Sweating is a physiologic process whose primary purpose is to help with regulation of body temperature. People normally sweat more profusely when it's hot outside or when exercising. People also sweat more in response to situations that make them nervous, angry, embarrassed, or afraid.
In an estimated 2 to 3% of Americans, however, sweating can be so excessive that it disrupts normal activities. Sweating of this severity is known as hyperhidrosis.
Hyperhidrosis may be present if you have any of the following:
- Excessive sweating
of the soles and palms that causes clammy hands and unpleasant foot odor.
- Profuse
sweating that soaks through clothing
- Sweating that results in a skin problem such
as prickly heat or a fungal rash
- Sweating that occurs at night or when the ambient
temperature is normal
 What
causes excessive sweating?
Hyperhidrosis can be primary
or secondary. Primary hyperhidrosis is the most common type. It most often affects
people who are otherwise healthy with excessive sweating involving the feet, hands,
head, and underarms. Secondary hyperhidrosis is caused by something else, such as
hormonal changes (e.g. menopause), anxiety, an overactive thyroid gland, caffeine
consumption, certain medications, and with some types of infection and cancer.
What
can be done for hyperhidrosis?
When hyperhidrosis is secondary to some other problem,
the most effective treatment is to address the underlying cause. For example, if
an overactive thyroid is responsible, addressing this condition should take care
of the problem. In instances where there is no known cause, treatment usually follows
a stepwise progression:
- Over-the-counter antiperspirants.
These are usually tried
first since they are readily available and fairly inexpensive. Antiperspirants have
an aluminum-based compound as their main ingredient, which works at the level of
the sweat glands to decrease sweat production. This distinguishes antiperspirants
from deodorants that merely block odor.
- Prescription antiperspirants.
When an
OTC antiperspirant is insufficient, use of a prescription antiperspirant may be
considered. These also contain aluminum compounds, but at a higher concentration
than the OTC products. Xerac and Drysol (aluminum chloride hexahydrate) are two
of the most common prescription antiperspirants. These products are most appropriately
used to prevent underarm sweating. Since they can be irritating and staining to
clothing, they are typically applied before bedtime. After several nights of use,
the prescription antiperspirant is then applied only once or twice weekly to maintain
the effect.
-
Iontophoresis. This treatment, most commonly provided by Dermatologists,
involves the use of a device that passes electricity through the skin while the
patient is immersed in water. While its mechanism of action is unclear, it has been
used successfully for decades. The procedure is painless, and typically takes anywhere
from 10 to 20 minutes.
- Oral medications. If you have ever experienced the side
effect of dry mouth from taking a medication, you can understand how this could
also reduce sweating. The most common class of medication used for this purpose
are called anticholinergics. Robinul (glycopyrrolate) is one of the most commonly
prescribed of these. In addition to dry mouth, these medications can cause other
side effects including constipation, blurry vision, urinary retention, loss of taste,
dizziness and confusion.
- Botox (botulinum toxin). Botox has been approved by
the FDA for use in excessive underarm sweating. It works by blocking the nerves
that trigger the sweat glands. Treatment involves the delivery of multiple injections
into the armpit and can provide up to 6 months of benefit. As expected, the treatment
can be uncomfortable, but side effects are uncommon.
- Surgery. This usually represents
the treatment of last resort. Surgery is only considered in cases of severe hyperhidrosis
when other treatments haven't worked. Two surgical options, removal of the sweat
glands themselves or a procedure known as a sympathectomy have been used. A sympathectomy
involves cutting certain nerves that are responsible for sweating and carries the
risk of nerve and artery damage.
 Are self-care measures helpful for excessive sweating?
There are a number of things that you can do to reduce sweating and associated body
odor. The first is to bathe daily with an antibacterial soap. Be sure to dry yourself
completely after bathing, since odor-causing bacteria thrive in a moist environment.
Whenever possible, wear natural fabrics, such as cotton, wool or silk. These help
to allow the skin to breathe. When exercising, one of the new high-tech fabrics
will help to wick moisture away from the skin. Wear shoes that are made of breathable
material, such as leather, and socks made from cotton or wool that will absorb moisture.
If possible avoid
certain foods or drinks, such as alcohol, spicy foods and caffeine.
If your sweating is precipitated by anxiety or stress, engaging
in relaxation exercises may be helpful.
If you have questions about excessive sweating
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