Sweating

Hyperhidrosis

is a medical condition in which a person sweats excessively and unpredictably. People with hyperhidrosis may sweat even when the temperature is cool or when they are at rest.

Causes, incidence, and risk factors

Sweating helps the body stay cool. In most cases, it is perfectly natural. People sweat more in warm temperatures, when they exercise, or in response to situations that make them nervous, angry, embarrassed, or afraid. Those with hyperhidrosis appear to have overactive sweat glands without such triggers. The uncontrollable sweating can lead to significant discomfort, both physical and emotional.

When excessive sweating affects the hands, feet, and armpits, it’s called primary or focal hyperhidrosis. Primary hyperhidrosis affects 2 – 3% of the population, yet less than 40% of patients with this condition seek medical advice. In the majority of primary hyperhidrosis cases, no cause can be found. It seems to run in families. If the sweating occurs as a result of another medical condition, it is called secondary hyperhidrosis. The sweating may be all over the body, or it may be in one area.

Symptoms

The primary symptom of hyperhidrosis is excessive wetness of the skin.

Treatment

Treatments may include antiperspirants, oral medications, iontophoresis, injectables such as Botox, and surgery.

Antiperspirants. Excessive sweating may be controlled with strong anti-perspirants, which plug the sweat ducts. Products containing 10% to 20% aluminum chloride hexahydrate are the first line of treatment for underarm sweating. Some patients may be be prescribed a product containing a higher dose of aluminum chloride, which is applied nightly onto the affected areas. Antiperspirants can cause skin irritation, and large doses of aluminum chloride can damage clothing. Note: Deodorants do not prevent sweating, but are helpful in reducing body odor.

Medication. Anticholinergics drugs, such as glycopyrrolate (Robinul, Robinul-Forte), help to prevent the stimulation of sweat glands. Although effective for some patients, these drugs have not been studied as well as other treatments. Side effects include dry mouth, dizziness, and problems with urination. Beta-blockers or benzodiazepines may help reduce stress-related sweating.

Iontophoresis. This FDA-approved procedure uses electricity to temporarily turn off the sweat gland. It is most effective for sweating of the hands and feet. The hands or feet are placed into water, and then a gentle current of electricity is passed through it. The electricity is gradually increased until the patient feels a light tingling sensation. The therapy lasts about 10-20 minutes and requires several sessions. Side effects include skin cracking and blisters, although rare.

Botox. Botulinum toxin type A (Botox) is FDA approved for the treatment of severe underarm sweating, a condition called primary axillary hyperhidrosis. Small doses of purified botulinum toxin injected into the underarm temporarily block the nerves that stimulate sweating. Side effects include injection-site pain and flu-like symptoms. If you are considering Botox for other areas of excessive sweating talk to your doctor in detail. Botox used for sweating of the palms can cause mild, but temporary weakness and intense pain.

Endoscopic thoracic sympathectomy (ETS). In severe cases, a minimally-invasive surgical procedure called sympathectomy may be recommended when other treatments fail. The procedure turns off the signal that tells the body to sweat excessively. It is usually done on patients whose palms sweat much more heavily than normal. It may also be used to treat extreme sweating of the face. ETS does not work as well for those with excessive armpit sweating.

Expectations (prognosis)

Aluminum chloride: Initially a patient may need to use it three to seven times a week. After sweating becomes normal, the person may need to use it only once every one to three weeks. If skin irritation is a problem, a doctor may temporarily prescribe a steroid-based cream.

Botox: Swelling goes away in a few weeks. The effect of a single injection can last up to a few months. Some patients need additional injections.

Iontophoresis: Sweating may be reduced after six to 10 sessions. After that, the person may need treatment once every one to four weeks.

Support Groups
International Hyperhidrosis Society