Perineal Hyperhidrosis

Excessive sweating in buttock/groin area called Perineal Hyperhidrosis can be embarrassing and I’ve seen recent request for advice re this.

Treatment of Regional hyperhidrosis is similar for all areas:

  • Anticholinergics – oxybutinin is often used for generalized sweating
    Skin Appendage Disord. 2015 Mar;1(1):6-13. doi: 10.1159/000371581.
    Oxybutynin for the Treatment of Primary Hyperhidrosis: Current State of the Art.
    Campanati A et al
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857824
    Although clonidine has been used at night and helps sleep:
    Torch, Evan M.
    Remission of facial and scalp hyperhidrosis with clonidine hydrochloride and topical aluminum chloride.
    Southern medical journal 93.1 (2000): 68-69.
    https://europepmc.org/article/med/10653070
  • Topical Aluminum Chloride – near double strength antiperspirant “Drysol”
    although usually used in armpits, above reference (E.Torch above)) describes use elsewhere. A review article here as well:
    Cho, Nam Joon, Seung Hun Lee, and Doo Yun Lee.
    Efficacy of a 20% Aluminum Chloride in Alcohol Solution in the Treatment of Hyperhidrosis: A Study Using a Hydrometer.
    Annals of Dermatology 10.1 (1998): 20-24.
    https://www.anndermatol.org/Synapse/Data/PDFData/0140AD/ad-10-20.pdf
    Could be bit irritatingĀ  so might be useful for pharmacist to put 0.5% Hydrocortisone into Drysol bottle. After few days use, might be good for days
  • Botulinum Injections – commonly used on hands/feet, face and armpits but has been used elsewhere on occasion and can last some for up to 8 months
    in:
    Kim, Won Oak, et al.
    Botulinum toxin: a treatment for compensatory hyperhidrosis in the trunk.
    Dermatologic surgery 35.5 (2009): 833-838.
    https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1524-4725.2009.01140.x
    they put 100 units BTX-A in 5 mls lidocaine 1% and injected every 1.5 cm with 0.1 ml (2 units)in:

    Huh, C. H., et al.
    Botulinum toxin treatment for a compensatory hyperhidrosis subsequent to an upper thoracic sympathectomy.
    Journal of dermatological treatment 13.2 (2002): 91-93.
    https://sweathelp.org/pdf/Huh%202001%20-%20Botulinum%20toxin%20treatment%20for%20a%20compensatory%20hh%20subsequent.pdf

    they put 100 unit botox into 10 mls normal saline and injected 0.1 ml (1 unit) in every cm subcutaneously.

  • Ionophoresis direct (DC) electrical current has been an inexpensive treatment for hands and feet hyperhidosis though need maybe weekly treatments. Use in buttocks is scarce but came across one reference in a blog message that I will repeat here as it could go down:
    https://www.iontodevice.com/hyperhidrosis/iontophoresis-on-the-buttocks-t515.html
    “Hi, I was wondering how one would go about doing iontophoresis on the buttocks area? I get a lot of sweating down there that it soaks my pants, and leaves noticeable marks on chairs. It is very embarrassing and serious.
    In your case we would recommend the Hidrex PS device, which is approved to treat other areas than just hands, feet and underarms.
    For the treatment you can place the electrodes on the floor, on a chair, wherever you feel comfortable. Then you place a wet towel (it should not be too dry, but the water should also not drip) on top of the electrodes and sit down. In other words, you sit with your buttocks on the towel, which is on the electrodes! Then you just regulate the current, remember to start with a low current, the buttocks is also a very sensitive part of the body!”
  • Ganglion blocks – Excessive perineal sweating suggests dysfunction of the local sympathetic ganglion which is just behind the rectum. There is a case where injecting this ganglion made a difference in sweating:
    Kim, Sung Taek, and Sie Jeong Ryu. “Treatment of hyperhidrosis occurring during hemodialysis: Ganglion impar block: a case report.” Korean J Anesthesiol 48.5 (2005): 553.
    https://www.koreamed.org/article/1011KJAE/2005.48.5.553
    I have found botulinum injection, followed in couple weeks with 50% alcohol injection might give a 12 week “holiday” in pain
    I wrote about it extensively at painmuse.org:
    http://painmuse.org/?s=impar

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