By: Richard Bleuze
Excessive sweating is known in the medical community as hyperhydrosis or hyperhidrosis.
Approximately 7 million people in the US are effected by excessive sweating and hyperhidrosis according to the American Academy of Dermatologists. Excessive perspiration is a condition whereby an individual produces an excessive amount of perspiration and sweat.
Almost every one sweats as a normal reaction to stress such as heat and exercise. However, some people sweat excessively underarms, on the hands or the feet, causing severe social and psychological embarrassment. These people suffer from a condition known as primary focal hyperhidrosis. It affects one in twenty people worldwide. Some people are so embarrassed by this condition that they never seek help from their medical doctors.
What is the result of excessive sweating?
Excessive sweating (hyperhidrosis) is an embarrassing complaint and significantly interferes with many daily activities.
Clothing becomes damp and unsightly and must be changed several times a day. Wear loose fitting garments made of fabric that does not stain.
Wet skin folds are prone to intertrigo.
It is embarrassing to shake hands and it difficult to write neatly.
Sweaty feet develop an unpleasant smell, ruin footwear and are prone to dermatitis or secondary infection (tinea, impetigo or pitted keratolysis). Expect to change your socks several times a day. .
What are the treatment options available for excessive sweating (hyperhidrosis)?
Before I begin, however, I'd like to mention the following for you to keep in mind: For decades, attempts at countering excessive sweating (hyperhidrosis) through alternative methods have been made. Conservative solutions, such as BOTOX, lotions, oral medications, electronic devices, acupuncture, anti-anxiety medications, beta blockers, biofeedback, and herbal medicines have had little or no effect on the problem. The only highly effective and permanent solution has been surgery.
That said, surgery should not be resorted to without attempting some of these alternative methods (Read my reasons below). In fact, many insurance companies demand that alternatives be tried before surgery is concluded upon.
General tips and advice
The following may be all that you need if the condition is mild, and may help in addition to other treatments in more severe cases.
If you find that soaps irritate the affected skin, use a bland soap substitute such as an emollient (moisturiser) ointment or cream. Frequent washing using a deodorizing soap can reduce the smell and discomfort, but overuse of soaps can also result in dermatitis. Choose a non-soap cleanser instead.
If possible, avoid any triggers which can make things worse such as heat or spicy food.
If you have armpit sweating:
Antiperspirant sprays, sticks, roll-ons and paints are available. Choose an unfragranced aluminium salt preparation suitable for hyperhidrosis (10-25% in alcohol or as a gel). Antiperspirants should be applied when the skin is dry, after a cool shower, just before bed. Wash off in the morning. They should be used for several consecutive nights then once or twice weekly. The stronger products can irritate; if so, apply hydrocortisone cream for a few days.
Note: ‘deodorants’ are fragrances designed to disquise unpleasant smells. They don't affect the amount of sweat produced.
Talcum powder and corn starch powder are suitable for mild hyperhidrosis. Apply between the toes, under the breasts and other skin folds.
Wear loose clothing under the armpits, and preferably not made with man-made fibres such as lycra and nylon.
If you have excessive feet sweating, it can help to:
Change socks at least twice daily.
Use an absorbent foot powder twice daily.
Wear a different pair of shoes on alternate days, to allow them to dry fully.
Avoid sport shoes or boots, as these are likely to have an occlusive effect. Absorbent insoles in shoes are useful, but may need replacing frequently.
Aluminium chloride - a strong antiperspirant.
If normal antiperspirants do not work, you doctor may advise an antiperspirant that contains aluminium chloride. This works like a 'strong' antiperspirant. It is thought to work by blocking the openings of the sweat ducts. It tends to work best in the armpits. However, it may also work for sweating of the palms and soles. Although it may also work on the face, some doctors do not recommend using this on the face as it may cause severe eye irritation if it gets into an eye.
There are several brands of aluminium chloride based antiperspirants. For example; Driclor and Anhydrol Forte which come in a bottle with a roll-on applicator; ZeaSORB - a dusting powder that contains aluminium chloride; and Odaban spray that contains aluminium chloride. You can buy these at pharmacies, and some are also available on prescription. It is important to use aluminium chloride based antiperspirants correctly. Read the instructions that come with the product you use. These usually include the following:
Apply to clean, dry skin. Therefore, wipe the skin dry with a towel or dry flannel before applying.
Ideally, apply at night (bedtime) when the sweat glands are less likely to be as active.
Wash it off the next morning.
Do not shave the area 24 hours before or after use.
Avoid getting it in the eyes, and do not apply on broken or inflamed skin.
Apply every 24-48 hours until the condition improves. Then apply once every 1-3 weeks, depending on response. (It may take a few weeks to build up its effect. This is because it is thought to gradually clog up the sweat gland which causes a gradual reduction in sweating.)
If successful, treatment can be continued indefinitely. You may only need to apply it once every 1-3 weeks to keep the sweating under control.
Note: aluminium chloride antiperspirants often cause skin irritation or inflammation. If this occurs, it is often still worth persevering if the irritation is tolerable as the benefit may outweigh the irritation. To reduce the effects of any skin irritation or inflammation that may occur:
Reduce frequency of use; and/or
Apply a short course of a mild steroid cream such as hydrocortisone 1% to the affected area twice daily. Steroid creams reduce inflammation.
Apply an emollient (moisturiser) every day after applying the aluminium chloride.
Iontophoresis
This is a treatment that uses electrical stimulation. It is used mainly to treat sweating of the palms and/or soles. It can also be used to treat armpit sweating. Treatment involves putting the affected areas (usually hands and/or feet) into a small container filled with water. A small electrical current is then passed through the water from a special machine. It is not painful or dangerous, but may cause a 'pins and needles' feeling. The exact way this helps to treat sweating is not known. It may help to block the sweat glands in some way.
Treatment usually consists of 3-4 treatment sessions per week. Each treatment session lasts 20-40 minutes. Most people report an improvement after 6-10 sessions. A maintenance treatment is then typically required once every 1-4 weeks to keep symptoms away. If the treatment does not work with tap water, a drug called gycopromium bromide is sometimes added to the water. This seems to improve the rate of success. However, iontophoresis does not work in every case.
Until recently the 'downside' to iontophoresis is that it required a trip to hospital for each treatment session. This can be time-consuming and impractical for some. However, modern machines are smaller and can now be bought for home use. So, if you find that this treatment works for you, you may wish to consider buying a machine to use at home. However, you should take advice from the specialist who recommended iontophoresis for you before you buy a machine.
You should not have iontophoresis if you are pregnant, or have a metal implant, or if you have a pacemaker.
Botulinum toxin injections
This is an option that usually works well for armpit sweating. Treatment consists of many small injections just under the skin in the affected areas. The botulinum toxin stops the nerves in the skin that control the sweat glands from working. Botulinum toxin is sometimes used to treat sweating of the palms and face. However, there is a risk that the injections may stop some of the nearby small muscles of the hands or face from working.
The downside of botulinum toxin is that the effect usually wears off after 4-12 months. Therefore, to keep working, the treatment needs repeating when the effect wears off. Some people get mild 'flu like' symptoms for a day or so after treatment. Also, the sites of the injections can be sore for a few days after treatment. Rarely, a severe allergic reaction can occur after an injection.
Medication
Medicines that block the effect of the nerves that stimulate the sweat glands are sometimes used. However,side-effects do commonly occur such as dry mouth and blurred vision. However, in some cases they work well and side-effects are minor.
Surgery
An operation is an option for people who have not been helped much by other treatments, or if other treatments cause unacceptable side-effects or problems. Since I do not recommend surgery, because of the effects (removal of sweat glands can lead to scarring in the underarms and other complications. Similarly, sympathectomy, which also is quite effective, carries the risk of unintended surgical side effects and rebound sweating in previously unaffected areas), I'm not going to discuss the various methods to reduce excessive sweating.
