An antiperspirant is an astringent that decreases eccrine and apocrine sweat secretion. Topical antiperspirant contains aluminium chloride hexahydrate. Aluminium salts collect in the sweat ducts and obstruct them resulting in reduction in sweating. Results may be satisfactory especially for patients with axillary hyperhidrosis. This medication is applied onto the affected area which must be clean and dry just before bedtime, then left overnight before washing it off the following morning. It requires an initial daily application of 7-10 nights in a row, then once a week for maintenance.

Iontophoresis is a device which passes direct electricity through the skin using tap water to block the sweat glands. Total treatment duration is about 20 minutes at an initial frequency of every 2-3 days, then stretched till once every 2 weeks. This mode of treatment is contraindicated in patients who are pregnant, those with severe skin lesions or local wound, and those with pacemakers and abnormal heart rhythm (cardiac arrhythmias). It may cause transient tingling sensation and irritation.

The preglandular neurotransmitter for sweat secretion is acetylcholine. Anticholinergics are drugs that inhibit the binding of acetylcholine to their receptors which results in decreased production of sweat. Examples of anticholinergics are glycopyrrolate and propantheline bromide. They are not commonly used due to side effects such as dry mouth, blurring of vision, constipation, difficulty in passing urine, dizziness, palpitations and insomnia.

Botox has been around for many years to treat muscle spasms and wrinkles. It consists of proteins that permanently block the nerve endings that supply the eccrine glands, thus preventing the glands from producing sweat. Treatment involves injection into the affected areas and needs to be repeated every 4-5 months. Drawbacks include pain and temporary muscle weakness.

Hyperhidrosis is due to overactivity of sympathetic nerves located in the chest cavity. Sympathectomy is an operation which destroys part of the nerve supply to the sweat glands in the skin. This procedure should only be performed after all the other measures have failed and after consultation with the surgeon.

The surgeon makes small incisions just below the armpit and inserts a special endoscopic instrument into the chest. The lung is briefly deflated for better visualization followed by destruction of the nerve. The extent or level of the sympathetic blockade varies according to the type of hyperhidrosis.

The most common side effect of ETS is compensatory sweating, which is an exaggerated sweating that may occur in the lower chest, back, abdomen, thighs and legs.