It seems that the power of electricity is often an overlooked option in the treatment of palmar and/or plantar hyperhidrosis. While iontophoresis is far from being a new option, it remains one of the most effective treatments. Few clinicals studies corroborate this but they all demonstrate convincing results. One of the more recent studies dates back about a dozen years and showed that more than one hundred (112 to be exact) experienced a greater than 80% reduction in the sweating of their palms. These observations came after 8 treatments and return of symptoms occured on average 35 days after the last treatment.
Pretty good, considering the difficulty associated with treating hyperhidrosis of the palms. Initial treatment is usually administered three times weekly (for example, 20-minute sessions on a monday/wednesday/friday schedule) and can be tapered to once weekly as the condition improves.
Mineral content of water is important for proper conduction of electrical current. A tablespoon of baking soda in each tray usually does the trick. In more resistant cases, the addition of glycopyrrolate or aluminum chloride hexahydrate - AlClHex (ingredients in DryDerm preparations) appears to increase the efficacy of the treatment. In one study, using an AlClHex iontophoresis solution, sweating returns to less than 60% of pre-treatment levels one month after treatment. In other words, AlClHex helps to reduce the frequency of treatments.
Combining iontophoresis with the nighttime use of a high-strength antiperspirant such as DryDerm is also recommended for greater efficacy. This strategy also reduces the frequency of iontophoresis treatments.  
While often overlooked, iontoporesis is a treatment option that deserves trial. It works well, is cost-effective, and relatively safe. Keep in mind that its efficacy can also be 'notched' up with the use of AlClHex or mixed treatment, that is, used in tandem with a high-strength antiperspirant.
As promised, we are sharing some of the data that we have compiled over the last few months from individuals that responded to our Hyperhidrosis Heredity Survey
Most of our responders had either axillary (51%) and/or palmoplantar hyperhidrosis (63%). The fact that responders total more than 100% indicates that some responders have the condition in both regions. Those reporting craniofacial sweating represent just a little over 20%. With the exception of axillary hyperhidrosis, these numbers are similar to the incidence in the general population (see 'Affected Regions' subtitle in our Focal Hyperhidrosis - A Snapshot page). 
Almost 60% report that another family member is also affected (this compares with 44% in a 2007 study - see 'Family History' subtitle). Of these, fathers are cited a little more often (40%), followed by mothers (35%), sisters (35%), and brothers (30%). Grandparents were mentioned by in less than 10% of our responders.
About one third of responders were aware of 'indirect' relatives being afflicted with hyperhidrosis. Of these, aunts and cousins were cited most often (each 55%). Uncles were mentioned in a little less than 20%. 
We should keep in mind that these data may not necessarily scientifically valid but they do corroborate many of the findings in the scientific literature. There is no question that focal hyperhidrosis has a hereditary component. We will update these data as more responses are collected. If you haven't already done so, and would like to participate in any of our surveys, just click on the Focal Hyperidrosis Learning Center link or icon. 
Many thanks for your continued readership and support. Its Summer vacation time and Sweating Matters will be back in early October. 
Stay tuned, as we will be presenting our Hyperhidrosis Heredity Survey results. If you haven't already done so, click the link to participate - responses are kept confidential, anonymous, and presented in aggregate manner only.

In memory of Tess, our beloved family Bedlington Terrier who passed away this Summer. Fourteen years of love and joy. We will miss you but not forget you 'Tessie'.
30 june 2015
Tess loved to nap in special little corners of the backyard.
In my usual quest to find the most current information on focal hyperhidrosis, I came across a medical journal review article* that emphasized the importance of proper treatment administration. I couldn't help but think that some people are probably not get maximum benefit from their topical antiperspirants because of suboptimal use. Improper use is also a principal source of skin irritation which can also lead to poor results.
If you are going to remember anything, keep the following key aspects in mind: 1) aluminum chloride hexahydrate products such as DryDerm should be left on the skin for 6 to 8 hours to be effective; 2) product should be applied to skin that remains dry for that period of time, for example, at nighttime during sleeping hours. Applied to a damp region will affect its efficacy in a negative manner and increase the likelihood of skin irritation. Though it is tempting to apply product in the morning, this is discouraged. The inevitable sweating that occurs during the day will adversely affect product efficacy; 3) the treated region should be washed off in the morning to avoid irritation from product that remains on the skin for an extended period of time; 4) irritation can usually be successfully treated with hydrocortisone 1% cream (available over or behind the counter in pharmacies) for up to 2 weeks. If the region has to be shaved occasionally, wait 24 to 48 hours before reapplying product to avoid possible irritation. See our Treatment DOs and DON'Ts to get the most from your treatment. 

Keep in mind that other treatment options such as Botox or iontophoresis can be complemented by topical products such as DryDerm. Individuals often tend to try different options witout thinking that they can actually be used together for added benefit. For more information about complementary treatment see our Resistant Palmoplantar Hyperihidrosis page.
*Dermatol Clin 32 (2014) 485–490
A study* published a few days ago indicates that several treatment options are quite effective when treating scalp and/or facial hyperhidrosis. The authors of the study looked at data published over the last five decades (48 years to be precise). They reviewed over 800 references and selected close to 30 studies that met their strict inclusion criteria.
Most effective treatments include topical glycopyrrolate, botulinum toxin A injections, oral oxybutynin and surgery. Both glycopyrrolate and botulinum were highly effective (over 96 to 100%) but the latter is often (50 to 100%) associated with forehead muscle side effects. On the other hand, glycopyrrolate side efects are rare. Oxybutynin seems a little less effective (80 to 100%) and has side effects in 76 to 83% of the cases. Sympathectomy (surgery) is quite effective in some cases (70 to 100%) but is often associated with troublesome compensatory sweating in 8 to 95% of cases according to the studies that were reviewed. For this reason, the authors recommend that surgery should be left as an alternative to other treatments if these fail.
*Am J Clin Dermatol, 2015 Jun 9 (epub ahead of print)
If you have ever considered surgery as an option to treat your hyperhidrosis, the following is likely to peak your interest. Sympathectomy is a procedure used to lessen or stop the flow of neural transmission or innervation to a specific region of sweat glands, usually the palmsunderarms, or facial region. This is often performed by either surgically cutting or physically clamping the 'overactive' nerves responsible for the excessive sweatingA recent study* has demonstrated that although cutting seems to provide better results, it is also associated with more compensatory sweating
According to the investigators the 'degree of post-operative sweating was lower in the cutting group....however the compensatory sweating was significantly more severe.' The study was done with almost 300 individuals that underwent sympathectomy for palmar hyperhidrosis. It can be assumed that similar results would be seen in sympathectomy for axillary hyperhidrosis. Results were compiled from questionnaires given to the patients. About one third (92) responded. Unfortunately the actual study results are not available at this point in time given that they have not been published. This information is very recent and was sourced from an 'epub ahead of print' version. We will follow-up once the study is published in the coming weeks.
*Hida K, et al. Clin Auton Res 2015, May 14 (epub ahead of print)
A number of studies have confirmed that primary or focal hyperhidrosis is an inherited condition. To some of us, this may be more obvious, given that a parent is also afflicted. To others, the condition may be present in an aunt, uncle or great grandparent. In some cases, there may not be any indication that the condition exists elsewhere in the family.
A study* of close to 50 individuals suggests that a positive family history is present in about 65% of those with hyperhidrosis. A larger Japanese study** of over 400 individuals indicated that a positive family history exists in 36% of individuals with hyperhidrosis. Of these, close to 60% were parent-child, and in about 20% the association is with siblings. A significant proportion (13%) of these individuals reported an incidence of hyperhidrosis in 3 generations within family.
Our own heredity survey (30 individuals) suggests that about 60% are positive for family history. To date, about 2/3 have cited immediate or direct family links (parents, siblings) compared to 1/3 mentioning aunts, uncles and cousins. A few (10%) reported hyperhidrosis in their grandparents.
Whatever the degree of family involvement in hyperhidrosis, there is no question that it has a strong hereditary component. The gene is present in 5% of the population. Individuals with the gene carry a 25% likelihood of passing along the condition to their offspring. That compares to 1% among those without the gene. In the next few weeks we will be creating a page featuring all the results from our Heredity make sure to come back and visit our Survey Results section.
* Ro, KM et. al. J Vasc Surg, 2002. ** Yamashita, N et. al. J Dermatol, 2009

If you haven't already done so, feel free to participate in our Hyperhidrosis Heredity Survey
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Hyperhidrosis Heridity Survey
Sweaty palms and soles are notoriously difficult to treat. Although DryDerm PP can help it may fall short of expectations in more resistant cases. If you are having trouble with your palms and/or soles, you may want to consider iontophoresis. In fact, you might try both a topical treatment like DryDerm PP and iontophoresis as opposed to one or the other.
Several studies have demonstrated that ordinary tap water iontophoresis usually provides a good degree of relief from symptoms. However, Additional studies have shown that using a solution of aluminum chloride hexahydrate (ACH) or glycopyrrolate (GLY) increases the efficacy of iontophoresis
More specifically, it has been shown that solutions of ACH or GLY provide a longer lasting relief. As a result, fewer treatments are required. These studies are summarized on our Iontophoresis Solutions - Study Results page. Solutions of ACH or GLY are available as concentrated solutions from the Dry Pharmacist - all you do is add a certain amount of water to render them ready-for-use (see our Special Orders page for more info).
If you haven't visited our site in a few weeks you may not be aware of DryDerm G. The Dry Pharmacist introduced this product a few weeks ago in efforts to treat gustatory sweating, a type of hyperhidrosis associated with the ingestion of certain so-called 'trigger' foods. 
Typically the excessive sweating is in the facial region. DryDerm G contains glycopyrrolate and is available in two strengths, that is, 0.5% or 1%. This ingredient has been shown to be very effective is a variety of studies. We created a page that demonstrates glycopyrrolate's activity on sweat glands and how it stops them from producing sweat. 
An international team of researchers has discovered a mutation in a gene that results in a condition called anhydrosis. This condition is at the other end of the ‘sweating spectrum', that is, an inability to sweat which can result in hyperthermia or heatstroke. Although hyperhidrosis is a bothersome and distressing problem, anhydrosis is a potentially lethal condition due to the body’s inability to cool down or self-regulate internal temperature increases.
The researchers came across a family with several members having this disorder. Although their sweat glands appeared normal from an anatomical or structural perspective, their ability to function properly was problematic. After performing an analysis of their genome, the researchers noticed an anomaly in a gene called ITPR2. This gene is responsible for coding or the production of a so-called ‘channel protein’.  These proteins are responsible for the flow of ions (e.g. calcium, potassium, sodium) across membranes - those of cells or organelles within cells. These are ‘smart’ proteins and only allow specific amounts of ions to enter and leave cells. This flow of ions often triggers a cascade of cellular reactions resulting in a specific outcome. In this case, the production of sweat. An alteration in the gene that codes for this protein will result in faulty cellular channels and a sweating disorder such as anhydrosis. A better understanding of how this mutation arises could eventually help treat or prevent this condition.
What is equally interesting is the idea that by inhibiting this channel protein we may be able to inhibit the flow of sweat. One of the hurdles in developing a drug that would inhibit this channel protein is the fact that this type of protein is also found in other tissues. The ideal agent would be one that is specific to the channel proteins found in sweat glands.
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