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Hyperhidrosis or excessive sweating can be caused by many factors including excessively hot or humid environments, eating hot or spicy foods, fear, stress, anxiety, medical disorders, disease or disorders of the sympathic nervous system or underlying malignancy.
This condition can be embarrassing and can affect one’s quality of life. Sweating is a natural function of the human body to reduce one’s body temperature when necessary due to weather, exercise, etc. Hyperhidrosis is excessive sweating when such triggers are not present. This tends to be unpredictable and cause much distraught to the patient due to excessive wetness of skin and clothes. This disorder can cause anxiety and have an emotional toll on the patient, which can worsen the condition.
Palmoplantar hyperhidrosis is the type that occurs on the palms, and soles. The underarms are often involved. It is usually inherited and emotionally based. It is due to overactive sweat glands in the skin, the cause for this is unknown. Patients in certain situations are fearful, stressed or anxious. It can be seen in childhood or adolescence. It usually disappears in adulthood.
Gustatory hyperhidrosis is the sweating that occur after eating hot or spicy foods. This type occurs on the forehead, chest or upper lip and is due to over active sympathetic nerves.Generalized hyperhidrosis or sweating over the entire body can be seen after vigorous exercise, hot, humid, tropical climates, in disorders with a high fever, in medical disorders such as diabetes mellitus, hyperthyroidism, hypoglycemia or low blood sugar, pregnancy, menopause, disorders of the sympathetic nervous system, medications, and underlying malignancy.
The dermatologist is usually consulted for the palmoplantar type of hyperhidrosis. All other types are usually referred to the primary care physician for work up and eventual diagnosis and treatment. Hyperhidrosis can be diagnosed by the patient’s history. There are relatively easy and pain free tests available that can be used to help assess the amount of sweat produced.
Treatment options usually begin with topical antiperspirants containing aluminum chloride or aluminum chlorhydroxide. Over the counter products range from 2.5%-4% concentration. Prescription strength begins with 6.25% strength and go to 35% concentrations. These products are usually applied at night, and are covered with a plastic dressing to increase penetration into the sweat ducts. Contact dermatitis or irritant dermatitis with swelling of the lymph nodes can develop when applied to the underarms, so the products are usually applied once or twice a week. Botox or botulinum toxin injections to the palms, soles or underarms has shown dramatic decrease in sweating. Side effects include cost, pain of injections and some grip strength loss when injected into the palms. A decrease in sweating can be seen from 7 months to 16 months in some patients. The use of oral medications, such as anticholinergic agents may be helpful. This method may be best administered by an Endocrinologist. Surgical excision, by elliptical removal of the underarm skin containing sweat glands is almost always successful. This approach is usually proceeded by thorough mapping of the sweat glands with cobalt chloride or starch iodide. Lastly upper thoracic sympathectomy has been found effective in severe hand sweating when all other methods fail. Surgical complications occur in less than 2% of patients.Your dermatologist can help you determine which treatment option is best for your individual needs.