Written by Dermatologist Dr Justine Kluk
What is hyperhidrosis?
Hyperhidrosis is a medical condition that literally means excessive sweating: “hyper” means too much and “hidrosis” means sweating.
We all need to sweat. If we didn’t sweat we’d overheat on hot days or when we exercise or get nervous. But in about 3% of the population, sweating happens when it doesn’t need to, and far more than is necessary to maintain a normal body temperature.
Hyperhidrosis tends to be localised, meaning that it only affects one or two parts of the body (the hands, feet, underarms or forehead) whilst the rest of the body stays dry. It is usually symmetrical so that both sides of the body e.g. both hands or feet etc. are affected. For people who are otherwise healthy, this condition is known as primary hyperhidrosis.
There are other medical conditions that may increase sweating, often in a more all-over or generalised fashion. This is known as secondary hyperhidrosis. Typical causes include diabetes, gout, overactive thyroid (hyperthyroidism), obesity, accident or injury, menopause, medications or food supplements and, rarely, tumours. Secondary hyperhidrosis may also cause excessive sweating overnight whilst you are asleep leading to soaked pyjamas and bed sheets. This sort of sweating should be reported promptly to your GP so that they can investigate and treat the underlying cause.
How might it affect me?
Primary hyperhidrosis is a long-term condition, often starting in childhood or adolescence. It occurs in all sexes and races, and often affects more than one member of the same family. Constant sweating leads to wet patches and staining of clothes, damp smelly shoes, difficulty gripping items such as pens, turning doorknobs or handling materials like paper. Hyperhidrosis sufferers are often reluctant to shake hands when they meet new people because they are embarrassed that their hands will be cold and clammy. Many are limited to wearing dark, loose clothing so that wet patches are less visible. Daily life can become a cycle of trying to conceal the effects of the condition, finding time and privacy to shower or freshen up during the day, and changing clothes every few hours. Some people will stop seeing their friends, withdraw from relationships and avoid work colleagues. Unfortunately, low self-esteem, loneliness and depression are not uncommon.
What are the treatments?
Primary hyperhidrosis is usually managed by a dermatologist. It is not unusual to try a couple of different options before finding the one that provides the best relief, and sometimes a combination of treatments may be needed.
The following treatment options may be discussed:
1. Antiperspirants
Antiperspirants containing aluminium chloride, such as Anhydrol Forte or Driclor, are often the first line of treatment. These are easy to buy online or at the chemist and are very affordable.
To get the best from this treatment, take a shower in the evening, dry the skin thoroughly afterwards and sit calmly until you have cooled down completely before applying your antiperspirant. The solution is drawn into the sweat glands and forms a plug so that less sweat is produced. Sometimes these products can cause mild stinging or irritation, but when applied as directed, antiperspirants can be very effective.
Some patients are concerned that antiperspirants will cause breast cancer or Alzheimer’s disease. To date, there is no evidence to prove this.
2. Iontophoresis
This is an excellent treatment for hyperhidrosis of the hands and feet. The affected areas are immersed in a shallow water bath through which a low-voltage current is transmitted. The treatment takes approximately 20 -30 minutes and is pain-free.
For the first couple of weeks, treatments are given every few days and most people find that they have stopped sweating after 6 – 10 treatments. Thereafter, maintenance treatment is needed when the affected areas start to become clammy, and before sweating starts again. This is typically anything from twice a week to once a month, and can be done at home if you purchase your own device.
3. Botulinum toxin injections
This is a safe and very effective treatment for underarm sweating. A series of tiny injections are placed throughout the armpits. In the hands of an experienced dermatologist, there should only be minimal discomfort.
Botulinum toxin injections temporarily block sweat gland activity at the treated sites. Results can be seen within a week and the effects last between 4 – 6 months. When sweating returns, treatment can be repeated.
4. Prescription medicine
A group of oral medicines called anticholinergics are sometimes used when hyperhidrosis affects several parts of the body. Although they can be very effective at preventing sweating, they can also cause other side effects like a dry mouth, dry eyes, constipation and blurred vision. This often limits their use at higher doses.
5. Surgery
If the medical treatments described above fail to bring relief, surgery may be considered. Surgery is permanent and carries risks. Your dermatologist can refer you to a surgeon to help you weigh up the risks and benefits of the following options:
- Surgical removal or liposuction of the sweat glands e.g. to the underarms
- Sympathectomy (cutting of certain nerves) e.g. to the palms
6. Newer hand-held devices
There are some newer treatment devices that use electromagnetic radiation to heat and destroy the sweat glands in the armpits. This is said to work within two clinic visits and have an enduring response. Unlike the more established treatments, although initial reports sound promising, it is difficult to know how successful these devices will turn out to be in the long-term.
Is there anything I can do?
The following self-help tips may be of use. For expert help, seek the advice of a dermatologist.
- Wear breathable fabrics like 100% cotton or silk.
- Opt for genuine leather shoes as these are also more breathable.
- Black or white clothes disguise wet patches better.
- Disposable sweat pads can be purchased to absorb excess underarm moisture.
- Carry a spare shirt or blouse and a change of socks in your work bag.
- Choose socks that wick moisture away from your feet e.g. merino wool.
- Alternate a couple of different pairs of shoes to give each pair time to dry out between use.
- Avoid triggers such as hot drinks, alcohol or spicy foods if you know that these exacerbate your symptoms.
- Odour-producing bacteria can thrive in sweaty skin – using an antibacterial body wash in the shower every day can help prevent this.
