Summary of treatment options available

Post Reply
Myskindr
Posts: 1
Joined: Sat May 17, 2014 4:31 pm

Summary of treatment options available

Post by Myskindr »

Hi all- I am currently attending the 2014 annual college of Derm meeting held in Melbourne and There was a presentation on the first day. Here is a summary of treatments available for those with HH and hopefully those who have HH will find it useful. Please note this is a summary of my notes and the comments are my opinion based on my personal experience treating this condition.

1. Natural - sufficient fluid replacement - excessive water intake can result in low blood sodium levels which can result in nausea, headaches, muscle spasm and other potentially dangerous side effects so please be careful with excessive water replacement
2. Topical- the most common topical product recommended are usually a whole host of antiperspirants which can be purchased over the counter. The benefits can be variable and unfortunately it is a case of trial and error for most patients. In Australia Drichlor is commonly recommended and contains aluminium chloride- many who apply it underarms (Axilla) find it irritating and I would suggest decreasing the freq of application to 2-3times each week and apply to dry skin. On the palms and soles it is reasonably helpful and fortunately irritation is less of a problem.
Glycopyrolate lotion - in different concentrations. This is a reasonable alternative to antiperspirants but will need a script and compounded by a pharmacist. I have personally never used this so can't comment further.
In the past formalin and gluteraldehyde were used but very uncommonly now due to the risk of developing allergic dermatitis.
3. Iontophoresis - most of my patients have purchased their machines online and generally have reasonable results using tap water alone. The improvement duration is variable as with any treatment but when it works well for some patients weekly maintenance is usually required.
4. Tablets- as mentioned in other parts of this forum Ditropan or propantheline- the reason why it is effective is the anticholinergic activity of both drugs but it is the same reason which results in the side effects. The most common is dry mouth. These drugs are usually short acting and it is the side effects which limits a higher dose.
5. Botulinum toxin injections- works well in 98% of patients. There are a small percentage who do not respond at all. It involves multiple injections and the benefits last between 4 months to over a year (minority). In the axilla ( armpit) Topical anaesthetic is useful to help the sting of the injections. On the palms- I usually use ice for pain relief or some doctors will use a nerve block. For reasons only known to medicare Australia - a rebate is available for the toxin injected ( by registered dermatologists and some other specialists). for HH of the axilla but not if you sweat excessively elsewhere.
6. Surgery - this is well covered in this forum. In the old days axilla vault excision was used but no longer due to the scars and also some would continue to sweat. Most patients who fail the above may consider transthoraci sympathectomy or liposuction has also been used. I don't know what the success or complications are for liposuction but am aware it is an option.

Thank you for reading

superyou
Posts: 68
Joined: Tue May 30, 2006 8:03 am

Re: Summary of treatment options available

Post by superyou »

I was not aware of a glycopyrolate lotion. This seems like it would be a good option. I once tried "Secure Wipes" which are cotton pads soaked with glycopyrolate. I found them to be effective but they are expensive.

pinker1
Posts: 14
Joined: Wed May 28, 2014 7:53 am

Re: Summary of treatment options available

Post by pinker1 »

I've tried Glycopyrrolate cream before, up to 1% I think. It wasn't very effective but I was using it on my hands and feet which are difficult to treat.

Post Reply