If you would like to know more about hyperhidrosis symptoms and diagnosis, and about hyperhidrosis treatments, read the following article for more information.
Excessive sweating (hyperhidrosis) is a common problem, especially of the palms, armpits and soles. It can be distressing and can have a serious impact on your life. In some cases, affected people avoid social contact with others because of embarrassment about the problem. However, hyperhidrosis is usually treatable.
What is excessive sweating?
Normal sweating is a way to help keep the body temperature steady in hot weather, during a fever, or when exercising. Excessive sweating (hyperhidrosis) means that you sweat much more than normal. Even when you are not hot, anxious or exercising you make a lot of sweat.
Excessive sweating is classified as either focal or generalized. It is important to know which type you have as the causes and treatments are very different.
Focal excessive sweating (focal hyperhidrosis)
This means that excessive sweating occurs in one or more of the following 'focal' places: palms of the hands, soles of the feet, armpits (axillae), or face. You sweat normally on the rest of the body. The cause is not known and it is not associated with any other conditions. It just seems that the sweat glands in these areas are 'overactive' or more sensitive than normal. In some people, it may 'run in the family' so there may be some genetic factor in causing it. It usually first develops in the teenage years, but it can develop at any age. Men and women are equally affected.
The severity can vary from time to time. It may 'come and go' and can be made worse by 'triggers' such as anxiety, emotion, spicy foods, and heat. Anxiety about the sweating itself may make it worse. However, for most of the time, nothing obvious triggers the sweating. Focal excessive sweating usually develops under the age of 25. It affects about 3 in 100 people. It tends to be a long-term condition, but symptoms improve in some cases over time.
If you have focal excessive sweating, you do not need any tests as there is usually no known underlying cause. Your doctor may suggest one or more of the treatments (listed later) if 'normal' antiperspirants do not work very well.
Generalized excessive sweating (generalized hyperhidrosis)
This means that you sweat more than normal 'all over'. This is less common than focal excessive sweating. However, it is usually caused by an underlying medical condition. A whole range of conditions can cause increased sweating. For example: anxiety disorders, various heart problems, damage to nerves in the spinal cord, side-effect to certain drugs, various hormone problems, infections, certain cancers, etc. If you have generalized excessive sweating your doctor is likely to examine you and do some tests to find out the cause. Treatment depends on the cause.
The rest of this page is only about focal excessive sweating.
What are the possible complications of focal excess sweating?
Although not a medically serious condition, excessive sweating can be distressing and embarrassing. For example, if you have bad palm sweating you tend to have a 'cold sweaty handshake' and sweat may drip from your hands onto work documents, onto computer keyboards, etc. If you have bad armpit sweating, you may become embarrassed by the frequent 'wet-patch' that develops on clothes under your arms. You may need to change clothes during the day. You may avoid social contact or avoid doing sports because of embarrassment about the condition.
Other complications are uncommon. In some cases, the affected skin can become macerated and prone to infection. There is an increased risk of developing eczema on the affected skin.
What are the treatment options for focal excessive sweating?
General tips and advice
The following may be all that you need if the condition is mild, and may help in addition to other treatments in more severe cases.
- If you find that soaps irritate the affected skin, use a bland soap substitute such as an emollient (moisturiser) ointment or cream.
- If possible, avoid any triggers which can make things worse such as heat or spicy food.
- If you have armpit sweating:
- Try using 'normal' antiperspirants regularly. (Note: there is a difference between antiperspirants and deodorants. Antiperspirants reduce the release of sweat, deodorants mask any unpleasant smell. However, sweat does not have a smell. It is only sweaty clothes that are not changed that may become smelly.)
- Avoid clothes that more easily show up sweat marks. For example, as a rule, white and black coloured clothes are less noticeable when wet than other colours.
- Wear loose clothing under the armpits, and preferably not made with man-made fibres such as lycra and nylon.
- If you have excessive feet sweating, it can help to:
- Change socks at least twice daily.
- Use an absorbent foot powder twice daily.
- Wear a different pair of shoes on alternate days, to allow them to dry fully.
- Avoid sport shoes or boots, as these are likely to have an occlusive effect.
Aluminium chloride - a strong antiperspirant
If normal antiperspirants do not work, you doctor may advise an antiperspirant that contains aluminium chloride. This works like a 'strong' antiperspirant. It is thought to work by blocking the openings of the sweat ducts. It tends to work best in the armpits. However, it may also work for sweating of the palms and soles. Although it may also work on the face, some doctors do not recommend using this on the face as it may cause severe eye irritation if it gets into an eye.
There are several brands of aluminium chloride based antiperspirants. For example; Driclor and Anhydrol Forte which come in a bottle with a roll-on applicator; ZeaSORB - a dusting powder that contains aluminium chloride; and Odaban spray that contains aluminium chloride. You can buy these at pharmacies, and some are also available on prescription. It is important to use aluminium chloride based antiperspirants correctly. Read the instructions that come with the product you use. These usually include the following:
- Apply to clean, dry skin. (It is more likely to cause irritation on wet or moist skin.) Therefore, wipe the skin dry with a towel or dry flannel before applying. Some people use a hair dryer to make sure the skin is dry before applying.
- Ideally, apply at night (bedtime) when the sweat glands are less likely to be as active.
- Wash it off the next morning.
- Do not shave the area 24 hours before or after use.
- Avoid getting it in the eyes, and do not apply on broken or inflamed skin.
- Apply every 24-48 hours until the condition improves. Then apply once every 1-3 weeks, depending on response. (It may take a few weeks to build up its effect. This is because it is thought to gradually clog up the sweat gland which causes a gradual reduction in sweating.)
- If successful, treatment can be continued indefinitely. You may only need to apply it once every 1-3 weeks to keep the sweating under control.
Note: aluminium chloride antiperspirants often cause skin irritation or inflammation. If this occurs, it is often still worth persevering if the irritation is tolerable as the benefit may outweigh the irritation. To reduce the effects of any skin irritation or inflammation that may occur:
- Reduce frequency of use; and/or
- Apply a short course of a mild steroid cream such as hydrocortisone 1% to the affected area twice daily. Steroid creams reduce inflammation; and/or
- Apply an emollient (moisturiser) every day after applying the aluminium chloride.
Iontophoresis
This is a treatment that uses electrical stimulation. It is used mainly to treat sweating of the palms and/or soles. It can also be used to treat armpit sweating. Treatment involves putting the affected areas (usually hands and/or feet) into a small container filled with water. A small electrical current is then passed through the water from a special machine. It is not painful or dangerous, but may cause a 'pins and needles' feeling. The exact way this helps to treat sweating is not known. It may help to block the sweat glands in some way.
Treatment usually consists of 3-4 treatment sessions per week. Each treatment session lasts 20-40 minutes. Most people report an improvement after 6-10 sessions. A maintenance treatment is then typically required once every 1-4 weeks to keep symptoms away. If the treatment does not work with tap water, a drug called gycopromium bromide is sometimes added to the water. This seems to improve the rate of success. However, iontophoresis does not work in every case.
Until recently the 'downside' to iontophoresis is that it required a trip to hospital for each treatment session. This can be time-consuming and impractical for some. However, modern machines are smaller and can now be bought for home use. So, if you find that this treatment works for you, you may wish to consider buying a machine to use at home. However, you should take advice from the specialist who recommended iontophoresis for you before you buy a machine.
You should not have iontophoresis if you are pregnant, or have a metal implant (such as a pin to fix a fracture), or if you have a pacemaker.
Botulinum toxin injections
This is an option that usually works well for armpit sweating. Treatment consists of many small injections just under the skin in the affected areas. The botulinum toxin stops the nerves in the skin that control the sweat glands from working. Botulinum toxin is sometimes used to treat sweating of the palms and face. However, there is a risk that the injections may stop some of the nearby small muscles of the hands or face from working. To many people, this risk is not worth taking.
The downside of botulinum toxin is that the effect usually wears off after 4-12 months. Therefore, to keep working, the treatment needs repeating when the effect wears off. Some people get mild 'flu like' symptoms for a day or so after treatment. Also, the sites of the injections can be sore for a few days after treatment. Rarely, a severe allergic reaction can occur after an injection.
Medication
Medicines that block the effect of the nerves that stimulate the sweat glands are sometimes used. For example, propantheline. These medicines are not used very often. This is because the success of these medicines is variable. Also, side-effects commonly occur. For example, a dry mouth and blurred vision. However, in some cases they work well and side-effects are minor.
Surgery
An operation is an option for people who have not been helped much by other treatments, or if other treatments cause unacceptable side-effects or problems.
For armpit sweating - an option is to remove the sweat glands in the armpit. There are various techniques. For example, one operation is to cut out the area of skin in the armpit that contains the sweat glands. This usually works to reduce sweating, but a number of people have had problems after this operation due to scarring and a loss of the full range of movement of the arm. A newer technique to 'scrape' the sweat glands from the under side of the skin through a small hole cut in the skin appears to give good results with less risk of complications.
For palm sweating - an option is to have an operation to cut some of the nerves that run down the side of the spinal cord. These nerves control the sweat glands in the hands. The operation is called 'sympathectomy'. It is done by 'key-hole' surgery using a special telescope to locate the nerve, and then to cut the nerve. Most people are pleased with the result of the operation. However, a complication that sometimes occurs following this operation is a compensatory increase in sweating in other parts of the body (such as in the chest or groin). Because of this effect, a small number of people who have this operation say that they regret having it done.
Before you undergo surgery, you should have a full discussion with the surgeon you are referred to. He or she will explain the pros and cons of the different surgical techniques, chance of success (usually high), and possible risks and complications. For example, as with any other type of surgery, there is a small risk from the anaesthetic. Also, wound infection and damage to other nearby structures, although uncommon, are other possible complications.
Surgery is not usually done for sweating of the soles. Although cutting the nerves next to the spinal cord in the lower back region may cure the problem of sweating, there is a high risk of this also affecting sexual function.
Further help and information
Hyperhidrosis Support Group
Web: www.hyperhidrosisuk.org
This is a web-based group offering advice and support to people suffering from hyperhidrosis (excess sweating).
©EMIS and PIP 2005
