The thermoregulators next to the skin are connected to the hypothalamus which helps regulate the body’s temperature. When the body releases heat, sweating occurs. Sweating helps the body stay cool. In most cases, it is perfectly natural. People sweat more in warm temperatures, when they exercise, or in response to situations that make them nervous, angry, embarrassed, or afraid.
However, excessive sweating occurs without such triggers. Those with hyperhidrosis appear to have overactive sweat gland regulators. The uncontrollable sweating can lead to significant discomfort, both physical and emotional resulting in to social phobias.
When excessive sweating affects the hands, feet, and armpits, it's called primary or focal hyperhidrosis. Primary hyperhidrosis affects 3 - 4% of the US population and as much as 15% in countries like Sweden and Noway, yet less than 40% of patients with this condition seek medical advice. In the majority of primary hyperhidrosis cases, no cause can be found. It seems to run in families.
If the sweating occurs as a result of another medical condition, it is called secondary hyperhidrosis. The sweating may be all over the body, or it may be in one area. Conditions that cause second hyperhidrosis include:
• Anxiety conditions
• Carcinoid syndrome
• Certain medications and substances of abuse
• Glucose control disorders
• Heart disease
• Lung disease
• Parkinson’s disease
• Spinal cord injury
•Tuberculosis or other infections
The primary symptom of hyperhidrosis is wetness and odor.
Exams and Tests
Visible signs of sweating may be noted during a doctor's visit. A number of tests may also be used to diagnose excessive sweating.
• Starch-iodine test. An iodine solution is applied to the sweaty area. After it dries, starch is sprinkled on the area. The starch-iodine combination turns a dark blue color wherever there is excess sweat.
• Paper test. Special paper is placed on the affected area to absorb the sweat, and then weighed. The heavier it weights, the more sweat has accumulated.
You may be also be asked details about your sweating, such as:
- Does it occur your face, palms, or armpits, or all over the body?
• Time pattern
- Does it occur at night?
- Did it begin suddenly?
- Does the sweating occur when you are reminded of something that upset you (such as traumatic event)?
• What other symptoms do you have, for example:
- Weight loss
- Pounding heartbeat
- Cold or clammy hands
- Lack of appetite
Treatments may include:
• Disposable Pads or Dress Shields. These discreet protectors offer an easy method of care at a low cost while providing the solution as sweat will be hidden and controlled.
• Clinical Antiperspirants. Excessive sweating may be controlled with strong anti-perspirants, which plug the sweat ducts. Products containing 10% to 20% aluminum chloride hexahydrate are the first line of treatment for underarm sweating. Some patients may be be prescribed a product containing a higher dose of aluminum chloride, which is applied nightly onto the affected areas. Antiperspirants can cause skin irritation, and large doses of aluminum chloride can damage clothing. Note: Deodorants do not prevent sweating, but are helpful in reducing body odor.
• Medication. Anticholinergics drugs, such as glycopyrrolate (Robinul, Robinul-Forte), help to prevent the stimulation of sweat glands. Although effective for some patients, these drugs have not been studied as well as other treatments. Side effects include dry mouth, dizziness, and problems with urination. Beta-blockers or benzodiazepines may help reduce stress-related sweating.
• Iontophoresis. This FDA-approved procedure uses electricity to temporarily turn off the sweat gland. It is most effective for sweating of the hands and feet. The hands or feet are placed into water, and then a gentle current of electricity is passed through it. The electricity is gradually increased until the patient feels a light tingling sensation. The therapy lasts about 10-20 minutes and requires several sessions. Side effects include skin cracking and blisters, although rare.
• Botox. Botulinum toxin type A (Botox) is FDA approved for the treatment of severe underarm sweating, a condition called primary axillary hyperhidrosis. Small doses of purified botulinum toxin injected into the underarm temporarily block the nerves that stimulate sweating. Side effects include injection-site pain and flu-like symptoms. If you are considering Botox for other areas of excessive sweating talk to your doctor in detail. Botox used for sweating of the palms can cause mild, but temporary weakness and intense pain.
• Endoscopic thoracic sympathectomy (ETS). In severe cases, a minimally-invasive surgical procedure called sympathectomy may be recommended when other treatments fail. The procedure turns off the signal that tells the body to sweat excessively. It is usually done on patients whose palms sweat much more heavily than normal. It may also be used to treat extreme sweating of the face. ETS does not work as well for those with excessive armpit sweating.
International Hyperhidrosis Society, www.sweathelp.org
Aluminum chloride: Initially a patient may need to use it one to four times a week. After sweating becomes normal, the person may need to use it only once every one to three weeks. If skin irritation is a problem, a doctor may temporarily prescribe a steroid-based cream.
Botox: Swelling goes away in a few weeks. The effect of a single injection can last up to a few months. Some patients need additional injections. This may also cause muscle damage as found in clinic tests.
Iontophoresis: Sweating may be reduced after six to 10 sessions. After that, the person may need treatment once every one to four weeks.
Some of the causes of hyperhidrosis can be serious. Always consult a doctor if you have excessive sweating.
When to Contact a Medical Professional
Call your health care provider if you have:
• Prolonged, excessive, and unexplained sweating
• Sweating with or followed by chest pain or pressure
• Sweating with weight loss
• Sweating that most often occurs during sleep
• Sweating with fever, weight loss, chest pain, shortness of breath, or a rapid, pounding heartbeat - these symptoms may be a sign of an underlying disease, such as hyperthyroidism
Sweating - excessive; Perspiration - excessive; Diaphoresis
Boley TM, Belangee KN, Markwell S, Hazelrigg SR. The Effect of Thoracoscopic Sympathectomy on Quality of Life and Symptom Management of Hyperhidrosis. Journal of the American College of Surgeons. March 2007;204(3).
Reisfeld R, Berliner KI. Evidence-based review of the nonsurgical management of hyperhidrosis. Thorac Surg Clin. 2008 May;18(2):157-66. Review.
Hornberger J, Grimes K et al. Recognition, diagnosis and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 2004; 51: 274-86
Lowe NJ, Glaser DA, Eadie N, et al. J Am Acad Dermatol. 2007 Apr;56(4):604-11. Epub 2007 Feb 15.Botulinum toxin type A in the treatment of primary axillary hyperhidrosis: a 52-week multicenter double-blind, randomized, placebo-controlled study of efficacy and safety.
Solish N, Benohanian A, Kowalski JW. Prospective open-label study of botulinum toxin type A in patients with axillary hyperhidrosis: effects on functional impairment and quality of life. Dermatol Surg. 2005 Apr;31(4):405-13.
Update Date: 5/13/2011
Updated by: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.