Excessive sweating (hyperhidrosis)

Sweat is essential to human survival as it cools the body's temperature and protects it from overheating. Excessive sweating (or hyperhidrosis) occurs when the sweat glands produce more sweat than is necessary to regulate body temperature. Regardless of the area affected, hyperhidrosis can have a detrimental effect on one's quality of life, as it can interfere with daily activities and undermine self-esteem.

Causes and aggravating factors

There are two types of hyperhidrosis: primary hyperhidrosis, which is its own medical condition, and secondary hyperhidrosis, which is a symptom of an underlying medical condition.

While the exact cause of primary hyperhidrosis is unknown, it may be related to over-activity of the central nervous system. It usually affects at least one of the following areas:

  • Underarms
  • Hands
  • Feet
  • Face

This type of hyperhidrosis, which appears to have a genetic component, usually develops during childhood or adolescence and continues through adulthood. Emotions (stress, fear, etc.) and heat may worsen symptoms. Sweating caused by heat (face, chest and back) can occur at any time, but emotionally-induced sweating (hands, feet and underarms) usually does not occur while sleeping.

Secondary hyperhidrosis is caused by another underlying medical condition such as menopause, endocrine disorders, obesity, nerve damage, or certain types of drugs. Unlike with primary hyperhidrosis, those with secondary hyperhidrosis experience generalized sweating, meaning it is not limited to certain areas of the body, and symptoms can occur while sleeping. Lastly, in those with secondary hyperhidrosis, excessive sweating usually starts in adulthood.

Since treatments differ depending on the type of hyperhidrosis, it is important to talk to a health professional to determine exactly what type you may have.

Treatment

The only treatment for secondary hyperhidrosis is to eliminate the underlying cause. Primary hyperhidrosis however, is a chronic condition, which means it cannot be cured completely. The following treatments however, can help manage symptoms:

  • Topical treatments (applied on the skin)
    • There are a variety of over-the-counter antiperspirants on the market. If a traditional antiperspirant is not enough, your pharmacist may be able to recommend an antiperspirant that contains aluminum chloride (e.g. Drysol, Hydrosal ) at a concentration ranging from 6.25% to 20%.
    • Contrary to popular belief, aluminum-based antiperspirants are not associated with an increased risk of developing breast cancer or Alzheimer's disease.
    • To reduce the risk of irritation, antiperspirants that contain aluminum chloride must be applied to completely dry skin once a day, at bedtime. Treated areas must be washed in the morning. Once excessive sweating is reduced (usually after 3 days), reduce application to once or twice a week.
    • Areas treated with aluminum chloride should not be covered as this may increase the risk of skin irritation.
    • If irritation occurs with the use of a product containing aluminum chloride despite these precautions, a hydrocortisone cream (e.g. Cortate ) may be applied on the affected area.
    • Methenamine cream (e.g. Dehydral ) is also available without a prescription for excessive sweating of the feet. This treatment however, is associated with a risk of allergic reaction and skin irritation.
  • Iontophoresis
    • This treatment involves treating the affected areas (usually the hands and feet) by placing them in a basin through which an electric current is passed.
    • For optimal results, the treatment (which lasts between 15 and 40 minutes depending on the device) should be repeated a few times over the course of several weeks.
  • Botox injections
    • While effective, Botox injections in the hands and feet can be painful, costly and may cause local muscle weakness.
  • Oral medications
    • Certain prescription medications may be used to treat hyperhidrosis. Due to the risk of adverse effects, they are used to treat several areas of the body or large surfaces, or when local treatments are ineffective. Some medications may also be used as needed (e.g. before a presentation at work).
  • Surgery
    • Given the invasive nature of the procedure, as well as the risks and possible adverse effects, which include compensatory sweating (meaning greater amount of sweating elsewhere in the body to compensate for the lack of sweating in the treated area), surgery is usually reserved for patients who are unresponsive to other treatments.

Good personal hygiene is essential to preventing excessive sweating in patients with hyperhidrosis. The following measures can be taken to avoid episodes of excessive sweating and/or unpleasant odours:

  • Wash daily with an antibacterial soap or cleanser.
  • Wear clothing made from natural fibers that are breathable.
  • Avoid alcohol and spicy foods.
  • Dry feet thoroughly after washing and use absorbent powder once or twice a day.

When to seek medical advice

  • When hyperhidrosis symptoms appear to determine whether an underlying medical condition is responsible.
  • If excess sweating impairs your daily activities.
  • If over-the-counter products are not having the desired effects.

For more information:

International Hyperhidrosis Society

www.sweathelp.org

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