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Conservative, non-surgical treatment is often suggested and recommended before considering surgical intervention for primary hyperhidrosis. Non-surgical treatment options include:
Aluminum Chloride (20%) - This is a topical solution that is very similar to the active chemical in an antiperspirant. It is applied directly to the palms of the hands and armpits. These antiperspirants have to be used 3-4 times per week. May cause irritation of skin and chaffing.
Tap water Iontophoresis where the hands and feet are soaked in an electrical solution 3-4 times per week. Can cause irritation and chaffing.
Botulinum Toxin Injections
Recently approved for the treatment of axillary hyperhidrosis. Botulinum toxin or botox is a neurotoxin used for the treatment of torticollis and dystonia to reduce muscle spasms and more recently for the treatment of facial wrinkles. Botox treatments have been found to be effective and been approved recently for use in Axillary HH. The technique entails multiple injections in the armpits after staining the sweat glands with a starch powder. The treatment can be effective; however has to be repeated every 4 to 6 months, as the effect wears off. The injections can be used in the hands, however it is not recommended for repeated injections into the hands as it can cause wasting of the small muscles of the hand, resulting in weakness in the hands. Not all patients achieve the same results with Botox injections and it can be expensive!
Anticholinergic and antidepressant drugs
Anticholinergic drugs (Robinul etc) maybe used with or without certain antidepressant medications. Anticholinergics are usually recommended in patients presenting with more generalized sweating occuring in the trunk, groin, thighs, head etc. The anticholinergic drugs can cause intolerable side effects like dry mouth, dizziness, palpitations etc. and may not be well tolerated in some patients.