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Hyperhidrosis – Why Do I Sweat So Much, And What Can I Do About It?
By Dr. Moghissi - July 2009
Hyperhidrosis is excessive, uncontrollable sweating. It usually begins in childhood or adolescence and is most commonly found in the underarm (axillary) area, palms, feet (plantar), and face, although it can be on any site on the body. Somewhere between 1 and 3% of the population is affected, and men and women are equally affected.
Although hyperhidrosis is not medically serious or life-threatening, it can significantly interfere with a person’s quality of life. People with hyperhidrosis may have cold, wet hands, and leave puddles of sweat on whatever they touch. Their feet will be prone to bacterial and fungal infections, and therefore may be discolored and smell. They soak through clothing at the underarms, leaving large dark wet spots that can be impossible to hide. They may sweat and drip from the face. This can really be a significant problem.
So what causes hyperhidrosis? No one is really sure, but we do know that sweat is produced to cool the body and prevent overheating. Nerves from the autonomic nervous system activate the sweat glands as a response to heat, hormones, stress, and physical activity (including exercise). There are 2 types of hyperhidrosis, generalized (all over the body) and localized (palms, soles, armpits, and face). Generalized hyperhidrosis occurs while awake and during sleep, and can be also be caused by infections, some types of cancers, low thyroid, diabetes, gout, and other endocrine diseases, menopause, psychological stress, alcoholism and some medications. Localized hyperhidrosis usually starts at puberty, and usually does not occur during sleep. It can also be caused by anxiety, certain odors, some foods (like coffee, chocolate, spices), and spinal cord injuries.
The next question is, what can be done? First, you should see a physician to rule out treatable medical causes. There are several options, and usually the cheapest and least invasive treatments are tried first. Please note that most hyperhidrosis treatments are not covered by insurance, although you should be able to use your flexible spending account to pay for them.
Usually the first treatment tried is an aluminum chloride antiperspirant which plug the sweat ducts. Drysol, Certain Dry, Maxim Facial Wipes, and Odaban are available in this country. They are usually moderately effective, but can cause skin irritation and itching.
Some medications that are used are glycopyrrolate, oxybutynin, propantheline, and benztropin. These medications all can have significant side effects, and need to be monitored closely by a physician. Other options are periodic propranolol or valium, to decrease stress induced sweating.
Primarily used for the hands and feet, the area is immersed in a shallow pan filled with water. The device sends a low voltage current through the water. This must be done for about 20 minutes, frequently at first, then every 2-4 weeks indefinitely to maintain dryness. The device is quite expensive, requires a prescription, and at times the treatments can be painful.
Botox injections are a great treatment for the armpits, but can also be used on the face, palms, soles, and other areas of the body. When done in the armpits, I find it usually lasts 4-6 months. Women generally require 50 units per armpit (100 units = 1 vial = $1000). Men generally require twice that. This is probably the most satisfying treatment, as it causes the least discomfort and is very effective. The main disadvantage is the cost.
Endoscopic thoracic sympathectomy (ETS) is performed under general anesthesia and is effective in most patients for sweaty palms. Unfortunately about 50% of patients will develop compensatory hyperhidrosis, meaning they will get excessive sweating at other (new) sites in the body. There are also the usual risks associated with any chest surgery.
Hyperhidrosis can be a debilitating illness, with significant social consequences and should not be thought of as just a cosmetic problem. There are effective treatments available, but most will have significant out of pocket costs. It is important to come in to see me (or see you doctor) if you have excessive sweating to rule out underlying medical illnesses, and so we can develop a treatment plan to help you cope with this problem.
Copyright 2017 Jasmine Moghissi, MD,PC.