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When your sweating is out of control

October 14, 2019 / Duncan Fisher
It may be a condition called ‘hyperhidrosis’.

We’re all supposed to sweat sometimes. It’s the body’s natural response to heat, exercise, and anxiety.

But some people sweat all the time, in enormous amounts, for no very clear reason. It can be so bad that they have trouble typing on keyboards, or holding pens, or playing racquet sports. It can be crippling socially. Adults with the condition may have trouble maintaining relationships, and children may feel unable to attend school.

Spontaneous over-sweating can cover the whole body. This is spoken of as ‘generalised’ hyperhidrosis. Or it can be ‘localised’ or ‘focal’, affecting palms, soles of feet, underarms, scalp, or face. Sometimes it’s two or three of these places.

It’s called ‘primary’ hyperhidrosis if its cause is not some illness or disorder, like a hormone problem, an overactive thyroid gland, or diabetes. Then it’s called ‘secondary’ hyperhidrosis. Some medications cause this too. Primary hyperhidrosis can start in childhood, and be lifelong. It appears to be partly hereditary.

Whatever its cause, the basic problem in hyperhidrosis is that your ‘eccrine’ sweat glands are being ordered to produce too much sweat, of the watery variety. (You have another kind of sweat gland, the ‘apocrine’ kind, that makes an oilier, sort of smelly, sweat. That kind isn’t involved in hyperhidrosis.)

Since it’s not clear why your nervous system is ordering all this excess sweat, it’s not possible to cure hyperhidrosis exactly. But your dermatologist can manage the symptoms, and help normalise your life.

Hyperhidrosis management options these days

Aluminum chloride antiperspirants help a lot of people. These are available over the counter in stores, or in heavier concentrations, by prescription. They can irritate skin, so they’re sometimes used with hydrocortisone cream.

Anticholinergic drugs, either topical or taken orally, can block the nerve signals that cause sweating. You can ask your doctor about glycopyrrolate, oxybutynin, or propantheline. Oral anticholinergics are the standard of care for generalised symptoms. They can cause side effects, however, and are not appropriate for every patient.

Iontophoresis, a simple way of passing a tiny electrical current through the skin, is a safe and easy way of treating focal symptoms in the palms. It involves a regular 20-minute hand-soak in a little pan of water. The water may contain glycopyrrolate, or it may not. It can be done at home. It helps a great many patients.

Botox, by injection, helps in the underarms, by deactivating nerve action in local sweat glands. It’s uncomfortable, but the effect can last for months. It’s not normally used for other affected areas. Botox injections have been tried in hands and feet, but have been found to be too painful to administer, and they sometimes cause local muscle weakness. A research team in the United Kingdom has had experimental success in driving Botox into palms with iontophoresis, however, painlessly and without apparent problems. This may be worth watching, and discussing with your dermatologist.

Microwave heat treatment, known commercially as ‘MiraDry®,’ is a new approach, that destroys sweat glands in a non-invasive, and fairly painless way. This may or may not be available in your area yet.

Surgical options exist too. Sweat gland removal is possible in very small focal areas. For generalised sweating, or for really severe sweating in the face or neck, a major procedure called ‘thoracic sympathectomy’ can be done, but it carries numerous risks, and can actually make over-sweating increase in previously unaffected parts of the body. This is serious surgery, involving severing of sympathetic nerves. It’s done endoscopically by a chest surgeon, not a dermatologist. It is considered a very last-ditch intervention.

What you can do

Some people have good luck wearing light, loose clothing, or absorbent underclothes. Frequent changes of clothes are sometimes all that people with hyperhidrosis need to get through their day. For some people, spicy foods are a trigger, best avoided. So is alcohol.

If you’re suffering from excess sweating, and these measures aren’t enough, it is time to see your dermatologist. This is not something you should need to suffer through.

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