Treating Hyperhidrosis In Your Patients This Summer

It is almost summertime and that means the season of perspiration. With 250,000 sweat glands in a pair of feet, many people may suffer from hyperhidrosis. Although excessive sweating occurs more in the summer months, patients with chronic hyperhidrosis typically suffer all year long.

Hyperhidrosis can occur locally in areas such as the axilla region, palms and soles of the feet, or it can occur globally. There are two forms. A person can have a primary genetic, sympathetic cause or a secondary cause due to pathologies such as obesity, a tumor, hyperthyroidism and gout. With excessive sweating, patients are prone to develop problems such as verruca, fungal infections of the skin, onychomycosis and other skin conditions. Most commonly, people with hyperhidrosis are embarrassed by the malodor and seek treatment for the condition due to the humiliation they feel.

Traditional treatments focus on iontophoresis, shoe sprays, powder, skin roll-ons such as antiperspirant and frequent change of moisture-wicking socks. Two treatments that are approved by the Food and Drug Administration (FDA) are the use of botulinum toxin (Botox^®,Allergan) for hyperhidrosis and miraDry^® (Miramar Labs).

Botox is an injection of a neuroinhibitor. Neuromuscular inhibition limits the production and distribution of sweat from the eccrine glands. One injects Botox into the soles of the foot. Traditionally, I have used a posterior tibial nerve block or patients can tolerate the procedure with an ethyl chloride spray. I use a 30-gauge needle in a 1-mL syringe to deliver the Botox on a 45-degree angle to the dermis. Clinicians can place the medication approximately every 1 to 1.5 cm apart in a grid-like fashion. One would mix the Botox by adding 1 mL of saline into 25 units of Botox. Use approximately 100 to 150 units per foot. After injection, over half of the patients will have mild erythema and half of the patients can do an activity immediately following treatment. It takes an average of three to five days for the Botox injections to become effective and the effects last approximately six months.

MiraDry is a newer modality that one applies to the axillary region of the arm. It uses heat energy to damage the eccrine glands. There are few reports on its use in the foot but I suspect miraDry may be a viable option in the future in the lower extremity.

Other treatments for hyperhidrosis include sympathetic nerve blocks, which a neurologist or pain management specialist can perform.