medications for hperhydrosis?

Question

my daughter suffers severly from this condition, which is excessive sweating of her entire body. She has seen many doctors but some of the medications have nasty side effects. She is 16 years old so a part of this may be hormonal, although not comletely the cause. Any one else with this condition? HELP.

Answer 1

Information on Hyperhidrosis or excessive sweating medications.
Anticholinergic medications have variable success in treating hyperhidrosis. Glycopyrolate (Robinul) is started at 1-2mg one to three times per day but generally patients need higher doses to have adequate results.

Unfortunately at high doses these medications have severe side effects such as excessive dryness of the mouth (cotton mouth), constipation, urinary retention, and blurry vision. Other side effects include memory impairment and reflex tachycardia.

Other anticholinergic medications such as Propentheline Bromide (Probanthine) and Oxybutynin (Ditropan) may also be used orally. However topical application of anticholinergic medications is usually not successful due to poor absorption by the skin.

Propranolol is a beta-blocker that has generalized anti sympathetic activity. It has been used to treat stress-induced hyperhidrosis, however it's side effects include general tiredness, slow heart rate and low blood pressure.

Herbal medication, biofeedback, acupuncture, and hypnosis have also been used to treat hyperhidrosis. Unfortunately these have limited success in treating hyperhidrosis.


Medical Care: Therapy can be challenging for both the patient and the physician. Both topical and systemic medications have been used. Other treatment options include iontophoresis and botulinum toxin injections.

Topical agents include topical anticholinergics, boric acid, 2-5% tannic acid solutions, resorcinol, potassium permanganate, formaldehyde (which may cause sensitization [Shelley, 1954]), glutaraldehyde, and methenamine. Drysol (20% aluminum chloride hexahydrate in absolute anhydrous ethyl alcohol is usually the most effective topical agent. Drysol should be applied nightly on dry skin with or without occlusion until a positive result is obtained, after which the intervals between applications may be lengthened. To minimize irritation, the remainder of the medication should be washed off when the patient awakes, and the area may be neutralized with the topical application of baking soda (Sato, 1989).
Systemic agents used to treat hyperhidrosis include anticholinergic medications. Anticholinergics such as propantheline bromide, glycopyrrolate, oxybutynin, and benztropine are effective because the preglandular neurotransmitter for sweat secretion is acetylcholine (although the sympathetic nervous system innervates the eccrine sweat glands). The use of anticholinergics may be unappealing because their adverse effect profile includes mydriasis, blurry vision, dry mouth and eyes, difficulty with micturition, and constipation. In addition, other systemic medications, such as sedatives and tranquilizers, indomethacin, and calcium channel blockers, may be beneficial in the treatment of palmoplantar hyperhidrosis.
Iontophoresis was introduced in 1952 and consists of passing a direct current across the skin (Bouman, 1952). The mechanism of action remains under debate. In palmoplantar hyperhidrosis, the daily treatment of each palm or sole for 30 minutes at 15-20 mA with tap water iontophoresis is effective (Sato, 1991). Intact skin can endure 0.2-mA/cm2 galvanic current without negative consequences, and as much as 20-25 mA per palm may be tolerated (Sato, 1991). Numerous agents have been used to induce hypohidrosis, including tap water and anticholinergics; however, treatment with anticholinergic iontophoresis is more effective than tap water iontophoresis (Abell, 1974).
Botulinum toxin injections are effective because of their anticholinergic effects at the neuromuscular junction and in the postganglionic sympathetic cholinergic nerves in the sweat glands.
In palmar hyperhidrosis, 50 subepidermal injections of 2 mouse units per palm (total 100 mouse units per palm) results in anhydrosis lasting 4-12 months (Shelley, 1998). Each injection produces an area of anhydrosis approximately 1.2 cm in diameter. The only adverse effect is mild transient thumb weakness that resolves within 3 weeks.
In a similar study, the effects of sodium chloride solution injections in one palm were compared with botulinum toxin injections in the other palm (Schnider, 1997). Treatment with 120 mouse units of botulinum toxin (injected into 6 sites in the palm) resulted in a 26% reduction in sweat production after 3 and 8 weeks and a 31% reduction after 13 weeks. Noted adverse effects included minor muscle weakness at the toxin-treated sites, which resolved after 2-5 weeks. Injections of botulinum toxin must be repeated at varying intervals to maintain long-term results.
Surgical Care: In addition to pharmacologic therapy, other treatments include surgical sympathectomy, surgical excision of the affected areas, and subcutaneous liposuction. Each modality has been used effectively.

Palmar hyperhidrosis is a benign functional disorder that is a psychological and social handicap (Kumagai, 2005). A survey showed thoracoscopic sympathectomy to be minimally invasive and to improve the patient's quality of life, even if compensatory hyperhidrosis occurs.

Sympathectomy has been used as a permanent effective treatment since 1920. Usually, it is reserved for the final treatment option (Kotzareff, 1920). Sympathectomy involves the surgical destruction of the ganglia responsible for hyperhidrosis.
The second (T2) and third (T3) thoracic ganglia are responsible for palmar hyperhidrosis, the fourth (T4) thoracic ganglia controls axillary hyperhidrosis, and the first (T1) thoracic ganglia controls facial hyperhidrosis.
Two surgical approaches are available: an open approach and a newer endoscopic approach. Recently, the endoscopic approach has become favored because of its improvements in terms of complications, surgical scars, and surgical times. Endoscopic thoracic sympathectomy is an effective treatment for hyperhidrosis; in one study, immediate positive results occurred in 832 (98%) of 850 patients (Drott, 1995). After a 31-month average follow-up, symptoms recurred in 17 patients. Improved quality of life has been described for upper limb hyperhidrosis after treatment with limited endoscopic thoracic sympathetic block at T4 (Panhofer, 2006).
Numerous complications are associated with this endoscopic treatment option; these include compensatory sweating (induction of sweating in previously unaffected areas of the body), gustatory sweating, pneumothorax, intercostal neuralgia, Horner syndrome, recurrence of hyperhidrosis, and the sequelae of general anesthetic use.

Of 850 patients who underwent endoscopic transthoracic sympathectomy, 55% had compensatory sweating (mostly on the trunk), and 36% had gustatory sweating (Drott, 1995). In a similar study of 72 patients who underwent transthoracic endoscopic sympathectomy (T2 or T2 and T3) for palmar hyperhidrosis, the success rate was 93%; compensatory sweating occurred in an overwhelming 99% of patients within 1 month after surgery, and gustatory sweating occurred in 17% (Lai, 1997).

T4 ganglion interruption for palmar hyperhidrosis is an effective approach that can simultaneously minimize the rate of compensatory hyperhidrosis (Chou, 2005). Thus, T4 sympathectomy may be an effective cure. Its rate of compensatory hyperhidrosis appears to be remarkably low compared with T2 sympathetic ganglionic interruption. An effective treatment for such compensatory sweating is the intradermal injection of botulinum toxin (Heckmann, 1998).
Surgical excision of the affected area (identified with iodine starch testing) removes the appropriate sweat glands, thereby eliminating sweating. This technique is particularly useful in axillary hyperhidrosis.
Subcutaneous liposuction is another means of removing the eccrine sweat glands responsible for axillary hyperhidrosis. Compared with classic surgical excision, this modality results in less disruption to the overlying skin, resulting in smaller surgical scars and a diminished area of hair loss (Lillis, 1990).
Consultations: Consult a neurosurgeon if sympathectomy is necessary in severe cases of hyperhidrosis that are refractory to all other treatments.

Answer 2

So..
Hyperhidrosis is a medical condition in which a person sweats excessively and unpredictably. People with hyperhidrosis may sweat even when the temperature is cool or when they are at rest. Sweating helps the body stay cool. In most cases, it is perfectly natural. People sweat more in warm temperatures, when they exercise, or in response to situations that make them nervous, angry, embarrassed, or afraid.
Excessive sweating occurs without such triggers. Persons with hyperhidrosis appear to have overactive sweat glands. The uncontrollable sweating can lead to significant discomfort, both physical and emotional. When excessive sweating affects the hands, feet, and armpits, it is called primary or focal hyperhidrosis. In most cases, no cause can be found. It seems to run in families.
If the sweating occurs as a result of another medical condition, it is called secondary hyperhidrosis. The sweating may be all over the body or it may be in one area.


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Answer 3

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Answer 4

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Answer 5

Excessive sweating in the absence of a high body temperature can certainly be caused by stress or emotional anxiety. It can also be caused by imbalances in your hormonal and nervous systems. But in general, the conventional medical view on hyperhidrosis is that there is no known cause or cure.

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Answer 6

Ashley gave lots of good info.

I've also heard that surgical 'sympathectomy' can be an cure for these kind of symptoms.

Ask your doctor if a consult with a surgeon would be a good idea.

Good luck; that must be hard for a 16 year old to deal with.

Answer 7

Well..im not sure if this could help out but I'm sorry about your daughter's case. Have you gone to a dermatologist? I know also there are procedures that can help out .I have seen a procedure removing the sweat glands of the armpits. But not of the whole body. God bless!

Answer 8

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