Systemic medication can be utilized for the medication and cure of generalized or focal hyperhidrosis. A lot of the medicines said to be helpful in treating hyperhidrosis have not been thoroughly tested in controlled laboratory experiments. Their utilization and effectiveness are only being based on subjective proof and hearsay. Moreover, at the dosage needed to inhibit hyperhidrosis effectively, it is most likely that the side effects of such substances can be debilitating to the patient. On top of that, most of these medicines are not even accepted by the United States Food and Drug Administration (USFDA) as treatment for the cure of hyperhidrosis disorder.

The most frequently used or abused drug medication for hyperhidrosis treatment is anticholinergic drugs. This particular drug obstructs the sympathetic stimulus of the eccrine glands by restraining the activity of acetylcholine at the synapse. The applications of these particular drugs are limited and restricted. The common side effects that are generally found and associated from the anticholinergic class medication may comprise of constipation, dry mouth, urinary retention, and visual disturbances such as mydriasis and cycloplegia.

Anticholinergic drugs utilized for the treatment of hyperhidrosis include such drugs as benztropine, glycopyrronium bromide, oxybutynin and propantheline. When stressful circumstances are expected to set off hyperhidrosis, the use of anticholinergic agent or benzodiazepine before the onset will most probably be beneficial. The drug acts as a preventive measure that stops the onset of extreme perspiration brought about by anxiety or stress.

The long-term utilization and application of benzodiazepine drugs such as diazepam is restricted due to the possible drug dependence of the patient. A lot of patients have also been noted to be lacking in tolerance to the sedative effects of such medication. A number of patients take five milligrams of diazepam before sleeping at night. They do this for several weeks to get used to its sedating effect. When the need arises during stressful situations they can then take the necessary meds without fear of its effects and/or side effects.

There have been numerous unverified accounts of people with hyperhidrosis responding to varied methods of systematic medication. Most of these accounts are single cases and there are also a small number of patients with specific types of hyperhidrosis responding to a variety of systemic medication. Such medications utilized include the following:

• Benztropine for hyperhidrosis associated with venlafaxine use
• Clonidine for facial and paroxysmal localized hyperhidrosis
• Indomethacin for generalized hyperhidrosis
• Oxybutynin for episodic hyperhidrosis with hypothermia
• Propantheline for hyperhidrosis in spinal cord injury
• Fludrocortisone for orthostatic hypotension-induced hyperhidrosis
• Diltiazem in familial primary hyperhidrosis

Botulinum toxin injection is supposed to be minimally invasive and has become an accepted therapy for patients who do not react favorably to more conventional forms of treatment.  This treatment therapy is normally done prior to resorting to surgery. Different therapeutic alternatives also vary in their length of efficacy. Side effects and response speed differ depending on the anatomic area treated. Topical therapy for focal hyperhidrosis or generally called antiperspirant treatment can be carried out with chemicals of several different classes. These classes comprise of astringent agents, topical anticholinergics, local anesthetics, and aluminum and other metallic salt solutions.

Most of the population in developed countries uses easily available over the counter antiperspirants for cosmetic and hygienic control of underarm sweating and odor. Individuals suffering from moderate to severe hyperhidrosis on the other hand require stronger remedies. Prescription medication and specially compounded solutions are commonly required for hyperhidrosis sufferers. Unfortunately these cures do not always give the desired effect.

Various topical agents analyzed are not easily obtainable commercially or do not have United States Food and Drug Administration endorsement and approval for the cure of hyperhidrosis. Only aluminum chloride has the approval of the USFDA for hyperhidrosis treatment. The preliminary treatment usually made for hyperhidrosis is normally non-invasive and does not necessitate any surgical procedure. There are commercially available ointments and salves (i.e., Drysol) that work as astringents and they have a tendency to dry up the sweat glands.

On the other hand, a different and acceptable cure for hyperhidrosis is iontopheresis. This is a hyperhidrosis treatment wherein electrical stimulation is used to lessen sweating. This procedure is normally done on the hands. Patients put their hands in a bath or basin of water wherein an electrical current is passed. This procedure stuns the sweat glands and tends to decrease the secretion of sweat for periods ranging from six hours to about 7 days.

One of the latest cures offered for hyperhidrosis is the injection of botulinum toxin or more commonly known as Botox. It is injected into the area where excessive sweating is experienced. This is a toxin that affects and sort of paralyzes the nerve endings. This toxin eventually reduces the transmission of the nerve impulses to the sweat glands which in turn results to reduce perspiration. It would normally require quite a few injections in the palms of the hands or armpits to complete the procedure.  The effect of the procedure is observed to range from 1 month to 6 months. Continual injections are practically needed to sustain an acceptable level of dryness.

Besides the above-mentioned treatments, many drugs and remedies have been used with varying degrees of success. These include sedatives (for patients with stress induced hyperhidrosis) and medications that have an effect on our central nervous system. A family practitioner or internist is usually the one who makes the diagnosis and initial treatment for hyperhidrosis. Hyperhidrosis cases that do not respond accordingly to simple treatment regimens are often referred to a specialist such as a dermatologist or neurologist. As a rule of thumb, surgery is only considered when the less invasive medical treatments have been exhausted.

To date, there are two types of iontophoresis devices that are currently seeing use in the United States: (1) The Drionic Iontophoresis unit, and (2) the Fischer Model MD-1a Iontophoresis unit. These two iontophoresis devices have received approval for treating hyperhidrosis from the United States Food and Drug Administration.

The use of electricity to treat human diseases has been studied for more than two centuries, not long after its discovery in the 18th century. It’s been mentioned in a few studies that Pivati introduced the use of iontophoresis in the treatment of arthritis in the 1740’s. Further studies in the following two hundred years have confirmed the efficiency of the procedure in administering drugs through a patient’s skin.

The use of iontophoresis to treat hyperhidrosis gained popularity in the 20th century:

1936 – Ichikasa realized that drugs administered through iontophoresis resulted in reduced sweating activity in the affected area.
1940’s – In a study independent from Ichikasa’s, Takata and Shelley successfully obtained anhidrosis (the reverse of hyperhidrosis) through iontophoresis with tap water.
1968 – Levit published his ideas on a practical device that administered iontophoresis to patients, further boosting the procedure’s popularity.

Studies have also shown that the skin’s sweat glands provide the least amount of electrical resistance during an iontophoresis procedure, indicating that drugs mainly enter the patient’s skin through these channels. While iontophoresis have been used by dermatologists in attempts to treat other medical conditions (such as scleroderma and vitiligo), hyperhidrosis seems to be the only medical condition readily treated by the procedure, owing to its widespread popularity and high success rate.

Iontophoresis delivers a charged molecule across the skin. This is done by placing it near an electrode of the same charge as itself, while another electrode of opposite charged is placed on another part of the body. While this explains how drugs are transported across the skin, it does not explain how tap water iontophoresis reduces sweat output. Exactly how this is done is still a mystery, although several theories have been suggested.

One early theory suggested that iontophoresis plugged sweat gland ducts, since iatrogenic miliaria developed when iontophoresis was administered on the back, chest, or arms of patients. Microscopic analysis did show keratin plugs blocking sweat ducts, but light and electron microscopy found no such blockages in a patient treated for palmar hyperhidrosis.

It would seem that iontophoresis may cause an impairment in a sweat gland’s function instead of a blockage. Other theories suggest that the procedure raises the threshold for transmission of sympathetic nerve impulse, or that it changes the physiology of cellular secretory system. Neurotransmitter levels in the eccrine gland or surrounding microciruclation remain unchanged after iontophoresis, however, so the subject still remains open to debate.

Iontophoresis treatment regimens vary with the device used, the areas of the body to be treated, and whether the procedures will be done at home or at the clinic.