The sweating disease. That's what we called it, my friends and I. We had to make a joke of it, or my friend would have cried when she sweat through her shirts while sitting in air-conditioned rooms.
Hyperhidrosis is a condition where your body produces more perspiration than is needed to cool the body and maintain appropriate body temperature. For sufferers this means profuse sweating even in cool temperatures and without physical exertion.
How many people suffer from hyperhidrosis?
"I don't think there are any hard statistics on the incidence [of hyperhidrosis]. I would estimate that it is something like 1 per 1000 people or so," says Richard Glogau, MD, a clinical professor of dermatology at the University of California, San Francisco who specializes in treating hyperhidrosis.
We're at a college football game on a comfortable September day. It is sunny and warm, but not hot. As we cheer for a great pass and an acrobatic reception, I lean over to my friend and whisper, "Um, you're sweating a lot again." I'm trying to help her avoid the embarrassment of anyone else seeing the grapefruit-sized sweat stains on the armpits of her green t-shirt. So she sits quietly with her arms at her sides, afraid to even wave to friends who pass by.
While teaching a workshop at a client site, I notice (as did everyone else in the room) that one of my co-presenters was sweating profusely from the armpits and even on the middle of his back. I returned to the office after the trip to learn that the client was upset that he had been sweating. They felt it was "unprofessional."
The social and professional problems associated with profuse sweating from the armpits (called axillary hyperhidrosis) are obvious, but it doesn't end there. People with palmar (hands) hyperhidrosis are afraid to shake hands, write on paper, or handle paper products at all. The foot sweat from plantar hyperhidrosis creates a bad odor or smell and may ruin some shoes permanently. Facial sweating is obviously embarrassing as everyone can see the perspiration on your face. Like axillary sweating, perspiration from truncal (torso) hyperhidrosis also can show through clothing.
The answer, in many cases, is unknown. This is called primary hyperhidrosis, because the sweating is not a symptom of some underlying condition. It is also referred to as idiopathic, again because the cause is unknown.
Although, the actual cause of hyperhidrosis is unknown, the mechanism by which the excessive sweating occurs is pretty clear. The sympathetic nervous system (the part of the nervous system that we do not control) sends signals to the sweat glands telling them to produce and eject sweat. Excessive sweating occurs when this system sends signals to produce more sweat than is needed to maintain body temperature. The big question is why?
For some people with hyperhidrosis there are answers. These people actually have another condition that is causing the excessive sweat. Called secondary hyperhidrosis, this can be caused by the following conditions:
What about stress? Though stress seems to worsen hyperhidrosis, most physicians don't consider it a cause.
"The nervous system is geared to sweat more [in people with hyperhidrosis], so the sweat response is more sensitive to stress in these people," explains Ib Odderson, MD, of Overlake Medical Center in Bellevue, Washington.
Yes, though in many cases the goal of treatment is to manage the disease rather than cure it entirely. Treatments for hyperhidrosis work to varying degrees depending on the type and severity of the condition.
There are no drugs that specifically treat hyperhidrosis. Some sedatives and anticholinergic drugs may reduce the sweating to some degree, but are not used because their side effects (dry mouth and blurred vision) are considered worse than the sweating.
Caffeine is one drug that should be avoided because it belongs to a class of chemicals that stimulate sweating. Though they do not specifically cause hyperhidrosis, caffeine and spicy foods can exacerbate the problem.
Treatments for light to moderate cases
Treatments for severe cases
For people whose sweating is profuse, dermatologists and neurologists are using the following techniques to help them.
Botulinum toxin injection (Botox )
In very small doses, botulinum toxin reduces sweating by blocking the messages that nerves send to sweat glands telling them to produce too much sweat. One treatment keeps most people dry for 4-10 months and has to be repeated. It is also quite expensive, estimated at $350-$700 per session.
The treatments for severe hyperhidrosis are being studied to determine their efficacy. Here's what experts in the field have to say:
"As a general rule, most people should try the [Botox] injections first, because there are no permanent long-term risks," advises Dr. Glogau of the University of California, San Francisco. "With surgery there are some risks," he adds.
Dr. Glogau has found liposuction to be "quite variable in its outcome." Having treated a number of patients who got only a partial response from liposuction, he reports, "I think that the choice is largely between Botox and sympathectomy."
On the other hand, Harold Brody, MD, clinical associate professor at Emory University School of Medicine calls liposuction "a marvelous procedure" for treating underarm sweating.
Dr. Brody explained which procedures seem to work best for each type of hyperhidrosis:
If you think that you may have hyperhidrosis, see your doctor. Remember, you are not just someone who sweats a lot. You may sweat a lot when you're exercising, but that doesn't mean you have to suffer through embarrassing sweat all day. There are several therapies that you and your doctor can discuss. And if your doctor doesn't know about this condition, find another doctor, or ask for a referral to a knowledgeable doctor. This is not a simple case of trying a stronger deodorant.
RESOURCES:
The International Hyperhidrosis Society
http://www.sweathelp.org
Society of Thoracic Surgeons
http://www.sts.org/
CANADIAN RESOURCES:
Hyperhidrosis
http://www.hyperhidrosis.ca/
Sweat Management
http://www.sweatmanagement.ca
Last reviewed April 2008 by Ross Zeltser, MD, FAAD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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