Hyperhidrosis is a medical condition characterized by excessive sweating, with the body producing far more sweat than would be needed to regulate body temperature. The severity of this condition varies, as does the focal point of the sweating, and there are a number of treatments for hyperhidrosis, ranging from extremely strong antiperspirants to surgical options.
In what is known as primary hidrosis, the condition appears alone, without any other symptoms, typically around the age of puberty. This form of hyperhidrosis typically strikes the palms, feet, and armpits, although excessive sweat can appear on other areas of the body. Patients may find it more frustrating than anything else, as they may be forced to change clothes frequently and to deal with the smell associated with the bacterial breakdown of sweat.
In secondary hidrosis, excessive sweating appears as a symptom of another medical condition, or as a byproduct of treatment. In this case, treating the underlying condition or completing the course of treatment will generally cause the problem to go away. Secondary hidrosis is far more likely to appear across the entire body, rather than concentrated in specific areas.
Hyperhidrosis is generally diagnosed when a patient complains of excessive sweating to his or her physician. The physician may ask to do some tests to eliminate underlying conditions before treating the hyperhidrosis, depending on the patient's medical history and general health. Generally, the first step is a prescription for a strong antiperspirant or a topical soak which can be used to reduce the amount of sweat produced by the body.
If this fails to work, various oral medications may be used; some drugs are used off-label to treat hyperhidrosis, while others are designed specifically for the treatment of this condition. Injections of Botox also appear to be effective in hyperhidrosis treatment. If these measures are not sufficient, surgery may be used to remove some of the sweat glands in the area, or to sever some of the nerves which may be stimulating the glands to sweat excessively.
As a general rule, hyperhidrosis is not dangerous. In some cases, it can lead to skin conditions and discomfort, and this combined with the embarrassment linked with the excessive sweating leads people to seek treatment. However, some patients prefer to just cope with the effects by changing clothes frequently, washing the affected areas regularly and well, and applying talcum powder to treat breakouts of sweating.
Changing your lifestyle and daily activities cannot cure primary hyperhidrosis, but it can improve your symptoms and make you feel more self-confident. The advice listed below may help to improve your symptoms.
Avoid known triggers that make your sweating worse, such as spicy foods and alcohol.
Use antiperspirant spray frequently, rather than deodorants.
Avoid wearing tight, restrictive clothing and man-made fibres, such as nylon.
Wearing black or white clothing can help to minimize the signs of sweating.
Armpit shields can help to absorb excessive sweat and protect your clothes.
Wear socks that absorb moisture, such as thick, soft socks that are made of natural fibres, or sports socks that are designed to absorb moisture. Avoid wearing socks that are made out of synthetic (man-made) materials and change your socks at least twice a day.
Buy shoes that are made of leather, canvas or mesh, rather than synthetic material.
If a regular antiperspirant has failed to control your sweating, your GP may prescribe a more powerful one for you. Aluminium chloride is often used to treat hyperhidrosis, and it works by plugging up the sweat glands.
You will need to apply aluminium chloride at night just before you go to sleep. To avoid irritation, make sure that the area of skin you apply it to is dry before you apply it. You will need to wash off the aluminium chloride in the morning.
If you apply aluminium chloride to your face, be careful not to get any in your eyes. Men should avoid shaving 24 hours before and after applying aluminium chloride to their face.
The most common side effect of aluminium chloride is some mild skin irritation or itching and tingling at the site where it is applied. However, these types of side effects should pass quickly.
If lifestyle changes and prescription antiperspirants do not control your symptoms, your GP should refer you to a dermatologist (a specialist in treating skin conditions). This is because you may require access to additional treatments that your GP will be unable to provide, such as
iontophoresis, botulinum toxin or surgery (see below).
Iontophoresis is an effective treatment if you have excessive sweating that affects your hands or feet. It can also be used to treat armpits, although this is usually less effective.
If your hands and feet need treating, you place them in a bowl of water and a weak electric current is passed through the water.
If your armpits need treating, then a wet contact pad is placed against each armpit and then a current is then passed through the pad.
The current is thought to help block the sweat glands.
The treatment is not painful but the electric current can cause some mild, short-lived discomfort and skin irritation.
Each session of iontophoresis lasts between 20 and 30 minutes and you will usually need to have two to four sessions a week. Your symptoms should begin to improve after a week or two, after which further treatment will be required at one-to-four week intervals, depending on how severe your symptoms are.
Iontophoresis has proved to be effective in 80% to 90% of cases. However, you will need to make regular visits to your local hospital’s dermatology clinic to receive treatment. Alternatively, iontophoresis kits that you can use at home are also available.
Botulinum toxin is a relatively new treatment for people with hyperhidrosis. Botulinum toxin is a powerful protein that can be used safely in tiny (minute) doses. Around 12 to 20 injections of botulinum toxin are given in the affected areas of the body, such as the armpits, hands, feet or face.
The procedure takes about 30 to 45 minutes. The toxin works by blocking the signals from the brain to the sweat glands, reducing the amount of sweat that is produced.
The effects of botulinum toxin usually last from two to eight months, after which time further treatment will be needed.
Video-assisted thoracic sympathectomy (VATS) is the most widely used type of surgery to treat hyperhidrosis. VATS is usually recommended to treat cases of hyperhidrosis that have failed to respond to other types of treatment.
During the procedure, a surgeon will make two small incisions on the side of your chest and remove some of the nerve tissue that runs from your sympathetic nervous system to the affected sweat glands.
VATS can be used to treat excessive sweating of the armpits, face and hands. However, treating excessive sweating of the feet it is not recommended because the operation carries a risk of causing permanent sexual dysfunction, such as impotence. This is because damage to the part of the sympathetic nervous system that runs down the back and into the legs could also damage the nerves that are connected to the genitals.
So far, VATS has been moderately successful in treating hyperhidrosis. However, the operation does carry a significant risk of associated side effects as outlined below.
The most common side effect of VATS is excessive sweating in another part of the body, usually the lower back or upper thighs. This is known as compensatory sweating.
It is thought that almost all people who have the VATS procedure will experience some degree of mild compensatory sweating. However, an estimated 1 in 20 people will develop a more severe form of compensatory sweating. This is more likely to happen if you are obese.