Hyperhidrosis (Excessive Sweating)

I knew a guy once who could literally squeeze water out of stone. Yes, I saw it with my own eyes. I got to know later that he had a problem with the sweat gland in his palms which produced so much sweat that it dripped at all times. He was suffering from hyperhidrosis.

Hyperhidrosis is the excessive production of sweat. Sweat is produced by sweat glands in the skin. The main function of sweat is to cool the body down or reduce its temperature. Thus, it is produced when the body temperature rises, such as when the weather is hot or when we exercise.

Sweat is also produced in states of embarrassment, anxiety and stress. This is because under these emotional states, the brain sends messages to the sweat glands in the skin to produce sweat.

About 1% of the population sweat excessively at all times even when they are neither hot nor exercising. While hyperhidrosis does not endanger the life or physical health of the individual, it can cause significant negative impact on the quality of life and cause difficulty with work, school and social relationships.

Excessive sweating of the hands interferes with many routine activities, such as securely grasping objects. Some hyperhidrosis sufferers avoid situations where they will come into physical contact with others, such as greeting a person with a handshake. Hiding embarrassing sweat spots under the armpits limits the sufferers arm movements and poses. In severe cases, shirts must be changed several times during the day.

Excessive sweating of the feet makes it harder for patients to wear slide-on or open-toe shoes, as the feet slide around in the shoe because of sweat. It also predisposes the feet to fungal infections.

Some careers present challenges for hyperhidrosis sufferers. For example, careers which require the deft use of a knife may not be safely performed by people with excessive sweating of the hands. Employees, such as sales staff, who interact with many new people, can be negatively affected by social rejection. Even the playing of musical instruments can be uncomfortable or difficult because of sweaty hands.

There are many forms of hyperhidrosis. It can either be generalized; affecting the whole body or localized; affecting specific parts of the body. Localised hyperhidrosis may be palmar (excessive sweating of the hands), axillary (excessive sweating of the armpits), plantar (excessive sweating of the feet), facial (excessive sweating of the face), cranial (excessive sweating of the head, especially noted around the hairline) and so on.

Hyperhidrosis can also be primary or secondary depending on the cause. Primary hyperhidrosis has no known cause and appears to be hereditary.

Secondary hyperhidrosis however has a known cause. Diseases of the thyroid or pituitary glands, diabetes mellitus, tumours, gout, menopause or certain drugs can cause hyperhidrosis.

Anxiety can exacerbate the situation for many sufferers. A common complaint of patients is that they get nervous because they sweat. They then sweat more because they get more nervous. Other factors can play a role; certain foods & drinks, nicotine, caffeine, and smells can trigger a response.

Hyperhidrosis can often be effectively managed. One needs to avoid situations and condition that makes sweating worse as well as change wet clothes regularly.

To prevent excessive sweating in normal individual, antiperspirants are use in the form of roll-ons and sprays. These contain substances such as aluminium chloride (or hexahydrate) which reduce sweating by blocking the sweat ducts so that sweat is not produced. Persons with hyperhidrosis however need large quantities of antiperspirants to achieve any good effects.

There are also oral medications which can help reduce excessive sweating. These drugs reduce anxiety or act on the nerves carrying information from the brain to the sweat gland. These drugs may be helpful but they also have considerable side effects such as drowsiness, visual symptoms and dryness in the mouth.

Injections of the botulinum toxin can also be used to disable the sweat glands. The effects can last from 4-9 months depending on the site of injections. With proper anaesthesia and expertise, the hand and foot injections are almost painless.

Surgical operations may also be used as the last resort to treat hyperhidrosis. The nerve which carries messages from the brain to the sweat gland can be excised (cut out), burned, or clamped my surgical means to prevent excessive sweating. This procedure causes relief of excessive hand sweating in about 85-95%. Recurrence rate can be high, and return of the sweating can be seen within 6 months of the procedure due to nerve regeneration. Side effects of this procedure include damage to other important nerves and excessive dryness of the palms (sandpaper hands).

Sweat gland suction is a new and novel technique adapted and modified from liposuction; approximately 30% of the sweat glands are removed, with a proportionate reduction in sweat.

Iontophoresis is a method for treating hyperhidrosis of the hands and feet. This involves the passing of low energy electricity through the hands and feet. The electricity cause the minerals in the water to clog the sweat glands, limiting the amount of sweat released. Some people have seen great results while others see no effect.

Weight loss, Hypnosis, Relaxation and meditation may also be helpful in reducing excessive sweating.