By | January 17, 2012
I have been learning about hyperhidrosis.
Hyperhidrosis (“HI-per-hi-DRO-sis”) is a condition where the sweat glands are overactive. It can affect the whole body, just the armpits or groin, or only the palms of the hands and soles of the feet. 1 to 3% of the U.S. population has it, and it usually runs in families.
I have several patients who have this condition. It can be pretty awful. One of them has a very hard time playing basketball, with his feet sliding around in his shoes. He twists his ankles a lot. Another one owns a restaurant, and always has to worry about glasses, dishes, the telephone, etc., slipping out of her grip.
There are actually 3 kinds of sweat glands in the body. The kind that is overactive in hyperhidrosis are eccrine sweat glands, which control “emotional sweating” and are concentrated in the palms and soles, with fewer in the armpits. These glands have an exaggerated reaction to normal emotional changes. Nervousness about having to shake hands or walk barefoot or stocking-footed in social settings makes this reaction even worse.
Here is what some folks say on the Internets:
“I hated giving high-fives as a kid.”
“I’m currently in college. I can’t take any notes because ill soak the page. I just sit there with my hands tucked away so no one sees.”
“Just simple things like typing on keyboards without sweat building in puddles, using iPhones, petting a cat, etc., can make all the difference.”
“I would always hold my drink in my right hand, this way if I were going to have to shake someone’s hand, my excuse for a cold wet hand was from the glass.”
“How can you tell someone you can’t hold their hand? I was always jealous of couples that could hold hands. I wanted that, but could never do it.”
There are some radical treatments that may be risky, have side effects, and may not even be very effective. These include Botox (botulism toxin) injections, to paralyze the glands, and surgery to cut the sympathetic nerve supply to the area (the “fight or flight” nerve supply). I do not recommend these unless every other option has already failed repeatedly.
Here are some less risky treatments to try:
1. Apply 20% aluminum chloride hexahydrate (prescription, brand names Drysol and Hypercare) nightly to dry skin. Cover (e.g., gloves and socks); rinse off in a.m. After improvement, may apply just twice weekly.
2. Topical glycopyrrolate (an anti-cholinergic medication that dries up secretions in general), 0.5 to 4% cream or solution, compounded in an acidic base. (You need a prescription that you can take to a compounding pharmacy, where they will make this preparation by hand. Insurance might not pay for compounded medications. A brand-name version is not available.) Apply nightly to dry skin and cover (e.g., gloves and socks); rinse off in a.m. May cause dry mouth (since it dries up secretions); stay well hydrated. Do not get in eyes (don’t touch face until gloves are on); causes blurred vision.
3. Oral medications might help, and may be chosen if they are needed for other conditions. Examples: indomethacin for gout or other inflammatory pain conditions; calcium channel blockers for high blood pressure; beta blockers for rapid heartbeat, hand tremors, or migraine prevention.
4. For palm-sole hyperhidrosis, iontophoresis (“eye-ON-toe-for-EE-sis”) can be tried.
~ Iontophoresis causes blockage of sweat ducts by directing a mild electrical current through the skin.
~ Once the sweat output is blocked or interrupted, sweat production on the palms and soles is, often suddenly and dramatically, “turned off.”
~ Iontophoresis appears to alleviate symptoms in approximately 83% of people with palm-sole hyperhidrosis, according to the American Academy of Dermatology.
~ It is safe and simple to perform.
~ The process is repeated every other day for 5-10 days, or until sweating is reduced to a comfortable level.
~ Once the desired dryness has been achieved, switch to a maintenance schedule of once every 1-4 weeks. ~ To maintain dryness, iontophoresis must be repeated as soon as sweating begins to return.
~ Most people report an improvement after 6 to 10 sessions.
~ The feet require a higher voltage than the hands.
~ In some locations, tap water may be too soft for iontophoresis to work. That is, it doesn’t contain enough electrolytes to help the electric current travel through the water and into the skin. Adding about a half-teaspoon of baking soda to each tray of water will correct of this.
~ If iontophoresis with plain water, or water with baking soda, doesn’t produce the desired dryness, glycopyrrolate (see above) can be added to the water. In the majority of cases this works.
~ Do not use iontophoresis if you are pregnant, have a pacemaker or metal implants (e.g., metal joint replacements), have a heart condition, or have epilepsy.
~ Remove all jewelry before iontophoresis.
~ If skin gets dried out, use moisturizer. Cover any scrapes, cuts, hangnails, and irritated skin with Vaseline before iontophoresis, to prevent irritation.
Iontophoresis machines can be purchased commercially ($500-1000) or made at home (~$30). Start by watching these videos that show how to make and safely use a home iontophoresis device:
One 8-minute version, new and improved from the original.
http://youtu.be/bOQfjZ9-Akw – Another version. (The author requested embedding the 10-minute video be disabled, but this is the link.)
Entertaining demonstration of use. Warning: contains a lot of swearing. Starts with about 18 volts (swearing), then reduces it to 12 (with good results).
…I placed 3 batteries in a series like the video… When I placed my hands in the water it made me cringe. I guess the shock felt a little too much for me. I ended up only hooking up 2 batteries in a series, which was around 12.7 volts, and when I put my hands in the water I could feel the current, but only for about 2 seconds.
…To my surprise that evening my hands were 50% dry, and the next day stayed that way all day.
…The next day, probably 75% dry, even better than before.
Finally, after the 3rd day… my hands were about 90% dry all day and night.
I had the impression that one could not really treat armpits the same way.
E.g., “Idromed [commercial manufacturer] only recommends for 2mA [milliamperes] max, because of the risk of ventricular fibrillation. And with 2mA, I don’t think you will see great results.”
But I may have been wrong.
“At the moment I’m trialing the homemade ionto, and made up my own underarm devices. First I simply wrapped cotton wool around the wire. Then I started using sponge cloths folded over foil, with the alligator clips attached. If anyone attempts this make sure you only start with a 6-volt battery. I stupidly without thinking made the switch over from treating hands, and used 18 volts. I literally jumped out of my chair. Even 12V is uncomfortable.”
“Armpits require a lower voltage than the hands or feet.”
“For underarm treatments, you’ll need to be especially careful. Make sure that the alligator clips don’t come in contact with the skin. Remove all clothing material with metal, such as an underwire bra, before beginning.”
I am a nursing student… Touching a patient or putting on gloves was a nightmare for me… For 2 weeks, I have not sweat any more, neither my hands nor my feet… I am a totally different person.
I am still in awe every single day at the miracle of my dry hands. I have been able to go back to church without the anxiety of having to shake or hold hands during the service. I happily hold the hands of my third graders and shake hands with their parents.
It has now been months… I have a completely different life. I’m the same person, but even better. I have always been social, but now I feel unstoppable, because I can hug, shake hands and not worry… I hope those out there will have the chance to experience what a “normal” life is like. It’s amazing.
The stories that people have told about this condition are striking to me in that their suffering always centers around the estrangement they feel from others. To not be able to freely touch another person – stranger, friend, or lover – or to not be able to freely touch a beloved animal companion – is a tragic deprivation, keenly felt every day. To feel that one is irrevocably different – almost indecent, “clammy,” “slimy” – is such a stigma, that people will pursue practically any solution that might lessen it – no matter whether it is dangerous, uncomfortable, or prohibitively expensive. (Fortunately, safe and affordable options exist.)
It teaches us, again, that touch and companionship are essentials of life. They’re not small things.
“…What a ‘normal’ life is like. It’s amazing.”
Every heart sings a song, incomplete, until another heart whispers back.
Those who wish to sing always find a song.
At the touch of a lover, everyone becomes a poet.
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