Once upon a time topical agents were the mainstay of treating sweating disorders. Over the years numerous chemicals have become available and include topical anti cholinergics, boric acid, 2-5% tannic acid solutions, resorcinol, potassium permanganate, formaldehyde (which may cause sensitization, glutaraldehyde and methenamine.
All the above chemicals are applied on to the dry skin at night. It is recommended that the skin be covered with a dry dressing. The results of these drugs are very variable. However, the major reason why all these drugs have fallen out of favor is because of the skin irritation that follows. In addition, the staining of the clothes is irreversible. Long term usage can cause cracking of the skin but without actually decreasing sweating. Maxum is another product on the market with a somewhat higher pH level, causing less irritation. Maxim can be purchased online. All drawbacks taken under consideration, lotions are the first step in attempting alternative methods to surgery. Today, the use of these chemicals has been relegated to the history books.
Aluminum chloride - a strong antiperspirant
If the above general methods do not help control the sweat and if the normal antiperspirants fail, one should try and get a prescription of an antiperspirant that contains aluminum chloride. Aluminum chloride is a 'strong' antiperspirant and is thought to act by blocking the sweat gland ducts. It tends to work best in the armpits. However, it may also work for sweating of the palms and soles. It is not recommended for use on the face because if the eye gets expose, it can cause a very painful irritation.
Several brands of aluminum chloride anti perspirants are available (Driclor, Anhydrol Forte, ZeaSorb, Odaban). Some come in a bottle as roll on applicator, others are in a powder form and others come in a spray. These anti perspirants work best when applied to clean dry skin and should be applied at night (when the sweat glands are less active). For these anti perspirants to work well, one should:
- apply the agent at bed time (sweat glands are less active at night)
- Wash off the agent in the morning
- Avoid shaving the area for at least 24 hrs
- Avoid getting it in the eyes
- do not apply on broken or inflamed skin or redden skin
The agent should be applied every 24-48 hours until the sweat starts to decrease. Once the sweat decreases, the agent can be applied every 1-2 weeks. The response usually takes at least 1-3 weeks to become obvious. Once sweating is under control, the agent should only be applied once every 2-3 weeks.
The problem with aluminum chloride antiperspirants is the severe skin irritation or inflammation. If this occurs and is tolerable, one may continue as it will decrease the sweating. To decrease the side effects of the anti perspirant, one needs to combine it with a topical corticosteroid.
This is an old technique that uses electrical stimulation. It is used mainly to treat sweating of the palms and/or soles and rarely the armpit. Treatment involves putting the affected areas (usually hands and/or feet) into a small container filled with water. A small electrical current is then passed through the water through special electrodes from a nearby machine. It is not painful or dangerous, but may cause a sensation of 'pins and needles' feeling. How it works is unknown but does help block the glands from secreting sweat.
Lontophoresis treatments are done 3-4 times per week and each session lasts about 30 minutes. Very few individuals claim improvement after 6-10 treatment sessions. A break of 2-4 weeks is allowed in between the sessions. Some recommend a maintenance treatment on a weekly basis. If ordinary tap water does not produce any results, a drug called glycopromium bromide is sometimes added to the water. This may improve the rate of success. However, Iontophoresis does not work for everyone and at best works for less than 3% of individuals.
Today Iontophoresis is done in clinics, hospitals and portable devices also allow for home use. Iontophoresis is not recommended if one is pregnant or has a pacemaker, metal clips or pins in the body.
Botulinum toxin injections
In the last decade Botulinum toxin has become an option in the treatment of axillary sweating disorder. The treatment includes injections of Botulinum toxin in the axilla. It acts by blocking the release of secretions from the sweat glands. Rarely it is used to treat sweating around the palms or the face. When used in the hand area, it is not only painful but may temporarily paralyze the small hands of the muscle.
Botulinum is not a cure for sweating and its effects wear off after a period of 4-10 months. Numerous injections (20-50) of the toxin are usually required. The treatments have to be repeated every 6-10 months. After the injections most individuals complain of flu like syndrome, which lasts a few days