Therapeutic target
- Reduction of sweating
- Reduction of the formation of odors
Therapy recommendations
- See the following therapy recommendations depending on the form of hyperhidrosis.
- See also under “Further therapy“.
Localized hyperhidrosis
In localized (focal) hyperhidrosis, the following therapeutic attempts can be made:
- Local therapy with antiperspirants such as aluminum chloride hexahydrate (15-25% concentration).
- Axillary hyperhidrosis: intralesional injection of botulinum neurotoxin (BoNT; chemical denervation/interruption of nerve pathways); duration of action: at least 6 months (therapy of choice).
- Hyperhidrosis of palms and soles of feet: Tap water iontopheresis (see below “Further therapy/physical therapy“).
- Systemic use of antihidrotics such as sage (3 x 80 mg dry extract/d), methanthelinium bromide (3 x 50 mg/d), bornaprine hydrochloride (4-8 mg/d).
- Glycopyrolate for gustatory sweating (taste sweating).
- Other drug approaches with anticholinergics such as methanthelinium bromide, tricyclic antidepressants such as amitriptyline or antihypertensives (beta blockers, calcium channel blockers) are recommended by some experts.
Note: Sage as a tea or oil may lower the seizure threshold; therefore, it is not recommended for those prone to cerebral seizures.
Generalized hyperhidrosis
- Therapy should be strictly based on the underlying cause.
- In patients with primary predominantly generalized hyperhidrosis, therapy with oxybutynin (anticholinergic) effectively alleviated symptoms after 6 weeks and improved the quality of life of affected individuals
Axillary bromhidrosis (excessive sweating and an unpleasant odor in the armpit area)
- Intradermal injection of botulinum neurotoxin (BoNT; chemical denervation/interruption of nerve pathways).
- In one study, fifty units of BTX-A were diluted in 2 ml of saline and injected intradermally into each marked point of the axilla; additional injections were applied at twice the dose (100 units/axilla).Results:
- After the first injection, 38 of 62 of the patients (61.3%) experienced no more unpleasant odor for four weeks or longer (median: 24 weeks).
- Of these, 21 received a second treatment. The median duration of effect of this collective was 28 weeks.
- Eight additional subjects received a third injection performed, four even received a fourth treatment (median duration of efficacy: 32 and 36 weeks, respectively).
- The efficacy of the treatment was reported by 53% of the subjects as “very good”, 29% described it as “good”, 16% as “moderate” and only 2% as “weak”; no side effects were reported.
- In one study, fifty units of BTX-A were diluted in 2 ml of saline and injected intradermally into each marked point of the axilla; additional injections were applied at twice the dose (100 units/axilla).Results:
