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Simple Treatment for Excessive Sweating (Hyperhidrosis)

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Excessive Sweating (Hyperhidrosis)

Excessive sweating, an overlooked and common problem, especially of the palms, armpits and soles. It can have a detrimental effect on an individual’s confidence and self esteem, causing stress and can have a serious impact on a person’s life. In many cases, affected people avoid social contact with others because of embarrassment about the problem. In many cases it can lead to depression. All the suffering and distress can be avoided simply by making people aware of what treatments are available. The condition is usually treatable, and the treatments are easily accessible. The majority of cases do not require a visit to the doctors.

What is excessive sweating?
Sweating is important for helping keep the body temperature constant during hot weather, during a fever, or when exercising.
Excessive sweating (hyperhidrosis) means that you sweat much more than normal. Even when you are not hot, stressed, or exercising, you make a lot of sweat.
Excessive sweating is classified into three types :

- Primary (idiopathic) focal hyperhidrosis

- Secondary focal hyperhidrosis

- Generalised hyperhidrosis

It is important to know which type you have, as the causes and treatments are very different.

Primary (idiopathic) focal hyperhidrosis
This means that excessive sweating occurs in one or more of the following focal places:

palms of the hands;
soles of the feet;
armpits (axillae);
face/scalp.

You sweat normally on the rest of the body. It tends to be symmetrical - that is, both palms, both feet, both armpits, etc, are affected. The exact cause is not known and it is not associated with any other conditions. (The word idiopathic means of unknown cause.) It just seems that the sweat glands in these areas are overactive or more sensitive than normal. In some people, it may run in the family so there may be some genetic factor involved in causing it. It usually first develops under the age of 25, but it can develop at any age. Men and women are equally affected. It is common and affects about 3 in 100 people.
The severity can vary from time to time. It may come and go and can be made worse by triggers such as anxiety, emotion, spicy foods, and heat. Anxiety about the sweating itself may make it worse. However, for most of the time, nothing obvious triggers the sweating. It tends to be a long-term condition, but symptoms improve in some cases over time.
If you have the typical symptoms of primary focal hyperhidrosis, you usually do not need any tests. Your doctor may suggest one or more treatments (below) if normal antiperspirants do not work well.

Secondary focal hyperhidrosis

This is uncommon. It means that the excessive sweating occurs in a particular focal part of the body. But, unlike primary focal hyperhidrosis, there is a known or likely cause. For example, a spinal disease or injury may cause sweating in one leg. Any focal sweating that is not symmetrical (that is, just in one hand, or one leg, etc) may suggest a secondary cause rather than primary focal hyperhidrosis which is usually symmetrical. Your doctor may suggest some tests to look for an underlying cause if one is suspected.

Generalised hyperhidrosis

This means that you sweat more than normal all over. This is less common than primary focal hyperhidrosis. However, it is usually caused by an underlying medical condition. A whole range of conditions can cause a generalised increased sweating:

anxiety disorders
various heart problems
damage to nerves in the spinal cord
side-effects to certain medicines
various hormonal problems (including an overactive thyroid gland)
infections
certain cancers, etc.
If you have generalised hyperhidrosis your doctor is likely to examine you and do some tests to find out the cause. Treatment depends on the cause.

The rest of this leaflet is only about primary focal hyperhidrosis.

What are the possible complications of primary focal hyperhidrosis?

This is not a medically serious condition, excessive sweating can be distressing and embarrassing. For example, bad palm sweating causes you to have a cold, sweaty handshake and sweat may drip from your hands , on to computer keyboards, etc. If you have bad armpit sweating, you may become embarrassed by the frequent wet patch that develops on clothes under your arms. You may need to change clothes during the day. You may avoid social contact or avoid doing sports because of embarrassment about the condition.
Other complications are uncommon. In some cases, the affected skin can become sore, irritated and prone to infection. There is a risk of developing eczema on affected skin.

Initial treatment options for primary focal hyperhidrosis

General tips and advice

The following may be all that you need if the condition is mild. They 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. examples are simple soap, oilatum soap
  • If possible, avoid triggers which can make things worse such as heat or spicy food.Keep a diary of what you eat and what products you use. Rate the level of excessive sweating, and eliminate foods or products that are causing high levels of sweating.
  • If you have armpit sweating:
    • Try using normal antiperspirants regularly. (Note: there is a difference between antiperspirants and deodorants. Antiperspirants reduce the release of sweat, deodorants mask unpleasant smells. Sweat does not have a smell. It is only sweaty clothes that are not changed that may become smelly.)
    • Avoid clothes that more easily show up sweat marks. As a rule, white and black coloured clothes are less noticeable when wet than other colours.
    • Wear loose clothing under the armpits. Avoid clothes made with man-made fibres such as Lycra® and nylon.
    • Consider using dress shields (also known as armpit or sweat shields) to absorb excess sweat and protect delicate or expensive clothing. These can be obtained via the internet or the Hyperhidrosis Support Group (contact details below).
  • If you have excessive feet sweating, it can help to:
    • Change your socks at least twice a day.
    • Use an absorbent foot powder twice daily.
    • Wear a different pair of shoes on alternate days. This allows them to dry fully.
    • Avoid sport shoes or boots. These are often less breathable than normal shoes are, so are more likely to keep the sweat in.

Aluminium chloride - a strong antiperspirant

If normal antiperspirants do not work, it is worth trying an antiperspirant that contains aluminium chloride. This is 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:

- Driclor® (roll on applicator)
- Anhydrol Forte® (roll on applicator)
- ZeaSORB® (dusting powder)

You can buy these at pharmacies. Order them from online pharmacies your247chemist.com. 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. (It is more likely to cause irritation on wet or moist skin.) Therefore, wipe the skin dry with a towel or dry flannel before applying. Some people use a hair dryer to make sure the skin is dry 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.
  • Some doctors do not recommend that you apply this treatment to your face.
  • 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 an emollient (moisturiser) every day after applying the aluminium chloride, and/or
  • Apply a short course of a mild steroid cream such as hydrocortisone 1% to the affected area twice daily for a maximum of 14 days. (Steroid creams reduce inflammation.)

Other treatments for primary focal hyperhidrosis

If the above general measures and antiperspirant treatments do not work, your doctor may suggest that they refer you to see a dermatologist (a skin specialist). The specialist may suggest one of the following treatments.

Iontophoresis

Botulinum toxin injections

Medication

Surgery