4=Hidefumi |last5=Kobayashi |first5=Yoshihiro |last6=Mizuno |first6=Kotaro |last7=Haneda |first7=Hiroshi |last8=Suzuki |first8=Eriko |last9=Endo |first9=Katsuhiko |last10=Fujii |first10=Yoshitaka |title=Endoscopic thoracic sympathectomy for palmar hyperhidrosis: Efficacy of T2 and T3 ganglion resection |journal=Surgery |date=July 2005 |volume=138 |issue=1 |pages=40–45 |doi=10.1016/j.surg.2005.03.026 |pmid=16003315 }}</ref><ref>{{cite journal |last1=Boscardim |first1=Paulo César Buffara |last2=Oliveira |first2=Ramon Antunes de |last3=Oliveira |first3=Allan Augusto Ferrari Ramos de |last4=Souza |first4=Juliano Mendes de |last5=Carvalho |first5=Roberto Gomes de |title=Simpatectomia torácica ao nível de 4ª e 5ª costelas para o tratamento de hiper-hidrose axilar |trans-title=Thoracic sympathectomy at the level of the fourth and fifth ribs for the treatment of axillary hyperhidrosis |language=pt |journal=Jornal Brasileiro de Pneumologia |date=February 2011 |volume=37 |issue=1 |pages=6–12 |doi=10.1590/s1806-37132011000100003 |pmid=21390426 |doi-access=free }}</ref> Most people find the compensatory sweating to be tolerable while 1–51% claim that their quality of life decreased as a result of [[Compensatory hyperhidrosis|compensatory sweating]]."<ref name="Steiner Cohen Kleiner et al 2008" /> Total body perspiration in response to heat has been reported to increase after sympathectomy.<ref>{{cite journal |last1=Kopelman |first1=Doron |last2=Assalia |first2=Ahmad |last3=Ehrenreich |first3=Marina |last4=Ben-Amnon |first4=Yuval |last5=Bahous |first5=Hany |last6=Hashmonai |first6=Moshe |title=The Effect of Upper Dorsal Thoracoscopic Sympathectomy on the Total Amount of Body Perspiration |journal=Surgery Today |date=10 December 2000 |volume=30 |issue=12 |pages=1089–1092 |doi=10.1007/s005950070006 |pmid=11193740 |s2cid=23980585 }}</ref> The original sweating problem may recur due to nerve regeneration, sometimes as early as 6 months after the procedure.<ref name="Gossot Galetta Pascal et al 2003"/><ref name="Yano Kiriyama Fukai et al 2005"/><ref>{{cite journal |last1=Walles |first1=T. |last2=Somuncuoglu |first2=G. |last3=Steger |first3=V. |last4=Veit |first4=S. |last5=Friedel |first5=G. |title=Long-term efficiency of endoscopic thoracic sympathicotomy: survey 10 years after surgery |journal=Interactive CardioVascular and Thoracic Surgery |date=18 September 2008 |volume=8 |issue=1 |pages=54–57 |doi=10.1510/icvts.2008.185314 |pmid=18826967 |doi-access=free }}</ref>

Other possible side-effects include [[Horner's syndrome|Horner's Syndrome]] (about 1%), [[gustatory]] sweating (less than 25%) and excessive dryness of the palms (sandpaper hands).<ref>{{cite journal |last1=Fredman |first1=Brian |last2=Zohar |first2=Edna |last3=Shachor |first3=Dov |last4=Bendahan |first4=Jose |last5=Jedeikin |first5=Robert |title=Video-assisted Transthoracic Sympathectomy in the Treatment of Primary Hyperhidrosis: Friend or Foe? |journal=Surgical Laparoscopy, Endoscopy & Percutaneous Techniques |date=August 2000 |volume=10 |issue=4 |pages=226–229 |doi=10.1097/00129689-200008000-00009 |pmid=10961751 |s2cid=31327456 }}</ref> Some people have experienced cardiac sympathetic denervation, which can result in a 10% decrease in heart rate both at rest and during exercise, resulting in decreased exercise tolerance.<ref>{{cite journal |last1=Abraham |first1=P. |last2=Picquet |first2=J. |last3=Bickert |first3=S. |last4=Papon |first4=X. |last5=Jousset |first5=Y. |last6=Saumet |first6=J.L. |last7=Enon |first7=B. |title=Infra-stellate upper thoracic sympathectomy results in a relative bradycardia during exercise, irrespective of the operated side |journal=European Journal of Cardio-Thoracic Surgery |date=December 2001 |volume=20 |issue=6 |pages=1095–1100 |doi=10.1016/s1010-7940(01)01002-8 |pmid=11717010 |doi-access=free }}</ref>

Percutaneous sympathectomy is a minimally invasive procedure similar to the botulinum method, in which nerves are blocked by an injection of [[phenol]].<ref>{{cite journal |last1=Wang |first1=Yeou-Chih |last2=Wei |first2=Shan-Hua |last3=Sun |first3=Ming-Hsi |last4=Lin |first4=Chi-Wen |title=A New Mode of Percutaneous Upper Thoracic Phenol Sympathicolysis: Report of 50 Cases |journal=Neurosurgery |date=1 September 2001 |volume=49 |issue=3 |pages=628–636 |doi=10.1097/00006123-200109000-00017 |pmid=11523673 |s2cid=25964524 }}</ref> The procedure provides temporary relief in most cases. Some physicians advocate trying this more conservative procedure before resorting to surgical sympathectomy, the effects of which are usually not reversible.