Alternatives to Surgery

In the past, some insurance companies have demanded that patients try BOTOX® Cosmetic (manufactured by Allergan – Irvine, CA) as treatment for Hyperhidrosis before resorting to a surgical procedure known as endoscopic thoracic sympathectomy (ETS)

Although the FDA has approved the use of BOTOX® Cosmetic for axillary sweating or excessive sweating under the arms, it has not been approved for the treatment of sweaty palms or feet (Hyperhidrosis).

It is somewhat concerning to us that insurance companies demand that BOTOX® Cosmetic be used for the treatment of sweaty hands and feet without the proper scientific knowledge of hyperhidrosis. In cases that BOTOX® Cosmetic is used for treatment of any form of Hyperhidrosis, it represents a temporary solution.

In some cases, the use of BOTOX® Cosmetic to treat Palmar Hyperhidrosis may be painful. There are methods for avoiding this pain, such as regional or general anesthesia. Therefore, patients should arrange for the BOTOX® Cosmetic treatment to be administered by an appropriate licensed physician. Since the treatment is temporary, numerous injections will be required.
Millions of people receive BOTOX® Cosmetic injections for various purposes without any side effects. However, BOTOX® Cosmetic is officially classified as a toxin. Based on this, and the factors above, it can be argued that it is not an ideal treatment.

For years, physicians have treated hyperhidrosis with a group of medications that were also used to treat peptic ulcers. These medications work by inhibiting a certain neurotransmitter (a chemical substance) that also interferes with receptors that play a role in the production of sweat.

The name of this neurotransmitter is acetylcholine. With these types of oral medications, such as Robinul, Ditropan, and Propantheline, success is very limited. Some patients discontinue use due to side effects such as dry mouth and blurry vision. Recently a medical paper from Brazil reported initial success with Ditropan, which is an anticholinergic agent. The final analysis is yet to be determined. Due to the fact that these types of medications can lose effectiveness over time, patients may increase doses, which may result in more severe side effects. Proceed with caution and discuss with your prescribing physician before increasing dosage of any medication.

Despite these concerns, we believe that this drug should be offered as an initial step in the treatment of excessive hand sweating. After proper treatment, or any other conservative measure, does not provide results, then surgical options may be considered.

In our experience, there are some patients who will report benefits from Ditropan, which is another anticholinergic agent. As long as the patient reports improvement without any side effects like blurry vision, dry mouth, or memory loss, they can continue using Ditropan.

If the side effects are unbearable, then the medication should be discontinued (after speaking your medical provider), and we suggest surgery should be considered. Similarly, if one of the anticholinergic agents shows positive results, but must be stopped as a result of negative side effects, other similar treatments can be considered instead.

Treatment for hyperhidrosis with oral-systemic agents has shown that many patients experience negative side effects. As a result, many do not pursue this option as a long-term solution.
Other systemic agents have been used for hyperhidrosis as well. These include amitriptyline, clonazepam, beta blockers, calcium channel blockers, and indomethacin. These were utilized before the 1990’s for patients with generalized hyperhidrosis.

A variety of case studies have been published showing benefits of certain oral medications. For example, clonidine has been used for the treatment of cranio facial hyperhidrosis. There are also reports that tested oxybutinin for the treatment of severe upper body sweating. Speak with your dermatologist or healthcare provider to learn more and determine if right for your medical situation.

Nearly all the studies that tested oral medications were conducted after topical treatment like iontophoresis and even BOTOX® Cosmetic did not produce results. The success rate was extremely low.

Drionic (manufactured by General Medical Co. – Los Angeles, CA) is an electric machine that uses iontophoresis as a means of slowing sweat production. The hands are placed in a tub-like container full of water as weak electric currents pass through the liquid. It requires steady use: at least three to five times a week. Success is possible, but limited, is our understanding based on reports.

There are reported cases and clinical trials which used x-ray guided injections of absolute alcohol to achieve the same sympathectomy effect that surgical methods provide. Even though initial success was reported, the long-term data is not as promising as the initial findings.

There is an inherent risk that the injected materials can move beyond the point where they were administered, resulting in collateral damage. It is also true that in cases of chemical lumbar sympathectomy, done for plantar hyperhidrosis, that the effect was temporary.

All of the above methods have been tried by some patients. As of yet, no wide-spread success has been noted when using these alternative methods of treatment.

Some circulating personal opinions talk about using a combination of conservative treatment methods to treat hyperhidrosis. In this situation people were adding anticholinergic medications to the liquid used in the iontophoresis machine or using oral and topical lotions at the same time. Sufficient study is still required to measure the potential success of this methodology. Even so, it may be considered as an option on a patient-by-patient basis.

Patients who suffer from hyperhidrosis are looking for any medical solutions that might solve their sweating problem. Unfortunately, due to a lack of knowledge among some physicians, patients may be labeled as suffering from mental or behavioral disorders. Those patients are sometimes put on psychiatric/psychological medications which offer little to no help at all. One problem with these types of medication, is the fact that they can create a possible chemical dependency.

These alternative treatments are those known to us and our opinions of these treatments based on our experiences with patients and studies that are available. All treatment options should be discussed with your healthcare provider prior to undertaking. Feel free to contact our office if you have questions!