Hyperhidrosis
Excessive sweating, also known as hyperhidrosis, poses a great dilemma to millions of individuals daily. This under-diagnosed disease often leads to social, occupational, and emotional disability. Unwarranted sweating can occur under the arms, on the face and scalp, palms of hands, soles of feet, and/or groin area. Sweating may arise at inopportune times: during social interaction, while shaking hands, or while working. Unfortunately, clothes, paperwork, and shoes may be damaged from the sweat which, for some, is dripping.
Individuals who suffer from hyperhidrosis should not feel ashamed or alone as nearly 8 million people living in the United States have hyperhidrosis. It is thought to result from an overactive nervous system and is not considered a neuropsychiatric disorder. Often, there is a family history of the disease. However, only about half of women and a third of men talk to a health care professional about their problem. Delay of treatment can perpetuate decreased quality of life since over 20% people with hyperhidrosis report the excessive sweating is not tolerable and interferes with daily life. This leads to less time at work, decreased participation in leisure activities, and interference in developing personal relationships.
A health care professional should be sought as the diagnosis of hyperhidrosis can often be unclear. The diagnosis of hyperhidrosis should be considered if two of the following occur for 6 months:
- First episode began before the age of 25
- Symmetric sweating (e.g. both underarms)
- Impairs activities of daily living
- Occurs at least one time a week
- Family history of excessive sweating
- Sweating does not occur in the area of concern at night
Other causes of the sweating should be excluded such as an illness with fever, endocrine and metabolic diseases (such as thyroid disorders), heart disease, medication use, substance abuse, and menopause. Despite the disabling effects of this disorder, there are several options for treatment. Treatment may vary slightly depending upon the location of the excessive sweating.
Axillary (under the arms)
The first step is to ensure that you are using an antiperspirant and not just a deodorant. If an over-the-counter antiperspirant does not alleviate the problem, then a prescription strength antiperspirant with the active ingredient of 20% aluminum chloride may be prescribed. This can sometimes lead to skin irritation which can be treated. However, if the irritation does not resolve, your dermatologist should be contacted. If the prescription strength antiperspirant fails then there are other options.
Iontophoresis (the application of low-level electric current to the surface of the skin) results in reduced production of sweat at that site. A battery-operated device called the Drionic unit, conforms to the shape of the underarm area, and uses tap water–wetted pads to stop sweating. Four to 15 treatments, 20 minutes long inhibit sweat for up to 6 weeks; 95% of patients showed improvement in 2 weeks, and 86% remained improved at 6 weeks. Minor re-treatment every 6 weeks is needed to sustain inhibition of sweating.
Botulinum toxin, also known as Botox®, can be injected into the underarm area to decrease sweating. This treatment is usually very successful and it eliminates sweating for 6 or 7 months. When botulinum toxin is unsuccessful, surgical options exist to remove the overactive sweat glands or to disrupt the nerves that release.
Palms (hands)
Prescription antiperspirant can also be used for the palms. This can be applied at bedtime then washed off in the morning. Another common form of treatment is tap water iontophoresis. This non invasive method involves the use a machine that delivers charged tap water to the skin for 20 – 30 minutes. However, pregnancy, pacemakers, or metal implants are a contraindication to use. If the antiperspirant or iontophoresis fails, then botulinum toxin is an option. Unfortunately, the pain from injections can be very intense and may require local anesthesia. Mild and temporary weakness of the hand may occur following treatment using botulinum toxin. Surgery is still an option when unresponsive to the other forms of therapy.
Soles (feet)
Prescription antiperspirant is also a first line of treatment for excessive sweating of the feet. However, extra hygiene measures are needed to help keep the feet dry. This includes changing socks at least 2 times a day and using absorbent foot powder 2 times a day. Shoes should be alternated daily in order to allow a pair to dry completely before the next wear. Shoes that are occlusive should be avoided, e.g. boots or sport shoes. Tap water iontophoresis is also used to treat the feet. If all of these methods are unsuccessful, then botulinum toxin can be attempted. Pain at this site can also be intense and may require local anesthesia. Surgery is not recommended for treatment of hyperhidrosis of the soles.
Face and Scalp
Treatment is limited for this area of the body. Botulinum toxin is an option for management. Although not frequently used, antiperspirant can be tried but caution should be taken to avoid the eyes. Food known by the individual to cause sweating, as well as other stimulants, should be avoided.
These forms of treatments for excessive sweating may not completely eliminate the problem. However, they can help an individual with hyperhidrosis gain a more functional life. No one should fear seeking help for this common condition as hyperhidrosis is a manageable disease for many.
By Pamela Summers, MD
References
1. Lear W, Kessler E, Solish N, Glaser DA. An epidemiological study of hyperhidrosis. Dermatol Surg. 2007 Jan;33(1 Spec No.):S69-75.
2. Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe NJ, Naver H, Ahn S, Stolman LP. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol. 2004 Aug;51(2):274-86.
3. utton DR, Kowalski JW, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol. 2004 Aug;51(2):241-8
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