Craniofacial hyperhidrosis is defined as excessive sweating of the face and forehead. Specifically, it causes excessive sweating of the scalp, nose, chin and cheeks. It can be caused by either primary focal hyperhidrosis or secondary generalized hyperhidrosis. Primary hyperhidrosis has an earlier onset and has no known underlying cause. Of the population of people who have primary hyperhidrosis, which effects 3% of the population, only 22.8% suffer with symptoms of craniofacial sweating. This means that facial sweating is a less common symptom of primary hyperhidrosis than palmar, plantar, and axillary sweating. However, for those who do experience excessive sweating of the face it can severely affect quality of life. For example, many women are unable to keep makeup on and sufferers can become very self conscious about their appearance. Craniofacial hyperhidrosis and anxiety are highly related as the face is such an integral element of social interactions. Men are more are affected than women and it has a later age of onset than other areas affected by hyperhidrosis.
Excessive sweating of the face can have different causes depending on whether it is a symptom stemming from primary focal hyperhidrosis or secondary hyperhidrosis. It is imperative to make that distinction and know about the types of hyperhidrosis before a cause can be determined.
Craniofacial sweating caused by primary hyperhidrosis has no well understood cause. Primary hyperhidrosis causes eccrine (sweat) glands to be overactive, but they are morphologically the same as normally functioning sweat glands. Many times stress can cause sweating on the face and neck to worsen, as can heat. It is also more likely to occur in men and typically begins in early adulthood. While some triggers of facial sweating are understood the etiology of primary focal hyperhidrosis is not.
When craniofacial sweating is caused by secondary hyperhidrosis the causative agent is easier to determine. There are a host of conditions and diseases that cause secondary hyperhidrosis which may be responsible for facial, scalp and neck sweating. These can include anything from infections, endocrine disorders and the use of some medications to very serious issues like cancers. Medication side effects are the leading cause of secondary hyperhidrosis, so it is important to review all medications a patient is taking to see if they may be causing excessive craniofacial sweating.
Excessive facial sweating is highly correlated with mental stress and patients often find that their symptoms are the worst during times of high anxiety. Often those who experience craniofacial sweating also suffer from stress sweating. If this is the case, then measures to reduce anxiety may also help to reduce the amount of sweating experienced. There are some anxiety reduction methods that can lessen excessive sweating which can be an important part of a comprehensive treatment plan. However, it is an important distinction to understand that hyperhidrosis is not typically caused by an anxiety disorder. Therefore, treatment of hyperhidrosis along with stress reduction techniques will be the most effective to minimize symptoms.
There are effective ways to stop head and neck sweating. Other treatments are specifically targetted to reducing and stopping excessive face sweating. The type of treatment each patient requires depends on the cause of their craniofacial sweating. For those with primary hyperhidrosis the goal is to reduce facial sweating and manage the symptoms via treatment. If a patient has craniofacial sweating caused by secondary hyperhidrosis then the goal is to eliminate the underlying issue, or to manage symptoms if the causative agent can’t be reversed. Treatments can also vary depending on the area of the face affected. For example, some people struggle with upper lip sweat and certain treatments will work better for that than others.
Antiperspirants, Creams and Oral Medications
The first line of treatment when attempting to stop facial sweating is to use topical antiperspirant creams. There are over-the-counter topical creams for hyperhidrosis that contain aluminum chloride, a substance that reduces the amount of sweat eccrine glands produce. It is safe to use some over-the-counter antiperspirants on the face, and there are some specific antiperspirants for areas like the face and groin that have sensitive skin. If this does not work then patients can move on to a prescription topical cream that contains an anticholinergic, usually glycopyrrolate or oxybutynin. According to the most recent research 2% glycopyrrolate cream seems to be an effective treatment for excessive facial sweating.
If topical creams do not work then doctors often move on to a type of oral medication for hyperhidrosis called an anticholinergic. This type of medication works on the entire body to reduce sweat production by interfering with the binding ability of a neurotransmitter called acetylcholine. There are not many studies on the efficacy of this treatment specifically for craniofacial hyperhidrosis. However, the studies that do exist show that oral medication does tend to help but can come with side effects. The main side effect that bothered patients in the studies available was dry mouth, although others can occur.
Botox injections are a third line treatment for craniofacial hyperhidrosis. Botox injections are used for the treatment of axillary hyperhidrosis most frequently, but they are used for facial sweating on occasion. However, there is no current consensus on the amount and type of botulinum toxin that should be used. Issues can also occur regarding aesthetic concerns due to Botox injections causing facial asymmetry and brow ptosis (drooping). When Botox injections have been studied for the treatment of craniofacial hyperhidrosis Botulinum toxin A was used and it was shown to be a relatively safe and effective treatment. More studies need to be performed to demonstrate the safety and effectiveness of this treatment over time, and in a larger group of people.
Endoscopic Thoracic Sympathectomy
This is a type of surgery used to treat primary focal hyperhidrosis. During the procedure the nerves of the sympathetic ganglia, the part of the nervous system that connects to sweat glands and is responsible for the flight or fight response, are disconnected from the eccrine glands. This prevents the body from being able to sweat in a particular area of the body because it can no longer communicate with the sweat glands in that location. This is a viable treatment option for those suffering from craniofacial hyperhidrosis. Usually, to get rid of sweating on the head and neck a surgeon will have to work on the T2 or T3 area of the spine. The nerves can be blocked by various means including clipping, transection, ablation and clamping. While ETS is very effective at stopping excessive sweating of the face, but it can come with some serious side effects. ETS comes with a potential complication called compensatory sweating, which causes the body to sweat excessively in areas the surgery was not performed on. Compensatory sweating can be so distressing that some patients decide to have the surgery reversed. There is a type of surgery called a needlescopic thoracic sympathetic block which essentially does the same thing as ETS but the nerves are just clipped. This way, if a patient experiences compensatory sweating, the procedure can more easily be reversed. Surgery should be reserved as a last resort for severe cases of craniofacial hyperhidrosis.
Excessive facial sweating can be an extremely burdensome form of hyperhidrosis. The good thing is that new treatments are being developed each year and many effective treatments are already available.
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