Which treatment is most applicable depends on where the sweating is occurring. Without any treatment there are still various way to try and reduce unwanted sweating. First avoid situations which may trigger sweating, for example stressful situations or hot places. Wear absorbent under layers to help dampen the effects. Have a change of clothes handy during the day, and if feet are where the main problem lies, buy shoes with good air flow.
Generalized hyperhidrosis is too widespread to treat with lotions, injections or surgery. But, some medicines taken as tablets can reduce the sweating. The most reliable ones are those that block the chemical signal between the nerve and sweat gland (ant cholinergic drugs). However these drugs also affect other body functions, which could result in effects including a dry mouth, blurred vision, tummy cramps, constipation, or difficulty in passing urine. They also may be harmful for people with glaucoma. To start with a small dose is used at first and the it is gradually increased.
The most effective anti perspirant appears to be aluminum chloride (20-25%) in 70-90% alcohol, applied in the evening 2-3 times/week. Generally, this treatment is sufficient in cases with light to moderate hyperhidrosis is although it must be repeated regularly. Note that a treatment that reduces sweating is called an antiperspirant, which is not the same as a deodorant, which reduces odor, generally via an antibacterial effect. Sides effects include sore red skin, which can be reduced by making sure that the skin is completely dry and then applying the antiperspirant, or by using hydrocortisone cream. Antiperspirants are most useful underarm but also may be somewhat useful on hands and feet also.
Sweat gland suction
This is for axillary hyperhidrosis (under arm) only. It is a recent technique which has been adapted from liposuction. On an out-patient basis with only local anesthesia, the sweat glands are permanently removed. The sweat glands and armpits are first softened and anaesthetized with a special solution. After a short period, the sweat glands can then be removed in a manner similar to liposuction. Small incisions are made above and under the armpits to remove the sweat glands through quick suction. The whole procedure takes between 60 to 90 minutes.
This hyperhidrosis treatment is most effective for sweating of the hands and the feet. The hands or feet are placed into water, and then a gentle current of electricity (15-18A via a D/C generator) is passed through it. The electricity is gradually increased until the patient feels a light tingling sensation. The therapy lasts about 10-20 minutes. It requires constant reapplication thereafter otherwise sweating will reoccur. It was originally developed to get glycopyrrolate into the skin. Many patients who suffer from light to moderate hyperhidrosis, are content with this method, however the treatment is time consuming and can cause discomfort. It is very difficult to apply to the armpit region and impossible in other areas. Equipment for home use can be bought relatively inexpensively. Also some hospital may offer a trial to see if the treatment has an effect. More on Iontophoresis can be found here.
Another popular hyperhidrosis treatment is Botulinum toxin type A (Botox). It was approved by the FDA in 2004 for the treatment of severe underarm sweating, a condition called primary axillary hyperhidrosis. Botox is one of the most lethal poisons known, as it interferes with the effect of the transmitter acetylcholine at the synapses, however in low doses it can reduce the transition of impulses and thus sweating activity. The procedure is as follows; small doses of purified Botulinum toxin injected into the underarm these temporarily block the nerves that stimulate sweating. The effect usually lasts between 2 and 6 months, although some patients may continue to benefit for 12 months. The treatment must then be repeated to continue suppression of the sweating. Side effects of the injections could include injection-site pain and flu-like symptoms, mild but temporary weakness and intense pain. Also it is a costly treatment, especially given that it must be redone continuously. Botox is most commonly used for underarm sweating, and it is not suitable for large areas. Botulinum toxin is not so used in the palms and soles because it can cause temporary weakness of the hand and foot muscles, and the procedure itself can be painful (though this can be alleviated somewhat by using anesthetic creams or injections.
Endoscopic Thoracic Sympathectomy (ETS)
Endoscopic Thoracic Sympathectomy is a hyperhidrosis treatment which involves surgery, what happens is that the nerves are cut, these are the nerves which send signals to the sweat glands to start sweating. It carries significant risks. With this procedure it is only possible to cut the nerve nodes responsible for the sweat glands of the hands and face. The procedure is as follows; the patient is placed under total anesthetic, the surgeon makes a few cuts under the arm, the lung of the patient is collapsed. An endoscope (tiny camera) is inserted so that the surgeon can see where the correct nerve is. The nerve is then removed and the lug is restored, the identical procedure is then done on the other side, the surgery generally will take about 30 minutes. Sides effects include; sweating may be increased in other locations to compensate for the signals not being sent, inability to raise the heart rate when working out physically, inability to control body temperature, very dry hands or feet. Also in 2003 ETS was banned in its birthplace, Sweden, due to overwhelming complaints by disabled patients. In 2006 FinOHTA, the Finish Office for Health Technology Assessment, showed in a review that there were strong indications of side effects as a result of the surgery.
Anti cholinergic drug glycopyrrolate
These will generally have too many side-effects to be useful against hyperhidrosis. In a few cases of someone who suffers from a lot of sweating on the trunk and not extremities, a low does of the drug may alleviate the symptoms without triggering the side-effects. Also solutions of the drug may reduce sweating in localized areas. It is most likely to be effective for excessive sweating of the scalp and forehead.
This is potentially useful with sweating on the soles of the feet. As formalin solution hardens the skin and may block the passage from the sweat glands to the surface of the skin