Too much sweat? Hyperhidrosis is the name for it.

Problems with sweating are not uncommon. For some people, it is a matter of having too much sweat, a condition also known as hyperhidrosis in medical terms.  Whatever name you give this condition, it can be a real nuisance for many people.  Patients who have excessive sweating often describe interference with their daily lives.  Clothes get soaked and stained.  It is often not possible to change clothes in the middle of the day.

  Sweaty hands make shaking hands difficult.  Soaked-through socks become breeding grounds for yeast, fungus and bacteria.

What is hyperhidrosis?

Hyperhidrosis is the medical term for excessive sweating.

Which areas does excessive sweating (hyperhidrosis) affect?

Excessive sweating can affect various areas of the body. Common areas where people may note excessive sweating include the armpits (axillae), palms of the hands, and soles of the feet.  This makes sense as those areas have a high concentration of sweat glands (eccrine glands) as compared to other areas of the body.  Other areas can be affected as well.

How is excessive sweating (hyperhidrosis) diagnosed?

The history provided by the patient along with a physical exam can help diagnose the condition.  A iodine sweat test may be performed in the office to help delineate areas of sweating.  In this test, an iodine solution is applied followed by starch.

  In areas of sweating, a dark coloration will appear.

If there are indicators of a medical condition causing the excessive sweating, additional tests may be performed.

How is excessive sweating (hyperhidrosis) treated?

There are several treatments which are used to decrease the amount of sweat.

Antiperspirants are often first-line treatments which are recommend.

  There is a range of strength of antiperspirants.  Many are available over the counter through popular name brands. Others may require a stronger clinical-strength antiperspirant for which a healthcare provider can write a prescription for such as a higher-strength aluminum chloride preparation.  The side effect of these stronger clinical-strength antiperspirants include irritation.  For this reason, it is important to follow your healthcare provider’s recommendation on how to use it.  For cases with irritation that will not go away with good application practices, a topical cortisone may be recommended.

Iontopheresis machines utilize an electric current to try to turn off the sweat glands.  This treatment is best suited for excessive sweating of the hands or feet as the area is submerged.  Depending on insurance coverage and the type of machine selected, this treatment option may be cost-prohibitive.  Side effects include irritation to the skin or discomfort during treatment.

Botulinum toxin injections are often referred to the first brand-name of this product, Botox ®.

  It is FDA approved for use against hyperhidrosis of the armpits.  However, it is also relatively commonly performed on the palms and soles, albeit these areas may experience much more pain during the treatment.  Injections do wear off so repeat injections are necessary.  In general, the treatment is repeated every 4 to 6 months.  Insurance coverage is variable for this treatment and if not covered, botulinum toxin injections for hyperhidrosis may be cost-prohibitive.  Side effects include weakness, especially when injected into the hands.  While injections into the armpits are generally well-tolerated pain-wise by patients, injections into the palms and soles may be very painful due to the increased density of nerve endings in these areas.

Pills by mouth include glycopyrrolate (Robinul ®) or oxybutynin (Ditropan ®).  Since these pills are taken by mouth, they can affect other areas of the body.  Your healthcare provider will make sure that these pills are okay for you to take, considering your other medical conditions and medications.  Usually you will be started on a low dose and the dose is increased as tolerated and to address the excessive sweating.  As these pills are systemic medications, they can have side effects which are important to discuss with your healthcare provider.

Surgery is sometimes performed to address excessive sweating. In the armpits, this may involve cutting out the affected area of skin along with the sweat glands within the skin.  Sometimes a procedure called a sympathectomy is performed to address a larger region of sweating.  It is important to obtain a consultation with the surgeon to understand the what to expect, the risks, and benefits of such procedures.

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