Don’t Sweat Me

By Peter Galvin, MD

[Today’s topic was requested by a reader. The reason I write this column is to provide medical education to the readers. Please feel free to request any topic and I will do my best to help.]

The term hidrosis, like diaphoresis, refers to perspiration, or sweat. Sweating is a mechanism by which the body controls its temperature, among other things. For example, a patient in distress, say in an ER, who is sweaty, is described as diaphoretic. Some people have hyperhidrosis or sweat more than normal. Hyperhidrosis is a medical condition in which a person sweats more than is required for regulation of body temperature. It can affect a person’s quality of life and cause moderate to severe emotional effects. Often called “the silent handicap,” hyperhidrosis can cause excessive sweating of the underarms, face, neck, groin, feet, or hands.

Hyperhidrosis can either be generalized or localized and is estimated to affect nearly 3% of the U.S. population. When excessive sweating is localized, for example palms and soles, it is referred to as focal palmoplantar hyperhidrosis (see photo). It is further classified as congenital (present at birth) or acquired (beginning later in life). While some cases of primary hyperhidrosis are inherited (estimated at 30% to 50% of primary cases), the cause of many primary cases is unknown. Secondary hyperhidrosis can be caused by a myriad of issues, for example certain types of cancer, endocrine system disturbances, infections, and medications. Conditions associated with hyperhidrosis include diabetes, Parkinson disease, hyperthyroidism, hyperpituitarism, anxiety disorder, pheochromocytoma, and menopause. It can also be linked to certain foods and drinks, caffeine, nicotine, and certain smells.

A diagnosis of hyperhidrosis is usually made by a dermatologist. Testing may be required to find a secondary cause. If excessive sweating occurs on only one side of the body, neurologic testing is often required. Treatment can be problematic. Most antiperspirants contain aluminum chlorohydrate, but treatment of hyperhidrosis requires solutions or gels with much higher concentrations of this chemical. Sometimes, lotions containing formaldehyde or anticholinergics can be used as they reduce perspiration by denaturizing keratin, which clogs the pores of sweat glands. Of course, like most medications, anticholinergics can have side effects including dry mouth, urinary retention, constipation, and visual disturbances. One-time oral doses of an anticholinergic can be taken prior to anxiety-producing occasions like speaking engagements, stage performances, and weddings. Injections of botulinum toxin type A (Botox) can be used to block neural control of sweat glands, but multiple injections are required, and the injections can be painful.

In severe cases, surgery may be used as a last resort. Endoscopic thoracic sympathectomy (ETS), which cuts, burns, or clamps the thoracic nerves that run alongside the spine, has been reported to be effective at rates above 80% for excessive hand sweating, but surgical side effects are common. The most common side effect is compensatory sweating, meaning sweating in different areas than prior to surgery. Excessive sweating of the hands can interfere with many routine activities, for example using a knife, grasping objects, or playing an instrument. Finally, there is an online website that can be helpful. Go to the website of the International Hyperhidrosis Society at www.sweathelp.org

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