What is hyperhidrosis (Excessive sweating)?

This is a medical condition that causes excessive sweating. The word hyperhidrosis” means too much (hyper) sweating (hidrosis). Excessive sweating happens when a person sweats more than is necessary. Yes, it’s necessary to sweat. Sweating cools the body, which prevents us from overheating. People who have hyperhidrosis, however, sweat when the body does not need cooling.

Many people who have hyperhidrosis sweat from one or two areas of the body. Most often, they sweat from their palms, feet, underarms, or head. While the rest of the body remains dry, one or two areas may drip with sweat.  sweatpatchtshirt

This excessive sweating can interfere with everyday activities. Hands can be so sweaty that it becomes difficult to turn a doorknob or use a computer. Sweat from the underarms often soaks through clothes, causing obvious sweat marks. Because the skin is often wet, skin infections can develop.

Hyperhidrosis: Signs and symptoms

If you have this medical condition, you may notice:

Visible sweating: When you are not exerting yourself, do you often see beads of sweat on your skin or have sweat-soaked clothing? Do you sweat when you’re sitting?
Sweating interferes with everyday activities: Does sweating cause difficulty holding a pen, walking, or turning a doorknob? Does sweat drip heavily on to your papers or computer?
Skin turns soft, white, and peels in certain areas: Does your skin stay wet for long periods?
Skin infections: Do you get frequent skin infections on the parts of your body that sweat heavily? Athlete’s foot and jock itch are common skin infections.

Two types of hyperhidrosis
Both types cause excessive sweating, but there are some differences.

Hyperhidrosis: two main types

Sweating is necessary to control body temperature during times of exercise and in warm/hot surroundings, and is a normal response to a rise in temperature or anxiety. Sweating is regulated by the sympathetic nervous system. In about 1% of the population, this system is revved-up and works at a very high level, causing sweating to occur at inappropriate times, far in excess of the amount necessary to
maintain normal body temperature.

Types and Affected Areas
Primary (or focal) Hyperhidrosis most commonly affects hands (palmar hyperhidrosis, feet (plantar hyperhidrosis) and underarms (axillae), but can also affect or other areas – face and scalp, back, neck, groin, legs and buttocks. It affects both sides of the body equally, and often starts in adolescence or even childhood. Typically, it is not present when asleep, and it can run in families. The cause is not known,
although anxiety can make it worse. Although it is not temporary, it can sometimes improve with age. Approximately half a million people in the UK are affected.

Secondary Hyperhidrosis can affect the whole body (generalised hyperhidrosis) or specific areas, or it may only affect one side of the body. People with secondary hyperhidrosis often sweat while asleep. It can be caused by illness or infection, obesity, or hormonal conditions such as an over-active thyroid, the menopause or diabetes.  It can also be a side effect of certain medications, including SSRI anti-depressants such as Prozac. These causes must be ruled out before Primary Hyperhidrosis can be diagnosed.

CAUSES

While doctors don’t know why primary hyperhidrosis starts, they have successfully linked it to over-activity in the sympathetic nervous system. Specifically, it is the Thoracic Sympathetic Ganglion Chain, which runs along the vertebra of the spine inside the chest cavity.

This chain controls the glands, known as the apocrine and eccrine glands, responsible for perspiration throughout the entire body. Depending on which part of the chain becomes overactive, different parts of the body become affected.

Hyperhidrosis of the hands and feet – Palmar and Plantar

Hyperhidrosis of the hands, otherwise known as Palmar Hyperhidrosis, is the most common place to suffer from excessive sweating.

sweatypalms

It can be a distressing problem, as having constantly wet hands makes it hard to write on paper, hold pens, or use tools or keyboards. Having to shake someone’s hand is embarrassing. Aluminium chloride Antiperspirants can be very effective for some, although these are more successful for treating axillae (armpits). Anhydrol Forte (roll on),  Driclor (roll on) and Odaban (spray) are available over the counter or on prescription. Maxim is a similar anti-perspirant available in the USA.

As these antiperspirants can cause irritation and soreness, it’s important to follow the instructions precisely – apply at night, to completely dry skin, and wash off in the morning.

Iontophoresis is the second choice of treatment, and in 85% of all cases is successful using just tap water. Those who do not get a complete cessation of sweating using only tap water can obtain, on prescription, Glycopyrromium Bromide (Robinul) which can be added to the iontophoresis baths.

Botulinum (Botox) injection is not licenced in the UK for palmar hyperhidrosis, but can be performed at some private hospitals. The skin on the hand is sensitive, and the treatment can therefore be uncomfortable. It would need repeating every 4 months or so, and so an anaesthetic each time is not always recommended. However some specialists do perform local anaesthesia for this.

Endoscopic Thoracic Sympathectomy (ETS) can also be performed, but this is radical surgery with potentially severe side effects. Iontophoresis is more popular now, more successful and less invasive.
If possible, wash hands with non-soap based emollient washes and moisturisers.

Hyperhidrosis of the feet (Plantar)

Hyperhidrosis of the feet, otherwise known as plantar hyperhidrosis is a common  problem, and many people have sweaty feet. Plantar hyperhidrosis is often associated with an unpleasant odour, maceration of the toes and mycotic infections. It is made worse by wearing synthetic shoes and man-made fibre socks. The smell of  sweaty feet comes from the bacteria that thrive in warm moist conditions, so wash
often and stick with leather shoes or sandals and 100% cotton socks. Change your socks often, and don’t wear the same pair of shoes 2 days in a row – give them time to dry out properly. Go barefoot whenever possible.
Anti-perspirants can be very effective.
Iontophoresis is very effective for most people if aluminium chloride antiperspirants don’t work.
Botulinum Toxin treatment (Botox) is not licensed in the UK for hyperhidrosis of the feet, and surgery is not generally recommended.

Hyperhidrosis of the armpits – axillae

Excessive sweating from the armpits is not just irritating, it can have a major effect on people’s lives. Sufferers are constantly aware of trying to hide embarrassing wetness or sweat stains on clothes, and this can interfere with work or social activities.
Avoid man-made fabrics and tight clothes, and reduce obvious signs of sweating by wearing black or white. Wash with emollient washes and moisturisers rather than soap-based cleansers.
Antiperspirants containing aluminium chloride are the first line of treatment, such as Aluminum Chloride, Anhydrol Forte (roll on), Odaban (spray) or Driclor.(roll on), which are available on prescription from your GP or over the counter. Treatment consists of applying the medication onto the skin and leaving it on overnight and washing off again in the morning. The skin must be dry and clean upon application. If the skin is moist, severe skin irritation may occur.

These antiperspirants must not be applied to broken, irritated or recently shaven skin. It may cause irritation, which can be alleviated by the use of a weak, corticosteroid cream.

Disposable Axillae Pads or sweat pads can be worn under clothing to absorb moisture.

Iontophoresis machines can be used to treat armpits, using Axillae pads.
Botox: Axillary hyperhidrosis can be treated by Botulinum Toxin A. This is only  available in a few NHS hospitals, but is performed in many private hospitals and clinics throughout the UK.

botox-underarm-sweating

Surgery: If these treatments have failed to control the symptoms, there are surgical procedures. Microwave sweat gland ablation (Miradry), Laser Sweat Ablation, Retrodermal Curettage and Vaser are procedures carried out privately, under a local anaesthetic, by only a handful of surgeons in the UK. Not much follow up experience is available for Miradry.
Endoscopic Thoracic Sympathectomy (ETS) is not recommended for axillary hyperhidrosis.

Self help and antiperspirants

Although you should talk to your GP to confirm you have hyperhidrosis, there are a number of things you yourself can do to minimise some of the symptoms of excessive sweating.

Antiperspirants:
Although many people use the terms ‘antiperspirant’ and ‘deodorant’ interchangeably, they are not the same. An antiperspirant is an astringent meant to decrease eccrine and apocrine sweat secretion, while deodorants are designed just to remove and mask unpleasant smells, but not reduce the sweating. If regular antiperspirants do not control your excessive sweating, an antiperspirant containing Aluminium Chloride is usually the first line of treatment. Anhydrol Forte (roll on), Odaban (spray) and Driclor (roll on) are sold in most chemists or on-line, and are available on a prescription from your GP. Maxim, available in USA, is similar.

driclor
Treatment consists of applying the medication onto the skin, leaving it on overnight, and washing it off in the morning. It’s important to follow the instructions closely. The skin must be dry and clean upon application; if it is moist, severe skin irritation may occur. It must not be applied to broken, irritated or recently shaven skin.
These antiperspirants may cause irritation, which can be alleviated by the use of a weak (1%), corticosteroid cream, or you may be able to control the sweating by using the antiperspirant less frequently.
Wear loose fitting clothes and avoid synthetic fabrics – choose 100% cotton, silk, linen or wool, and genuine leather shoes or sandals which allow your feet to breathe. Black or white clothing tends to show sweat marks less. Absorbent underlayers, such as T-shirts, also help to absorb the sweat, and there are products which claim to be extra absorbent. You may need to change clothes or socks and shoes
more than once a day, and avoid wearing the same pair of shoes twice in a row – they need time to dry out fully. When you exercise, wear fabrics that wick moisture away from the skin, and moisture-wicking athletic socks are helpful for some.
Identify any trigger factors for sweating, such as crowded rooms, rushing about, alcohol, spicy foods and hot or caffeinated drinks etc, and avoid these triggers.