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Hyperhidrosis

Hyperhidrosis is the medical term for excessive sweating. The problem may be limited to a few problem areas or may affect the whole body. Especially problematic areas include armpits and palms.

Excessive sweating most commonly starts after puberty. It may be present to some degree at all times, but is at its worst when under stress such as during exams, interviews or dating. Excess sweating that affects areas other than the armpits and palms may also be a sign of more serious problems. For this reason, systemic, neurological and anxiety conditions need to be ruled out; however most cases have no underlying cause. This is especially the case if you suffer from night sweats.

Other possible causes can be other medications, menopause, or as a symptoms of another issue, for example hypoglycemia.

While it may not be dangerous, hyperhidrosis can make many tasks more difficult, damage self-esteem and confidence, and interfere with many jobs — for example working with a keyboard.

Treatments

The first stage of treating hyperhidrosis is lifestyle changes such as avoiding sweating triggers, e.g. spicy foods and alcohol, wearing looser clothing, and using strong anti-perspirant.

Unfortunately, most over-the-counter antiperspirants are not strong enough to overcome hyperhidrosis. There are more effective treatments available by prescription, usually containing aluminium chloride which blocks sweat glands. These may be somewhat irritating and sometimes take a while to get used to.

They should be applied at bedtime to completely dry skin and washed off in the morning shower, and not combined with a regular deodorant. This is repeated nightly until the sweating is under control. After it begins to work, use once or twice weekly to maintain the effect, and use a regular deodorant on the other days. This method kind of medication is less effective on the thick skin of the palms and soles.

If this treatment doesn't work well enough there are alternatives. Botox injections, a treatment popular for wrinkles, will control excessive sweating for 4 to 6 months. Botox is a purified protein which has the ability to block the chemical which activates sweat glands. It is possible to use Botox for palm sweating, however sometimes it may cause a temporary weakness of the grip.

People who have not had success with the above treatments may consider anticholinergic medication. This kind of medication is an especially good option when someone has generalized sweating. These drugs are safe but may have side effects including dry mouth, constipation, urine retention, blurring of vision, and heart palpitations. Since these side effects are dose dependent, it's best to start with a low dose and slowly increase the dose if needed.

If non-surgical options have all failed, there are surgical alternatives. For example, a surgical procedure called 'endoscopic thoracic sympathectomy' can cure hyperhidrosis of the palms or armpits. It does this by selectively damaging relevant nerves that control sweating. It may cause some increased sweating on other parts of the body, and has been known to have other nervous system related side-effects, which should be discussed with your surgeon.

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Medical Secretary, Julie De Pascalis
M: 07809 442942  
E: dermatologyconsultantlondon@gmail.com