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Sweating

sweating

This is a common problem, especially of the palms, armpits and soles. It can be distressing and can have a serious impact on your life. In some cases, affected people avoid social contact with others because of embarrassment about the problem. However, the condition is usually treatable.

What is excessive sweating?

The main reason for sweating is to keep the body temperature steady in hot weather, during a fever, or when exercising. Increased sweating (hyperhidrosis) means that you sweat much more than normal.

Excessive sweating is classified into three types (as follows). It is important to know which type you have, as the causes and treatments are very different.

  • Primary (idiopathic) focal hyperhidrosis is the excessive sweating, which occurs in one or more of the following focal places: palms of the hands; soles of the feet; armpits (axillae); face/scalp.
  • Normally, sweating occurs symmetrically. 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 may run in the family so there may be some genetic factor involved in causing it. It usually first develops under the age of 25, but it can develop at any age. Men and women are equally affected.

    It may come and go and can be made worse by triggers such as anxiety, emotion, spicy foods, and heat. Anxiety about the sweating itself may make it worse. However, for most of the time, nothing obvious triggers the sweating. It tends to be a long-term condition, but symptoms improve in some cases over time.

  • Secondary focal hyperhidrosis means excessive sweating occurring due to 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 may suggest a secondary cause.
  • Generalised hyperhidrosis, means that you sweat more than normal all over. This is less common than primary focal hyperhidrosis. However, 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 (including an overactive thyroid gland), infections, certain cancers, etc.
Does primary focal hyperhidrosis cause any complication?

Although not a medically serious condition, excessive sweating can be distressing and embarrassing. Other complications are uncommon. In some cases, the affected skin can become sore, irritated and prone to infection. There is a risk of developing eczema on affected skin.

How is it treated?

Initial treatment options for primary focal hyperhidrosis include:

  • General tips and advice:
    • If you find that soaps irritate the affected skin, use a bland soap substitute such as an emollient (moisturiser) 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. (Note: there is a difference between antiperspirants and deodorants. Antiperspirants reduce the release of sweat, deodorants mask unpleasant smells. Sweat does not have a smell. It is only sweaty clothes that are not changed that may become smelly).
      • Avoid clothes that more easily show up sweat marks.
      • Wear loose clothing under the armpits.
      • Consider using dress shields (also known as armpit or sweat shields) to absorb excess sweat and protect delicate or expensive clothing.
  • 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. This allows them to dry fully.
    • Avoid sport shoes or boots. These are often less breathable than normal shoes are, so are more likely to keep the sweat in.
  • 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.

    Apply to clean, dry skin. (It is more likely to cause irritation on wet or moist skin.) Therefore, wipe the skin dry with a towel or dry flannel before applying. Some people use a hair dryer to make sure the skin is dry before applying.

    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.

Other treatments for primary focal hyperhidrosis

If the above general measures and antiperspirant treatments do not work, your doctor may suggest that they refer you to see a dermatologist (a skin specialist). The specialist may suggest one of the following treatments.

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.

If the treatment does not work with tap water, a drug called glycopyrronium bromide is sometimes added to the water. This may improve the rate of success. However, iontophoresis does not work in every case. Also, some people develop side-effects from the treatment, such as a dry or sore mouth and throat, and dizziness, for up to 24 hours after each treatment episode.

Until recently the downside to iontophoresis was that it required a trip to hospital for each treatment session. This can be time-consuming and impractical for some. However, modern machines are smaller and can now be bought for home use.

You should not have iontophoresis if you are pregnant, or have a metal implant (such as a pin to fix a fracture), or if you have a pacemaker.

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. Botulinum toxin is not licensed to treat sweating of the palms and face. This is because there is a risk that the injections may stop some of the nearby small muscles of the hands or face from working.

Medication

Medicines that block the effect of the nerves that stimulate the sweat glands are sometimes used. For example, propantheline bromide. These medicines are not used very often. This is because the success of these medicines is variable. Also, side-effects commonly occur - for example, a dry mouth and blurred vision. However, for some people they work well and side-effects are minor.

Surgery

An operation is an option for people who have not been helped much by other treatments, or if other treatments cause unacceptable side-effects or problems.

For armpit sweating - an option is to remove the sweat glands in the armpit. The operation done ,is to cut out the area of skin in the armpit that contains the sweat glands. This usually works to reduce sweating, but a number of people have had problems after this operation due to scarring and a loss of the full range of movement of the arm.

newer technique is to scrape the sweat glands from the underside of the skin through a small hole cut in the skin. This appears to give good results with less risk of complications. A recent innovation has been to use a laser to destroy the sweat glands in the armpit - laser sweat ablation (LSA). This may result in less scarring than other surgical techniques.

For palm sweating - an option is to have an operation to cut some of the nerves that run down the side of the spinal cord. These nerves control the sweat glands in the hands. 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.

Most people are pleased with the result of the operation. However, a complication that often occurs following this operation is a compensatory increase in sweating in other parts of the body (such as in the chest or groin). This can be worse than the original problem in the hands. Because of this effect, a number of people who have this operation say that they regret having it done.


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