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Excessive Sweating (Hyperhidrosis)

excessive sweating

Normal sweating helps to keep the body temperature steady in hot weather, during a fever, or when exercising. Excessive sweating (hyperhidrosis) means that you sweat much more than normal. Even when you are not hot, anxious, or exercising, you make a lot of sweat. Excessive sweating is classified into three types .

Primary (idiopathic) focal hyperhidrosis

This means that excessive sweating occurs in one or more of the following focal places: palms of the hands; soles of the feet; armpits (axillae); face/scalp.

You sweat normally on the rest of the body. It tends to be symmetrical - that is, both palms, both feet, both armpits, etc, are affected. The exact cause is not known and it is not associated with any other conditions. It just seems that the sweat glands in these areas are overactive or more sensitive than normal. It usually first develops under the age of 25, but it can develop at any age. Men and women are equally affected.

The severity can vary from time to time. It may come and go and can be made worse by triggers such as anxiety, emotion, spicy foods, and heat.

Secondary focal hyperhidrosis

This is uncommon. It means that the excessive sweating occurs in a particular focal part of the body. But, unlike primary focal hyperhidrosis, there is a known or likely cause. For example, a spinal disease or injury may cause sweating in one leg. Any focal sweating that is not symmetrical (that is, just in one hand, or one leg, etc) may suggest a secondary.

Generalised hyperhidrosis

It is usually caused by an underlying medical condition. A whole range of conditions can cause a generalised increased sweating. For example: anxiety disorders, various heart problems, damage to nerves in the spinal cord, side-effects to certain medicines, various hormonal problems, infections, certain cancers, etc.

What are the possible complications of primary focal hyperhidrosis?

Although not a medically serious condition, excessive sweating can be distressing and embarrassing. If you have bad armpit sweating, you may become embarrassed by the frequent wet patch that develops on clothes under your arms.

General tips and advice

  • If you find that soaps irritate the affected skin, use a bland soap substitute such as an emollient ointment or cream.
  • If possible, avoid triggers which can make things worse such as heat or spicy food.

If you have armpit sweating:

  • Try using normal antiperspirants regularly.
  • Avoid clothes that more easily show up sweat marks.
  • Wear loose clothing under the armpits.

If you have excessive feet sweating, it can help to:

  • Change your socks at least twice a day.
  • Use an absorbent foot powder twice daily.
  • Wear a different pair of shoes on alternate days.
  • Avoid sport shoes or boots.

Aluminium chloride - a strong antiperspirant

If normal antiperspirants do not work, it is worth trying an antiperspirant that contains aluminium chloride. This is a strong antiperspirant. It is thought to work by blocking the openings of the sweat ducts. It tends to work best in the armpits. However, it may also work for sweating of the palms and soles.

Ideally, apply at night (bedtime) when the sweat glands are less likely to be as active.

Wash it off the next morning.

Do not shave the area 24 hours before or after use.

Avoid getting it in the eyes, and do not apply on broken or inflamed skin.

Some doctors do not recommend that you apply this treatment to your face.

Apply every 24-48 hours until the condition improves. Then apply once every 1-3 weeks, depending on response.

Other treatments for primary focal hyperhidrosis

Iontophoresis

This is a treatment that uses electrical stimulation. It is used mainly to treat sweating of the palms and/or soles. It can also be used to treat armpit sweating. It works well in most cases. Treatment involves putting the affected areas (usually hands and/or feet) into a small container filled with water. A small electrical current is then passed through the water from a special machine. It is not dangerous, but may cause some discomfort or a pins and needles feeling. The exact way this helps to treat sweating is not known. It may help to block the sweat glands in some way.

You will usually need 3-4 treatment sessions per week. Each treatment session lasts 20-40 minutes. Most people see an improvement after 6-10 sessions. A maintenance treatment is then usually required once every 1-4 weeks to keep symptoms away.

Botulinum toxin injections

This is an option that usually works well for armpit sweating. Treatment consists of many small injections just under the skin in the affected areas. The botulinum toxin stops the nerves in the skin that control the sweat glands from working.

Surgery

For armpit sweating - an option is to remove the sweat glands in the armpit. There are various techniques. For example, one operation is to cut out the area of skin in the armpit that contains the sweat glands. A newer technique is to scrape the sweat glands from the underside of the skin through a small hole cut in the skin. A recent innovation has been to use a laser to destroy the sweat glands in the armpit - laser sweat ablation (LSA).

For palm sweating - The operation is called a thoracoscopic sympathectomy. It is done by keyhole surgery, using a special telescope to locate the nerve, and then to cut the nerve.
Surgery is not usually done for sweating of the soles. Although cutting the nerves next to the spinal cord in the lower back region may cure the problem of sweating, there is a high risk of this also affecting sexual function.


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