Hyperhidrosis

What is Hyperhidrosis?

Hyperhidrosis is a condition in which the body’s sweat glands are overactive, meaning you sweat more than you need to. Hyperhidrosis can be triggered by a medical condition or an emotion such as anxiety. The condition can leave you feeling uncomfortable and embarrassed, meaning many people do not seek treatment. Managing the symptoms can be challenging, but there are treatments available which can help.

There are two main types of hyperhidrosis:

Focal hyperhidrosis: Also called primary hyperhidrosis, excessive sweating is caused by an inherited gene mutation. It usually affects the hands, feet and armpits, and starts earlier in life. Excessive sweating is usually caused by focal hyperhidrosis.

Generalized hyperhidrosis: Also called secondary hyperhidrosis, excessive sweating is caused by a different medical condition, such as diabetes or Parkinson’s disease. Certain medications can also cause sweating as a side effect.

What Causes Hyperhidrosis?

We sweat naturally to cool ourselves down. Our nerves tell the sweat glands to begin sweating if we are exercising, are feeling nervous or if we are sick. In people with hyperhidrosis, the glands work excessively for no reason, and we sweat when we don’t need to.

Focal hyperhidrosis can be caused by:

• Some smells or foods, including caffeine, citric acid, spices, chocolate and peanut butter.
• Emotional triggers such as stress or anxiety.
• Heat.
• An injury to the spinal cord. Generalized hyperhidrosis can be caused by:
• Dysautonomia (autonomic dysfunction).
• Exercise, heat or humidity.
• Menopause.
• Psychological stress.
• Certain infections like tuberculosis.
• Certain cancers like Hodgkin disease.
• Certain metabolic disorders, such as diabetes, hyperthyroidism, hypoglycemia, gout and pituitary disease.
• Certain medications, including some antidepressants and insulins.

What are the Symptoms of Hyperhidrosis?

The symptoms of hyperhidrosis vary from person to person in severity and the impact they have on daily life. Sometimes symptoms are mild and fluctuate, and sometimes sweating is excessive and very challenging. Symptoms can cause:

• Sweat to pool under the arms or on the back
• Clothes to become soaked with sweat
• Beads of sweat to appear on the face
• Hands and feet to become damp
• Excessive sweating may also lead to:
• Sweat leads to itching and inflammation.
• Body odor (when bacteria mixes with sweat).
• Marks on clothing when sweat, bacteria and deodorants mix.
• Changes in the skin, for example discoloration or paleness
• Cracks or wrinkles on the skin.
• The skin on the feet becomes soft or disintegrates, called maceration.

Symptoms can differ depending on the type of hyperhidrosis you have. Focal hyperhidrosis usually causes excessive sweating on both sides of the body, doesn’t cause night sweats, and typically doesn’t stop without treatment. It mainly affects the armpits, feet, hands, face, lower back, and genitals.

Generalized hyperhidrosis causes sweating all over the body. It can cause patients to sweat while sleeping.

While sweat doesn’t smell, when it mixes with bacteria on the skin, it can cause an odor.

How is Hyperhidrosis Diagnosed?

Many people don’t seek advice from their doctor about excessive sweating as they are embarrassed to talk about it. However, discussing the condition can be a relief and there are treatment options available.

Firstly, your doctor will discuss your medical history and symptoms with you in detail.

Tests may be needed to determine what is causing you to sweat excessively, which may include blood or urine tests to confirm or rule out an underlying condition. Your doctor may also want to measure how excessive your sweating is. This is done by the following tests:

• Paper test: A special paper is placed on the affected area to absorb and measure the sweat.
• Starch-iodine test: An iodine solution is put on the affected area and starch is sprinkled over the iodine. Excessive sweat will turn the solution dark blue.

How is Hyperhidrosis Treated?

At the moment, there is no cure for focal hyperhidrosis. Your medical team will focus on treatments that reduce symptoms and improve quality of life.

Treatment for secondary hyperhidrosis focuses on identifying the underlying cause and treating this, to make excessive sweating stop.

You may be referred to a dermatologist for hyperhidrosis treatment, who will begin by suggesting lifestyle changes or medications. These can include:

• Lifestyle changes: Showering more often and only wearing breathable materials can improve mild symptoms.
• Antiperspirants: Aluminum-based products seal sweat glands, so sweat isn’t produced. Prescription strength antiperspirants are available, but they can cause skin irritation.
• Medication: Anticholinergic drugs make aluminum-based antiperspirants more effective but come with side effects. Antidepressants can also reduce sweating and reduce anxiety. Beta blockers may also be effective.
• Cloth wipes: Prescription glycopyrronium tosylate wipes can reduce sweating of the armpits.

If these treatments aren’t effective, your doctor may recommend specialized therapies, which include:

• Iontophoresis: Hands or feet are placed in a tub of water and a low electrical current is passed through the water. Over a course of treatments, sweat glands are blocked.
• Botox® injections: The botulinum toxin is injected into overactive nerves to stop production of sweat. The treatment lasts for several months then needs to be repeated.
• Microwave therapy: A device is placed next to the affected area which emits thermal energy and destroys sweat glands. The treatment can permanently stop underarm sweating.

If none of the treatments are working, surgery may be considered. The involves the removal of the sweat glands from the armpits or disconnecting the nerves that are responsible for hyperhidrosis symptoms can offer lasting results. However, surgery may cause side effects such as sweating in other parts of the body.

Hyperhidrosis can impact your self-confidence and the way you live your life. Many effective and often simple treatments are available to treat and manage the condition, so always talk to your doctor.

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