Hyperhidrosis

Definition

Hyperhidrosis is sweating more than would be expected in the temperature of the environment.

Description

This condition is characterized by constitutional hyperactivity of the eccrine sweat glands. The disorder may be generalized, consisting of excessive body sweating, or localized, with sweating confined to the palms, soles, armpits, groin, and under the breasts.

As a rule, onset is in childhood or during puberty. Patients experience a heightened reaction to sweating stimuli such as anxiety, pain, exercise, tension, caffeine, and nicotine.

The sweat-prone areas may be localized or generalized. When the palms and soles are involved, the skin may appear pink or blue-white, and may even macerate, crack, or scale, particularly on the feet. Patients often experience spontaneous relief in adult life.

Causes and Risk Factors

The cause is unknown. In very rare cases, hyperhidrosis of the palms and soles is thought to be inherited as an autosomal dominant genetic trait.

One must distinguish between idiopathic hyperhidrosis from excess sweating due to malfunction of the thyroid or pituitary gland, infection, diabetes mellitus, tumors, gout, and menopause.

The disorder affects males and females in equal numbers.

Treatment

Before treating generalized hyperhidrosis, a possible primary disorder must be ruled out. For patients with palmar-plantar-type hyperhidrosis, cotton socks and shoes that promote the circulation of air prevent overheating of the feet. Alternating footwear is helpful. Applications of medicated powder formulated to hamper bacterial growth is useful.

For refractory cases, topical agents such as aluminum chloride in ethyl alcohol may be indicated for axillary sweating but is often useless for sweating hands. Short-term courses of anticholinergic drugs are also useful in severely afflicted patients but the side effects of dry mouth, drowsiness and constipation frequently occur.

Super-antiperspirants may be of some help. These are essentially superstrength formulas of regular underarm antiperspirants. The active ingredient, aluminum chloride, actually reduces the sweat output (unlike deodorants, which just deal with odor). Heavyweight formulas are available over the counter in concentrations up to 12 percent, compared with 4 to 6 percent in regular antiperspirants. Even stronger concentrations are available with a prescription. The trick is to use them correctly. They work only when applied to dry skin.

Do not apply them to broken skin or freshly shaved underarms. To increase their effectiveness, apply them at night before bed, since the nervous system is less active during sleep. In the morning, shower as usual, then apply regular antiperspirant to the underarms. Two or three applications of this combined treatment should keep one dry for another three days.

One approach to treatment is to control stress. Whether or not emotional stress is the instigator, stress does make the sweating worse.

Stress management therapists take three main approaches to help a patient calm overactive sweat glands. First is the daily use of relaxation tapes or meditation. Second is biofeedback training; and third is traditional psychotherapy that investigates and aims to remove the causes of stress.

Surgery is available in extreme cases in which sweat glands are removed from underarms, or the nerves that trigger the sweat glands in the hands can be cut.

Questions to Ask Your Doctor

What is the probable cause of the excessive sweating?

Would a super-antiperspirant help?

What are other treatment options?

Do you recommend stress management?

Would surgery be indicated?