Consider this: An axillary hyperhidrosis patient reviewing her office-based treatment experience on RealSelf.com gave her treatment a Not Worth It rating. She wrote that she tried Botox (Allergan) and MiraDry (MiraDry) and those treatments worked, but she couldn’t afford treatment maintenance. So, she bought a less expensive over-the-counter option, Certain Dri (Clarion Brands). It works and is affordable, according to her review.
Understanding hyperhidrosis and focusing on what’s practical for patients who want the condition treated are themes of a comprehensive hyperhidrosis review published September 2019 in the Journal of the American Academy of Dermatology (JAAD).
“I found that recent papers focus on the new technology and expensive treatments that majority of our patients cannot afford,” according to review author Jisun Cha, M.D., associate professor of dermatology at Thomas Jefferson University. “This paper focuses on the practical points, for example how to use topical antiperspirants or how to use iontophoresis devices.”
Dr. Cha tells Dermatology Times that she has encountered many hyperhidrosis patients who were discouraged not only by the costs of treatments like botulinum toxin injection or laser therapies, but also because they couldn’t tolerate the pain of injection or simply were afraid of needles. And while patients might know about the more expensive hyperhidrosis treatment options, many are not well informed about the less expensive treatments or how to apply those treatments.
“I wanted to reiterate the basic and practical part of hyperhidrosis treatment that seems to be underestimated by both patients and providers,” Dr. Cha says.
The review addresses disease pathophysiology, diagnosis and treatment, as well as emotional and financial burdens associated with hyperhidrosis.
Hyperhidrosis Types & Diagnostic Pearls
Hyperhidrosis, which dermatologists diagnose when sweating exceeds thermoregulatory needs and causes significant emotional, physical or social issues, affects at least 4.8% of people in the U.S., according to the paper.
About 93% of patients have primary hyperhidrosis, in which they generally have focal and bilateral sweating impacting the axillae, palms, soles and craniofacial areas. The primary type often begins between 14 and 25 years of age and results from neurogenic overactivity, even though patients have normal eccrine sweat glands.
While many think complex autonomic nervous system dysfunction and aberrant central control of emotions are primary hyperhidrosis etiologies, genetics might come into play with primary hyperhidrosis, as 35% to 56% of these patients have a family history, according to the review.
Other patients have secondary hyperhidrosis, with a more generalized and asymmetric distribution resulting from an underlying cause, such as disease or medication. Antidepressants, antibiotics antivirals and hypoglycemic agents are among the drugs that can cause secondary generalized hyperhidrosis. Alcohol, cocaine and heroin use and withdrawal can cause the secondary type, too.
Dr. Cha reports no relevant disclosures.