My upfront advice: Please do your homework and research first. I have had several treatments and made lot of choices out of desperation (and self-imposed ignorance). Although I am overall pleased with the outcome, in the early stages I did not do enough preliminary patient research, second-opinion consultation and I certainly did not fully consider the (potential and actual) side affects.
I am a 35 year-old man who first experienced severe plantar and palmar hyperhidrosis since adolescence. I recall sweat would drip from my hands and feet. It affected so many aspects of my life, similar to many of the other stories I have read on this site. Here are my experiences with various forms of treatment:
After consultation with my general practioner, I sourced an Iontophoresis machine to trial. As a teenager I did not have the patience and did not persist with this course of treatment, I just recall it was time consuming and ongoing. I can't provide any recommendation as I did not commit. I however can't say it won't work for you, but please see if you can rent/borrow this device before committing to an outright purchase. I was actually borrowed mine from another patient via my doctor at no cost.
ENDOSCOPIC THORACIC SYMPATHECTOMY (ETS)
Fast forward 12 years, I met with a vasular surgeon who offered to perform Endoscopic thoracic sympathectomy for my sweaty hands. Although the doctor did the obligatory discussion, the side affects were “down played” to me. I signed up with little consideration for the potential side effects and have since learnt the procedure is quite invasive and I really suggest you do your homework and seek a second opinion. The procedure took a few hours, my health fund covered the bulk of the surgery and anesthetist, regardless I perceived the benefits of dry hands outweighed the upfront cost, I stayed in a private hospital for three days post-surgery. It is keyhole surgery and I have a small cross-shaped scar under each armpit. I felt the benefits fairly soon afterwards and can now say my hands are completely dry. I need to apply hand cream more often by it's no concern. I however need to stress the significant side effect is compensatory sweating on my chest and front, in which I will talk more about soon.
ENDOSCOPIC LUMBAR SYMPATHECTOMY
Within six months I visited the same vascular surgeon, where I requested to have surgery to help with my sweaty feet. This was another day procedure, with a two-night stay and from memory was it was of similar cost to ETS, I was recommended to take a week off from work as the incision points were very tender and not to disrupt the stitches. I have two fairly large scars across the lower part of my stomach. The doctor downplayed how visual the scarring would be, and recommended I apply Bio-Oil (for mother's with stretch marks). I suggest to any ELS patient to be referred to a dermatologist without delay to mitigate the scaring, which is much harder (and more expensive) to remedy if left untreated after the initial healing stage.
There is a lot of literature out there that advises not to have ETS/ELS as the compensatory sweating is too impactful and creates more anxiety than it is worth. I however know in my personal experience that is was worth it, even in times where by chest and back is covered in sweat. I have permanently dry hands and feet, which if anyone who has hyperhidrosis in these areas can appreciate the impact it has. For 9 months of the year the compensatory sweating does not affect me, due to the cooler weather and I don't give it a moments thought. Once again, I strongly recommend you do your research and make a carefully informed decision.
TREATMENTS FOR COMPENSATORY SWEATING
However, during the Spring / Summer periods I have to put in a lot of effort to mitigate the excessive compensatory sweating on my chest and back. I wear a singlet under my shirt to help “soak” the sweat to avoid unsightly sweat patches showing. I wear only cotton and no polyester to help with breathability.
DITROPAN AND TOPICAL DITROPAN
During the Spring and Summer I take Ditropan orally (5mg tablet) both first thing in the morning and late afternoon in anticipation of the commute to and from work or when I am not in air conditioning. It is really cheap and readily availably as its primary treatement is for UTI's. I have been recommended to take with food to for effectiveness and it takes approximately 1 hour to take effect and the benefit will last approximately 3 hours. The first side affect I experience (like most) is dry mouth. My doctor assures me that I will be okay to continue taking Ditropan without long term concern. However a second doctor has suggested that is causes lethargy, cognitive delay and even dementia later in life. (Please research and consult with your own doctor to verify these concerns for you.) The second doctor has provided me a prescription for Ditropan in a topical gel form to apply directly to the areas needed. It however is much more expensive and less readily available as I need to source it from a specialty compounding pharmacy, so I am yet to try.
CLINICAL STRENGTH ANTIPERSPIRANTS
I used to use a pharmacy only roll-on antiperspirant on my chest and back, I applied first thing in the morning after I showered and allowed time to fully dry before getting dressed. It did provide limited protection, however it is no longer available. I have since moved over to an over the counter “clinical strength” roll out antiperspirant. I feel that too does actually offer limited protection from sweating in moderate temperatures. My doctor advises me to be careful not to apply excessively as it dries out the skin increases the possibility of infection. (One again, please research and consult with you doctor if this is right for you.)
LASER SPECKLE FLOW GRAPH (LSFG)
I have recently begun reading up on the application of laser speckle flow graph for compensatory sweating. To be honest I have no opinion on the subject, nor have I consulted a doctor but I have read some academic articles on the subject. I would be open to anyone who has experience or knowledge on the subject. I question if there is even a specialist that even offers LSFG in my part of the world.
BOTULINUM TOXIN (Botox)
I recently attended to a clinic that specialises in sweat treatment. I tried for first time (to coincide with Summer) a round of botox to my chest. Firstly let me say that it is really painful, and I otherwise would consider my pain threshold somewhat high. My priority was to treat the back, but have learnt it is too difficult, ineffective and costly. However I agreed to treat my chest and had 4 mls administered, spread out over 40 different injection points. Secondly it was considerably expensive, which I was aware of and I also knew the treatment would only last 3 – 6 months. To be frank, the area treated is fairly localised and I still sweat in the untreated areas, so I personally won't be doing that again. I would like to hear from anyone that advocates such treatment.
I am open to feedback and suggestions here. I also make myself available to answer anyone's questions they may have, based on my experiences and treatments I have undergone.