Treatment of excessive sweating of the hands and feet with iontophoresis has been practiced since the 1940s. It is particularly useful for people who’ve tried prescription or clinical strength antiperspirants, but find that they need a stronger treatment. For people with hyperhidrosis of the hands and/or feet, iontophoresis treatments typically result in dramatically decreased sweating with a very high success rate—over 80%, according to the American Academy of Dermatology. (Treating underarm hyperhidrosis with iontophoresis is not typically recommended, although people can have success with it.)
Iontophoresis uses water to conduct a mild electrical current through the skin’s surface. While it’s not entirely understood how or why iontophoresis works, it is thought that the electric current and mineral particles in the water act together to microscopically thicken the outer layer of the skin, thereby blocking the flow of sweat to the skin’s surface. Once this sweat output is blocked or interrupted, sweat production in the treated areas stops.
Iontophoresis has no significant or serious side effects and the drying results do not decrease in effectiveness with long-term use.
Patients can purchase iontophoresis devices for in-home use and they can sometimes be found at doctors’ offices. For mild to moderate hyperhidrosis, the battery-operated Drionic device may suffice
Underarm surgery techniques include: excision, curettage, liposuction, and laser. During excision, sweat glands may be cut out. Similarly, during curettage they may be scraped out. During liposuction they may be removed by suction. Using lasers, tissue containing sweat glands is liquefied. Combinations of curettage and central excision, or of curettage and liposuction may be used, as well as combinations of liposuction and laser treatments. Dermatologists often have good results with these techniques. Each of these procedures can be done under local anesthesia (meaning that the patient is not completely “out”) and in an office setting (as opposed to in a hospital setting).
All of the techniques mentioned above have the same goal: to remove or injure the sweat glands so that they can no longer produce perspiration. Sweat glands are located just beneath the skin (where the skin and the underlying fat meet) and are thus accessible for these types of interventions. In the underarms, the sweat glands are also fairly localized, making surgery a viable option. For a number of reasons (including the dispersal of sweat glands and scarring) local surgeries are not done for palmar hyperhidrosis (excessive hand sweating), plantar hyperhidrosis (excessive sweating of the feet), or facial sweating. Other treatments such as iontophoresis and Botox are better choices for these non-armpit body areas.
During liposuction, a physician will use a small tube to suck out the superficial layer of fat in the armpit where the sweat glands are. During curettage, a special surgical tool with a circular loop on the end is used along the skin’s under-surface to scrape out as many of the sweat glands as possible, or to at least damage them enough so that they no longer work. During suction-curettage the liposuction tube and the curettage scraping method are both used. It’s important to note that excision, indicating the complete removal of underarm tissue containing sweat glands, is NO LONGER RECOMMENDED because heavy scarring can cause serious range of motion problems – even to the point where a person may not be able to move his or her shoulder normally.
A newer liposuction technique is showing promise for treatment of underarm hyperhidrosis. In this technique, liposuction is combined with the use of laser to liquefy the tissue containing the sweat glands. The laser’s energy is applied directly to cells (including the cells of the sweat glands), causing them to rupture so that the body can drain them away and/or liposuction can remove the damaged cells.
One of the benefits of local surgery for excessive sweating is that for whatever glands you injure or remove, there is often a permanent result – the affected glands will not produce any more sweat. One of the difficulties is that sweat glands are too small to be seen, even with surgical instruments, so even the most experienced dermatologist is going in “blind.” It is difficult for physicians to know how many sweat glands they are removing or damaging and therefore the results can be highly variable.
Axillary surgery can be performed in a physician’s office under local anesthesia. Recovery is usually a couple of days although patients may feel sore for up to a week and need to limit their arm activity (sports, lifting above their heads, etc.) during that time. If sweat reduction has not been sufficient, it is also possible to repeat a procedure or to use Botox or antiperspirants to control sweating from remaining sweat glands. Compensatory sweating has not been associated with local surgery. As with any surgery, there are potential complications such as infection. There also may be bruising, swelling, loss of sensation in the underarms, and scarring depending upon the size and number of incisions that the physician uses.
Health insurance organizations often do not recognize local surgeries as a treatment for hyperhidrosis and so will usually not pay for it. Botox, on the other hand, is approved by the U.S. FDA for the treatment of axillary hyperhidrosis so it’s much more likely to be covered by insurance. Often, patients who want an axillary surgery and are good candidates for it have to pay for it themselves. It may also be difficult to find a dermatologist who is experienced in sweating-related surgeries for the underarms. These are advanced techniques. So if you think this is something that may be right for you, do some research to find the right dermatologist to perform the surgery.
People with excessive sweating live with a variety of day-to-day challenges: personal and professional limitations, ongoing discomfort, looming embarrassment, to name just a few. Hyperhidrosis sufferers know that this one thing impacts everything they do (or can’t do); it’s an ever-present worry.
Thankfully, we are seeing great improvements in hyperhidrosis treatment and in the understanding of this under-acknowledged condition. Yet far too often we hear from hyperhidrosis patients about their difficult and often irreversible side effects caused by endoscopic thoracic sympathectomy (ETS) surgery. Some have even lost their lives.
After all other treatments have been tried, adjusted for individual circumstances, and still found to be ineffective, surgical treatment for excessive sweating may be an option considered by your physician. There are a few different types of surgery that may used to treat hyperhidrosis. The most invasive of these is endoscopic thoracic sympathectomy (ETS). ETS is considered a last resort because it frequently causes serious, irreversible compensatory sweating (excessive sweating on large areas of the body or all over) as well as other dibilitating effects such as extreme hypotension, arrhythmia, and heat intolerance. In fact, most physicians do not recommend ETS surgery because of the serious negative side effects of the procedure.
During ETS surgery, surgeons attempt to interrupt the transmission of nerve signals from the spinal column to the sweat glands and to thus prevent these nerve signals from “turning on” the sweat glands.
The procedure is performed with the patient under general anesthesia. A miniature camera is inserted into the chest under the armpit. A lung is temporarily collapsed so the surgeons can cut or otherwise destroy the nerve paths associated with the overactive sweat glands. This procedure is permanent; there have been no successful reversal procedures reported.
After the surgeon completes this procedure on one side of the body, he/she performs the same procedure on the other side. ETS is most often used to treat severely sweaty palms, sometimes the combination of sweaty palms and sweaty underarms, and rarely facial flushing and sweating, but it is major surgery (even though it’s called ‘minimally invasive’) with significant risks, and limited success.
A recent story in a British newspaper described the case of a young woman, 27-year-old Louise Field, who became brain damaged after suffering from a lack of oxygen when her lung was accidentally punctured during ETS surgery to control her palmar hyperhidrosis. With no chance of recovery, her parents Patricia and Phillip Green made the heartbreaking decision to turn off Louise’s life support machine two days after the procedure.
Louise Field’s unfortunate death is an extreme case, with clear indications of negligence on the part of her medical team, but it serves as a cautionary tale for those who are considering ETS for their excessive palmar sweating. Because ETS surgery has several serious side effects, and because its results are largely irreversible, many experts consider it an option of last resort.
The biggest drawback to this surgery is that, while ETS may be effective in reducing or eliminating the sweat in the targeted area, almost all patients experience some degree of compensatory sweating in a different part of the body.
Compensatory sweating is excessive sweating that occurs on the back, chest, abdomen, legs, face, and/or buttocks as a result of ETS surgery. It can be equally or even more extreme than the original sweating problem. In a study involving 121 patients at the Medical City Hospital of Dallas, Texas, compensatory sweating occurred in more than 80% of the patients undergoing ETS. Similarly, in a Danish study conducted at the Aarhus University Hospital, 90% of the patients undergoing ETS for underarm sweating, reported compensatory sweating, half of whom were forced to change their clothes during the day because of it.