Hyperhidrosis patients may not have to sweat it out

The words “don’t sweat it” offer little encouragement to people who have been diagnosed with hyperhidrosis. Nearly 5% of the population suffers from a diminished quality of life because of this excessive sweating condition.

Maral Kibarian Skelsey, MD.

During the AAD Summer Meeting session Sweat Matters (U014), Maral Kibarian Skelsey, MD, director of the Mohs Surgery Unit and a clinical associate professor at Georgetown University, explained the emotional toll the condition takes on patients.

“Hyperhidrosis can affect almost every aspect of a person’s life. It can have an impact on the choice of a profession and the ability to be promoted; it affects relationships and the quality of social relationships. Some people are reluctant to date because of it,” Dr. Kibarian Skelsey said. “It affects which sports and other leisure activities someone might choose. Children with hyperhidrosis may avoid school. Studies show that 85% of those affected report being embarrassed and 71% report anxiety. Depression, anxiety, and attention deficit disorder are all increased in those with hyperhidrosis.”

What causes it?

The majority of hyperhidrosis cases have no known cause, although there is often a hereditary component, Dr. Kibarian Skelsey said. Also, the condition is sometimes the result of a medical condition or a medicine or food supplement that a person consumes.

Dr. Kibarian Skelsey urged dermatologists to be sensitive to the topic and consider the diagnosis. Unfortunately, she said many patients are embarrassed and unlikely to bring it up on their own.

What dermatologists can do

Physicians can improve patients’ quality of life by offering treatment tailored to the patient’s age, location of hyperhidrosis, and willingness to tolerate a particular side effect profile. Topical treatments include prescription strength antiperspirants, systemics, and topical anticholinergics (which now come in wipes), iontophoresis, botulinum toxin injections, microwave technology, and surgery to remove sweat glands.

Dermatologists must also be mindful of managing the side effects of the various treatments, she said.

“Everything has potential side effects. These can run the gamut from urinary retention, constipation with anticholinergics to muscle weakness with Botox to compensatory hyperhidrosis and scarring with surgery,” she said. “Individualize the treatment for each patient and titrate to the response using the lowest dose. Counsel patients in advance to offset some of the anti-cholinergic side effects. Physicians who carefully review with patients how to use the treatments, such as the glycopyrrolate cloths, can mitigate the potential for side effects.”

Encourage conversation

The best advice Dr. Kibarian Skelsey offered dermatologists was to talk to patients about the condition and the effect on their lives.

“Many don’t realize that there are safe and effective treatments for hyperhidrosis. Almost half the patients with hyperhidrosis wait years before speaking to a health care provider about the problem,” she said.