Suffering from excessive perspiration or hyperhidrosis can dominate your thoughts, and interrupt your life. It is hard to explain to people who sweat normally just how embarrassing it is to always have sweat rings on your clothing, or to feel the need to wipe your hand across your pant leg before you extend it to another person because you fear that your sweaty palm will disgust them.
People think you are nuts because you shower two or three times a day, but what they do not know is that you live in constant fear that your excessive sweating will cause you to smell badly. More than likely, you suffer from extreme dry skin because you shower so much that you have washed all of the natural oils away. People who do not have hyperhidrosis do not understand this type of sweat.
Most people sweat when they get hot, and sometimes they sweat when they are nervous, but people who suffer from hyperhidrosis sweat all of the time, or at least it seems like the sweat never stops. You get up, take a shower, put on fresh clothing, and within a few minutes the sweat ring will form under your arms. You will not have left the comfort of your home and you will already be sweating.
The people who have facial hyperhidrosis constantly have to wipe the sweat from their brow to keep it from running down their face in streams. That is hyperhidrosis. It means women may not be able to wear makeup. It means not sharing clothes with your girlfriend, and even being afraid to try clothes on in the store. It means never shaking hands with someone without drying yours off first. It means your shoes are wet on the inside, and they have horrible odors, because of the decomposing sweat and the bacteria.
Hyperhidrosis may not be a deadly disease. Foundations are not out raising money to help save the victims, but hyperhidrosis is a condition that can alter your life in negative ways. It does stop you from enjoying social engagements. It makes you wear three shirts even in the summer when everyone is wearing tank tops. It stops you from dancing close with others, and it makes you feel dirty, and ashamed.
You did nothing to create your hyperhidrosis, and it is time you stop living like a recluse because you fear that you will sweat in public. There are several treatment options for this condition, and research is still being done to find ways to permanently cure it.
If you suffer from hyperhidrosis, you are not alone. You are joined by roughly three percent of the population. That knowledge will not stop you from sweating, nor will it make you feel liberated, but it can give you solace in knowing that others are fighting this battle with you.
Let’s try and look at hyperhidrosis, what causes it, how it is treated, and the hopes for the future. Maybe some of this information will help you in your struggle.
Chapter 1: The Science of Sweat Glands
Sweating is a natural part of the human body. Our bodies are designed to produce sweat when our internal temperature rises too high. As the sweat evaporates off of our skin, it cools the body, much like the radiator in a car cools the engine by pushing coolant through surface lines to reduce internal heat.
You have two different types of sweat glands. These are the eccrine sweat glands and the apocrine sweat glands. The eccrine sweat glands are evenly distributed throughout our body. They are your primary cooling system, while the apocrine sweat glands are generalized to the perianal areas and to the armpits. The apocrine sweat glands are not a part of the body’s cooling system.
Apocrine Sweat Glands
Apocrine sweat glands do not produce the watery sweat that cools our bodies. Instead these glands are positioned close to a hair follicle. The apocrine sweat gland produces an odorless, oily fluid. You might be thinking that the odorless part of that statement cannot be correct, because your armpits are smelly, and the more of that secretion that is emitted from them, the smellier they become. But the odor comes as the fluid starts to decompose. Bacterial decomposition causes the odor, not the presence of the oily fluid.
In order for the apocrine sweat glands to emit the secretion the body has myoepithelial cells that create a muscle lining for the secretory cells of the apocrine sweat glands. The muscle formed by the myoepithelial cells contracts and this contraction applies pressure to the secretory cells. The pressure causes the build-up of the oily fluid in the secretory ducts to be forced into the nearest hair follicle.
The number of apocrine glands that people have, and the amount of sweat they produce, vary from one individual to the next. The good news is that most of the time, as people grow older, the number of glands tends to diminish.
Eccrine Sweat Glands
Eccrine sweat glands are the primary cooling system of the human body. These glands are spread out all over the body, but they seem to be most prevalent in the palms of the hands and on the soles of the feet. When we get overheated our hands and feet begin to produce the watery sweat.
Sweat is composed of primarily water, but it also contains electrolytes it gets from blood plasma, and sodium chloride. The sodium chloride in the watery substance we call sweat is why our sweat tastes salty.
What Triggers Sweat?
The stimuli that causes you to sweat may come from a combination of your internal body temperature and the mean temperature of your skin’s surface. Your sweat glands are also triggered by emotional factors. Some of the emotional causes of sweat are:
You sweat when you are faced with these emotional periods because adrenaline acts on the sweat glands to cause them to produce sweat. The majority of sweat produced by the eccrine glands is due to acetylcholine stimulation.
You can also trigger sweating by ingesting certain foods. Hot and spicy foods can actually stimulate receptors located in the mouth that signal the need for a thermoregulatory response. Peppers, and spicy foods, contain a compound called capsaicin. Capsaicin is what causes these foods to seem hot. The capsaicin binds to the receptors in the mouth and triggers the sweat that forms on the face, the scalp, and the neck of the person eating the food.
Antiperspirants and Deodorants
There are a lot of people who think that these two items do the same thing. This is not the case.
Deodorants are designed to mask, or cover up the odor produced when the secretion from the apocrine glands starts to decompose. Think of deodorants as a cologne you wear primarily under your arms. Deodorants cannot stop the production of sweat.
An antiperspirant actively reduces the amount of sweat from the eccrine and apocrine sweat glands. Antiperspirants contain metal salts. These metal salts act on the keratin fibrils in the sweat ducts and this causes the sweat ducts to become plugged. This reduces or stops the sweat from being secreted from the duct.
Some products on the market include ingredients that make them have antiperspirant and deodorant (AP/Deo) properties.
Now we know why everyone sweats, but let’s look at the condition of hyperhidrosis that causes extreme sweating in so many people.
Chapter 2: What is Hyperhidrosis?
Hyperhidrosis is pronounced HI-PUR-HI-DROE-SIS.
In short, hyperhidrosis is the over-production of sweat. This over-production may occur in the eccrine sweat glands, or in the apocrine sweat glands. There are many people who suffer from this condition and actually have over-production of sweat occur in more than one location.
This condition occurs in men and women equally. It occurs in all of the races with no prevalence to one over another. It happens to people who are the perfect weight, and in great physical condition. It also happens to people who are overweight. Hyperhidrosis is an equal opportunity condition.
Hyperhidrosis severity is measured according to a four point scale called the hyperhidrosis disease severity scale or HDSS. This scale helps medical professionals to determine the extent of your condition, and to determine if the current method of treatment is helping to any great extent. A HDSS can be administered by a medical professional, and you can also do a self-completed HDSS.
The questionnaire can be adjusted according to the type of hyperhidrosis you suffer from. A score of 1 simply means that you do not really have a problem controlling your sweating condition, and 2 means you have some difficulties, but are not overly bothered by the sweat, and a 3 or 4 means you have reached the end of your rope and you need help stopping the sweat from pouring.
Always be honest with yourself when you are filling out one of these questionnaires. Your doctor cannot help you to overcome the condition if you are not one hundred percent honest with them about the severity of the condition, how the condition makes you feel, and the things you have tried to stop the condition. Remember that the medical professionals are there to help you, not to judge you.
Types of Hyperhidrosis
The condition of hyperhidrosis is basically broken up into two categories.
Primary hyperhidrosis is categorized as an over-production of sweat that is not in direct relation to any other medical condition the patient may suffer, or medication the patient may be taking.
Secondary hyperhidrosis is categorized as the over-production of sweat caused by another physical ailment or medication a person takes to treat it. Secondary hyperhidrosis can often be reversed by changing the medicines that the person takes, or by treating their other medical condition.
Hyperhidrosis by body parts
Hyperhidrosis can cause the over-production of sweat anywhere on your body. The most prevalent areas are:
- The face (facial hyperhidrosis). Includes profuse sweating on the brow above the eyes, the upper lip, and on the neck of the individual.
- Scalp. May cause sweat to drip from your brow where your hairline meets your brow, or from the nape of your neck where your hairline stops.
- Underarms (axillary hyperhidrosis). Is possibly the most prevalent location where people experience hyperhidrosis symptoms. Sweating under the arms is often accompanied by sweating of the hands, face, or feet.
- Hands (palmar hyperhidrosis). When you have sweaty palms all of the time.
- Feet (plantar hyperhidrosis). When you have really sweaty feet.
Ages Most Frequently Affected
Primarily, this condition affects people who are over 14 and under 64, but it can strike at any age. Infants, young school aged children, and teens have also been diagnosed with the condition.
Hyperhidrosis seems to be especially difficult for teens to deal with. The teen years are filled with peer pressure, and the struggle to define who you are, and where you fit into society. When a teen suffers from hyperhidrosis they do not have the self-confidence to participate in sports, or to join other teens in social engagements. They live in fear of being made fun of, and they simply withdraw into themselves and isolate themselves from the world.
The teens who have this condition often develop a sense of self-loathing that they carry into their adult lives. Adults can choose to seek treatment, or attempt to live with their condition, but it is imperative that a teen suffering from hyperhidrosis see a doctor. Their future really does rely on them learning ways to deal with this problem.
Signs and Symptoms of Hyperhidrosis
Of course, sweat is the sign of hyperhidrosis, but this condition causes more than just glistening sweat. You may be experiencing:
- Sweating when you are at rest.
- Sweating when the temperature is not the cause.
- Sweating so heavily from your face, or hands, that the water visibly drips.
- Sweating so severely on your feet that your socks and shoes get wet.
- Sweating of the feet even in the winter when your feet feel cold.
- Sweating so hard that your shirt becomes wet under the arms within minutes of getting dressed.
- Blushing or intense redness of the face.
- Sweating from the face so heavily that you cannot perform your work, or eat a meal without stopping to wipe away the sweat
See a doctor if:
- You are sweating on your palms, your feet, or your underarms so profusely that it interrupts your daily routines.
- If you are experiencing these high levels of sweat once a week, or more.
- You are suddenly having night sweats that you cannot think of a reason for.
- You are suddenly having palms so sweaty they drip, or you need to change shirts frequently because of armpit sweating, and the temperatures, or your activities, do not correspond with the amount of sweat you are producing.
- You run a temperature that is higher than 101° Fahrenheit.
- Any pustules form in the area where you sweat the most.
- If you start to suffer from boils or signs of a staph infection.
What Causes Hyperhidrosis
There is no definite answer as to what causes the condition to occur. Some surgeons believe that the primary cause is sympathetic over-activity of the sweat glands. This sympathetic activity is thought to be made worse by emotional upsets, nervousness, or intense excitement. It is also believed that certain foods and drinks, and stimulants like caffeine and nicotine, can cause the condition to be more active.
Some medical conditions are associated with an increased occurrence of hyperhidrosis. These conditions include:
- Heart attack
- Riley-Day syndrome
- Orthostatic hypotension disorder
- Parkinson’s disease
- Congestive heart failure
- Night sweats
- Hines & Black syndrome
- Mercury poisoning
- Pituitary gland disorders
- Thyroid gland disorders
- Trench foot
- Harlequin syndrome
Hyperhidrosis may be brought on by certain medications taken for other conditions. People who take medications to regulate diabetes, or their blood pressure, may experience a form of excessive sweating disorder as a side-effect of their medication.
Chapter 3: Treatments for Hyperhidrosis
The doctor will likely talk to you about when you are noticing the episodes of extreme sweating, and what you have tried to alleviate the condition. They will likely have some blood work done to eliminate other medical conditions of which over-production of sweat can be a symptom.
Treatments vary according to the intensity of the condition and the part of the body. You might respond well to a prescription antiperspirant, and another person might not get any effect from those substances. Hyperhidrosis is a very personal condition, and each patient will need to find the treatment that works best for them.
The first line of defense against hyperhidrosis is an antiperspirant that contains aluminum chloride (in its hexahydrate form). You can start this type of treatment anytime, since these products are sold over the counter.
The antiperspirants are primarily used in treating axillary hyperhidrosis, due to their high effectiveness in that area. Some people do apply these products to the soles of their feet, and sometimes to the palms of their hands.
These antiperspirants can be found in different presentations: different active ingredient concentrations, ingredients’ quality and purity, form (liquid or gel), buffer agents (ethanol, water, others), and extra ingredients that enhance the effectiveness of the formula and the user experience.
One note on active ingredient concentrations. The FDA approves the use of up to 15% of aluminum chloride (hexahydrate) for OTC antiperspirants. There are higher concentration products (20%) that can be bought with a prescription. This is not recommended, since there are trials proving that 15% is as effective as 20% and more tolerable for the skin.
The only side effect of these specially formulated antiperspirants is itchiness and skin irritation for the first few applications. These are easily solved by suspending their use for 3 or 4 days. There’s new research on skin protectant ingredients to help reduce these side effects without compromising the effectiveness of the formula.
Antiperspirants are the safest and least expensive method for treating the excessive sweating condition. They also have the highest success rates for axillary hyperhidrosis. Costs for this treatment are usually below $100.
Anticholinergics are oral medications used to treat the symptoms of this condition. You have to be careful, since several of these medications are not approved by the FDA as treatments for hyperhidrosis. These can usually interact with other medications we could be taking. And sometimes the side effects can be less desirable than the excessive perspiration. Please do not take any of the following without consulting a doctor.
- Propantheline. May cause dry mouth, swelling from urinary retention, constipation, mydriasis (prolonged dilation of the pupil in the eye) or cycloplegia (paralysis of the ciliary eye muscle).
- Glycopyrronium bromide. May cause dry mouth, water retention, constipation, eye conditions like mydriasis and cycloplegia, drowsiness.
- Oxybutynin (main ingredient in Ditropan). May cause drowsiness, impaired vision, dry mouth.
- Glycopyrrolate (main ingredient in Robinul). May cause drowsiness, impaired vision, dry mouth.
- Propantheline bromide (main ingredient in Probanthine). May cause drowsiness, impaired vision, and dry mouth.
- Benztropine (main ingredient in Cogentin). May cause dry mouth, impaired or blurred vision, drowsiness.
Botulinum Toxin (Botox) Injections
Botox injections can be effective. The problem with Botox injections is that it will take several injections in each area that experiences excessive sweating for it to work, and the effects will only last for 4 to 6 months. These injections can be quite painful, and they are very expensive; the price can quickly add up to thousands of dollars.
Botox injections must be administered by someone who has been trained in this procedure and the use of this medication. Botox is powerful enough to paralyze the muscles where it is injected causing the muscle to be unable to contract. When the muscles surrounding the sweat glands cannot contract the sweat cannot be expelled from the sweat ducts.
Botox has numerous side effects. The majority of people who have a side effect from a Botox injection report that they suffered from headaches, nausea, redness at the injection site, pain at the injection site, and some say they had the same symptoms of someone with the flu. Other patients complained of muscle weakness, or the loss of muscle control after receiving an injection. Difficulty in swallowing or breathing after receiving a Botox injection is rare, but is not unheard of.
The Food and Drug Administration requires Botox, Dysport, Xeomin, and similar medications to have black box labeling warning of the dangers of complications if the toxins being injected were to spread beyond the site of injection.
MiraDry treatments are performed in the office of a state-certified physician. The specialized MiraDry tool emits heat into the area where the sweat glands are located, while keeping the outer dermis layers protected by a cooling system.
The majority of patients that have used the new MiraDry treatments since the FDA approved them in 2011 report that they had reduced amounts of sweat production after the initial treatment, and they continued to have improvements in their sweat production with each subsequent treatment.
MiraDry treatments cost between $1,500 and $1,800 for a one hour treatment. The majority of patients need to have two treatments for effective sweat reduction. The treatments are usually spaced three months apart. That makes the average person pay between $3,000 and $3,500 for this type of procedure.
Electric Current Stimulation
Iontophoresis is another type of treatment that may stop hyperhidrosis. This treatment uses electrical current stimulation and has been practiced since the 1940s.
Iontophoresis is generally used to treat hyperhidrosis on your hands and feet. The patient will have the portion of their body that is affected by hyperhidrosis immersed into a tub of water. The doctor will make an electrical current pass through the water. The electrical current will be gradually increased until you feel a tingling sensation.
The treatment process takes about thirty minutes to complete. When you first begin to get treatments you will need to get one every few days for the first couple of weeks. The majority of patients report that they stop sweating after treatment number 4 to number 7.
Once you stop sweating you will need to start doing maintenance treatments. Maintenance treatment schedules vary from individual to individual. Some people only need treatments once a month to keep their sweating under control, and some people need to have their maintenance treatments once a week.
No one knows for sure why this treatment is effective in stopping excessive sweating, but it is believed that the electrical current somehow causes the opening to the sweat gland to become plugged.
There are now iontophoresis machines available for home treatment of hyperhidrosis. Quality equipment can cost $500 and upwards.
Pregnant women, and people who have metal joint replacements, or pacemakers, should not receive this type of treatment. The main side effects that people complain of are redness and skin irritations, generally where the skin enters the water line. Applying petroleum jelly on these areas, or over any open sore will help to reduce the amount of irritation you have.
This surgical treatment is probably the most invasive of all hyperhidrosis treatments, and unfortunately 80% of the people who have it are dissatisfied with the final results. The procedure is done by a surgeon destroying the nerves that trigger sweating by cutting them or clipping them at the sympathetic nervous system.
Along your spinal cord there are collections of nerve cells called ganglia. The surgeon will go in and cut the ganglia that corresponds to the area where you experience the excessive sweating. A laser beam is used to do the cutting, and the entire procedure is done as an outpatient procedure so you will go home the same day, actually within a few hours of completion.
The scarring from the procedure will be minimal, but it will be permanent. If the surgeon does the procedure endoscopically there will be little to no scarring.
Most patients are out of surgery within an hour. The majority of people return home on the same day that they have the procedure, and have no scarring associated with the surgery. The sutures are beneath the skin and will dissolve over time. People complain of soreness at the incision site and in the chest area, but they can often return to work the day after their procedure with minimal restrictions.
The side effects of endoscopic thoracic sympathectomy (ETS) surgery can range from slight to devastating. The side effects include but are not limited to:
- Compensatory sweating in other locations on the body.
- An increase in total body sweating.
- Cardiac sympathetic denervation, which can lower a person’s heart rate by 10%. This lower heart rate impairs the the work/rest level at which the heart is designed to function properly.
- Gustatory sweating while eating and smelling spicy or hot foods occurs in a small number of patients following ETS surgery.
- Horner’s syndrome is a risk associated with ETS performed on people with facial hyperhidrosis. This syndrome causes drooping of the eyelids, pupil constriction, and severe facial sweating. The chances of developing Horner’s syndrome after an ETS is close to 0.3%.
- A small number of patients report neuritis or neuralgia following ETS surgery. Neuritis is a non-specific pain located between the shoulders of the individual. The condition is usually treated by giving the person an anti-inflammatory medication. Most of the time the condition goes away within a few weeks, but there are rare instances when the condition is permanent.
- Some patients report that the skin on their faces, scalp, or neck, became very dry after ETS surgery.
Not everyone is a good candidate for endoscopic thoracic sympathectomy. People who have cardiac illnesses are not good candidates. People who have thyroid conditions, and people who have excessive scarring on their chests are not considered to be good candidates for this type of surgery. People who have pleural disease are not good candidates for this procedure.
Within a week of having the surgery you will return to work. If your excessive sweating interferes with you performing your job, your surgical costs might be covered by your medical insurance. The procedure will cost between $10,000 and $20,000, depending on the facility where you have it done, and other mitigating factors.
Sweat gland removal surgery can be beneficial if your main problem is axillary hyperhidrosis. The sweat glands can be removed from this area using a liposuction technique so the incisions are kept small.
Sweat gland removal surgeries may be performed by a cosmetic surgeon. You can have traditional surgery to cut the sweat glands out of the area that you have trouble in, or you can have suction curettage performed.
When you have suction curettage, you will go to the hospital or clinic as an out-patient. This is a form of liposuction. To begin, the sweat glands that are going to be removed have a local anesthetic applied to them. The anesthetic will cause the glands to be softer and stop you from feeling any discomfort during their removal.
Two small incisions will be made at the upper edge of the armpit. The surgeon will scrape the sweat glands loose and then suction them out. Curettage means scraping in medical terminology.
The entire procedure will take between sixty and ninety minutes. You will need to remain at the hospital or clinic for a few hours after the procedure so you can be monitored for excessive bleeding, or swelling.
There are some drawbacks to having suction curettage performed. All surgeries, even minor ones like this, have the risk of creating complications during, or after the procedure. Some patients also experience compensatory sweating on their backs, torso, or legs after they have the sweat glands removed from under their arms.
This procedure can cause the skin to become taut, so it can make raising your arm above your head or stretching your arm out painful and nearly impossible to achieve, especially if the wound healed improperly and resulted in some reduced muscle function.
This treatment costs between $4,000 and $7,000 dollars.
An arthroscopic shaver is used to permanently destroy the majority of the sweat glands in your armpit. An incision is made in the armpit and the affected skin is gently pulled away from the underlying tissue. The shaver is used to destroy the sweat glands, and because of the method used the hair follicles in the area will not be disturbed, and the scarring is so minimal it is rarely noticed.
This procedure costs about $5,000. One of the side effects that patients complain of is that they began to sweat in other locations after the surgery.
Chapter 4: Tips to Help You Manage the Symptoms
Lifestyle changes and home remedies used for hyperhidrosis include:
- Wear garments made of silk, cotton, or wool. Natural fibers such as these allow your skin to breathe and help you to feel cooler, and sweat less.
- Wear fabrics with large weaves so they allow more air to flow around your body.
- Try relaxation techniques such as deep breathing to help you reduce the amount of stress and anxiety you suffer. This will also help you to reduce the amount of sweating you do.
- Wear light colored shirts, because you sweat more when wearing dark colors due to the fact that your body temperature is higher when you wear dark colors.
- Place baking soda on a damp cloth and clean under your arms, or the soles of your feet with the cloth. This will help eliminate odors from sweat.
- Shower with cold water. And we don’t need to say it, but shower every day.
- Use antibacterial soaps to reduce bacteria, and thus body odor.
- Apply witch hazel to the affected area; it will lower the skin’s pH, thus making it difficult for bacteria to thrive. This will help you control body odor caused by sweat-decomposing bacteria.
- Choose socks that are made from all-natural materials like cotton. Cotton absorbs moisture and helps to keep your feet dry.
- Use over-the-counter foot powders to help absorb the sweat. You can place these powders directly onto your skin, or in your socks or shoes. These powders may also help to eliminate the stinky odors that this condition creates.
- Keep your hair cut short if you have hyperhidrosis of the scalp or neck. You can also get your hair thinned if you have excessively thick hair to help keep your scalp cooler.
- You may drink herbal teas containing St. John’s wort, astragalus, sage, and valerian root to try and decrease the amount of sweat you produce.
- Switch to decaffeinated coffee and tea. Caffeine increases your heart rate and can raise your blood pressure, so it can also increase the amount of sweat you produce.
- Do not wear a hat if you are prone to excessive sweating. Hats keep your internal temperature higher because they do not allow your body to cool down properly. You want your head to be uncovered so your core temperature can be reduced.