Hyperhidrosis occurs when overactive sweat glands release a volume of sweat that is significantly more than the body’s normal requirement. It is often disruptive to all aspects of a person’s life, and may affect everything from career choices and recreational activities to relationships, emotional well-being, and self-confidence. Visit our Brisbane clinics today to be sweat-free!
Treatments for Excessive Sweating
Treatments are under Medicare
Antiperspirants are 1st line
Hyperhidrosis is classified as a medical condition & not cosmetic, hence why some treatments are under Medicare. Hyperhidrosis is where profuse sweating occurs beyond what is necessary to cool the body. This debilitating condition affects approximately 2 to 5 percent of the population & can lead to anxiety, embarrassment & social isolation.
Did you know that antiperspirants can be effective in mild cases of excessive underarm sweating? The best types are ones that contain aluminum. The higher the concentration of aluminum chloride, the better the results, at the expense of skin irritation.
Anti-sweat injections are the most predictable way to reduce sweating
How do I know if Medicare will subsidize my sweat problems?
This medical treatment is partially covered by Medicare. It involves injections with a very fine needle placed just under the skin’s surface. Injections function by blocking the chemical in the body that triggers the action of sweat glands. It is effective in 96% of cases, & on average last 6-7 months. Up to three sessions are subsidized in a 12-month period.
Severe sweating is defined as sweating that impacts your life. This means if hyperhidrosis limits your clothes choices & causes embarrassment either at work or socially. If so, you may qualify for a Medicare rebate, providing antiperspirants are not effective.
The most effective way to stop excessive underarm is anti-sweat injections. This treatment is effective in over 98% of cases & is covered by Medicare. The procedure takes less than a minute to perform & often lasts beyond 6 months.
Our dermatologists have over two decades of clinical expertise in the field of hyperhidrosis treatments. Our dermatologists were the first to use treatments such as miraDry & iontophoresis. We have been using anti-sweat injections for the past 22 years.
We can manage all forms of hyperhidrosis including axillary, palmar, plantar, compensatory & facial sweating.
Primary HH is due to genetics as it frequently runs in families (not all cases). It starts around puberty & persists throughout adult life. It affects 2-5% of the population & presents as-
- Sweaty underarms
- Sweaty hands
- Sweaty feet
- Facial & scalp sweating
This condition is considered medical, even though cosmetic clinics advertise treatments. It causes significant impairment in the quality of life, confidence & relationships.
Being a medical problem, some cases are covered under Medicare. *
Secondary HH is less common. It is due to drugs, stress, anxiety & a whole lot of other medical problems including tumours, infections & neurological problems. A dermatologist can tell the difference.
Here is the algorithm. It is what most dermatologists follow.
- First line is aluminium chloride antiperspirants. See the relevant section on how to use it properly.
- Second line is glycopyrrolate wipes or creams
- Third line is iontophoresis with tap water. You can add salt if you live in Brisbane as the tap water here can vary with ion concentrations.
- Fourth line is iontophoresis with glycopyrrolate
- Fifth line is anti-wrinkle. It works, it’s expensive, it lasts 3-5 months. It’s not on Medicare for the hands, but it is for sweaty armpits.
- Sixty line is ETS surgery
Tablets can be used intermittently for relief or breaks. You can obtain these through your GP.
Pulse current or PS is more comfortable than direct current, but both are equal in efficacy.
Tap water iontophoresis can be effective in 30% of patients. Brisbane water is not ion rich, so adding a teaspoon of salt can make this treatment more effective.
- Glycopyrrolate iontophoresis can be effective in up to 80% of patients
- This process needs to be repeated every 3-14 days- yes variability is marked.
- Each treatment session takes between 8-20 minutes, depending on if hands and or feet are treated
Side effects are rare, but include temporary dry mouth and blurred vision
Using a good unit such as the Idromed 5 PS will give you EXACT parameters so that future treatments can be replicated.This treatment is extremely variable. Some patients get over 2 weeks relief with one 10-minute treatment, others only 2-3 days.
We advise a trial of the Glyco- Ionto before embarking on purchasing a machine.
We used to perform iontophoresis on a daily basis for up to a dozen patients a day. The problem is that this procedure does not have a Medicare rebate, hence cost for the patients can be prohibitive.
Victoria has a special HH unit in a public hospital, hopefully Queensland will follow in the next few years. Our dermatologists can guide you as to who to see.
Very. But you cannot have this procedure if you are pregnant or if you have any metal in your body (plates, pacemakers etc). Side effects include-
- Over dry hands with eczema (easy to fix with moisturizers).
- Transient skin irritation.
- Anticholinergic side effects- dry mouth, blurred vision etc…Easily titrated with subsequent treatment.
Yes, but it is awkward as you need to apply pads to the area. This gets cumbersome. Go to sweathelp.org & have a look at their treatment protocols. Most devices including the Idromed 5, Dermadry, & Fisher brands will have pad adaptors.
Iontophoresis can be done with water, glycopyrrolate or salt water in the underarm area. As a guide, 20-25% of patients respond, with remission times of 1-4 days. anti-wrinkle iontophoresis gives longer results, but there is no Medicare claim of this procedure. anti-wrinkle MUST be injected into the underarms as per Medicare guidelines.
There are only two brands that public hospitals use- Fischer MD2 units and the Idromed 5 PS. We prefer the Idromed because it is more user friendly and delivers pulse current. PS or pulse current delivers current that is ‘gentler’, so children (and adults) do not feel the current or shock, compared to traditional direct current.
The downside with Idromed is the reliability issues, even though it is made in Germany, one in three units fail at the 6–18-month mark. They do offer a limited warranty.
You can try creams & lotions for all areas of sweating, including the underarm, hands, feet, face & compensatory. Dermatologists can compound various topicals with anticholinergics, the most common is glycopyrrolate. Concentrations range from 0.5 to 3%. The higher the concentration, the better it works, the higher the side effect profile.
Creams & lotions are best for compensatory HH or as a facial wipe for foreheads, back of neck etc. They can work for excessive underarm sweating; however the efficacy rate is about 10%.
Glycopyrrolate absorption can lead to side effects including dry mouth, dizziness, drowsiness, constipation, urinary retention, & dry eyes. If you keep the surface area to 2-3 palm sizes it will be fine.
Glycopyrrolate are highly specialised in their formulation, in addition most patients will require a customised concentration to obtain the best results, whilst minimising side effects. Contact MySkin Pharmacy in Taringa for more information.
You will require a prescription from a doctor or nurse practitioner, you do not need to see a dermatologist for this prescription. Ask them to write: ‘Glycopyrrolate 1% in lotion base, apply to the sweat area in the evening before bed.’ Maximal surface area of three palm sizes.
Yes, in some cases facial wipes that contain 1% glycopyrrolate can be effective. DryDerm is a Canadian brand. Online pharmacies in Canada that can supply off label compounded solutions. Just Google.
Tablets can work for all types of HH, including excessive underarm sweating. These tablets are universally associated with side effects, so start slow. Tablets include anticholinergic agent & oxybutynin. These are usually taken in rotational therapy, or can be integrated into your anti-wrinkle injections for underarm sweating.
Learn more (link to tablets for sweating in the sweating section)
Injections with anti-wrinkle is the treatment of choice for axillary HH or underarm sweating. We have performed just over 8,000 cases over the past 2 decades. This treatment is partially covered by Medicare; however you must trial 20% aluminium chloride antiperspirants first. If you fail treatment or if you have skin irritation, you will qualify for injections. Injections must be done by a dermatologist & not a cosmetic GP or a nurse.
anti-wrinkle works by blocking the nerves that stimulate the eccrine or sweat glands to produce sweat. Though it works in all sweat gland areas, it is only subsided by Medicare for the hands.
For excessive underarm sweating, side effects are extremely rare. They include-
- Bruising of the injected area
- Tiny bumps that may last 12-48 hours
There are only a handful of compensatory HH cases reported in the literature. It is transient & mild. We have only seen one case in over 8,000 procedures over the past 22 years. It is that rare.
Injections are not performed if you are pregnant, (OK if breastfeeding), have an allergy to this medication, or have certain neurological conditions. Your treating dermatologist will screen you prior to treatments.
Recovery for hyperhidrosis treatment is fast, because there are no incisions, no anaesthesia and no scarring. You will be able to go back to work the same day as your procedure.
Treating sweaty hands and feet is difficult, and there is no easy solution. The most successful treatment is called glycopyrrolate Iontophoresis using a reliable iontophoresis machine and a consistent glycopyrrolate solution.
Glyco – ionto uses a solution that you soak your hand and or feet in. A current draws the glycopyrrolate solution (this is an anti-sweating solution that stops your sweat glands from producing sweat) into the eccrine units of your hands- feet. Here are some facts on Iontophoresis- Direct or Pulse current can be used to deliver ions to the eccrine or sweat glands.
Sweat reduction injections are great, however there is one prohibitive fact that limits its use – the costs. Unlike treating sweaty underarms where there is a Medicare and PBS item rebate (patients only pay $460 for the treatment),
anti-wrinkle for hands and feet are NOT covered under Medicare. Treating both hands cost $2500 and may only last 3-4 months. Pain is not an issue, as we always use a super strong gel together with nerve blocks and ice. Cost is the rate limiting fact.
This leaves us with surgery- surgery can be very effective in treating palmar HH or sweaty hands. The success rate is up to 95%, however there is a catch. More than 50% of patients can develop compensatory HH or sweating elsewhere. This is unpredictable and can range from mild to severe. This treatment is the very last resort.
This can only be used for underarm treatments, and not sweaty hands – feet. miraDry 2 has been in the works of development for the past 2 years. Rumour has it that it may treat hands & feet.
As part of the Medicare process to determine if you qualify for anti-wrinkle injections to the underarms, we need to exclude drug induced causes. They include- antidepressants, lithium, dexies, & others.
In many cases, drugs are taken to reduce anxiety secondary to sweating in the first place. We can screen this, so don’t stress.
The most reliable treatment is with anti-wrinkle injections. The amount used will vary according to the sites & surface area. Here are some quick facts-
- Takes 3-5 minutes to perform
- Works in 7-14 days
- Can only be used on the scalp, neck, forehead
- Last 3-6+ months
- Not subsided by Medicare (only underarms)
- Cost between $490 to $1500 per treatment
Other treatment options include glycopyrrolate wipes (see below) or lotions. They can be effective in 25-40% of cases. These are compounded by pharmacies.