How Much Sweat Is “Excessive?”
Sweating is the body’s way of cooling itself. But excessive sweating — or producing as much as five times more sweat than is needed — is a real medical condition. According to the International Hyperhidrosis Society (IHS), as many as 365 million people worldwide experience excessive sweating. It’s an equal opportunity problem, affecting both men and women. People with hyperhidrosis sweat profusely nearly all day, every day. And hyperhidrosis doesn’t just cause physical problems: “It affects personal relationships, work productivity, intimate relationships, exercise and leisure activities, and really all aspects of life,” says Dee Anna Glaser, MD, president of the IHS and professor and interim chairman of the dermatology department at Saint Louis University School of Medicine. In fact, according to a study published in June 2017 in Health and Quality of Life Outcomes, the day-to-day social impact of hyperhidrosis is one of the highest concerns amongst people who have the condition. Sophia Wastler, 43, a small-business owner from Virginia Beach, Virginia, knows that firsthand. She started noticing excessive sweating on her palms and under her arms when she was just 9 or 10 years old. “My teachers would mark my work as messy since the sweat from my palms would get on the paper and smudge the ink,” she recalls, adding that she withdrew socially because she didn’t want other kids to see her sweat. “I would try to hide myself with baggy clothes.”
What Causes Excessive Sweating?
The most common type of excessive sweating is called primary focal hyperhidrosis, meaning the sweating occurs only in specific small areas of the body and is not caused by another medical condition or a medication. The most common areas involved are the armpits, face, palms of the hands, and feet. As in Wastler’s case, it often begins in childhood or adolescence and does not usually occur when the person is asleep. The cause of this type of excessive sweating has not been conclusively pinpointed, but Dr. Glaser says it’s definitely not a hygiene problem. Genetics is thought to play a role; Wastler says there are other cases of excessive sweating in her family tree. Another type of excessive sweating, known as secondary generalized hyperhidrosis, is caused by an underlying medical condition or is a side effect of a medication. The sweating is usually experienced over larger parts of the body and may occur during sleep. Common causes include:
AnxietyMenopauseDiabetesHyperthyroidismCancerGoutInfections such as tuberculosisInjuryObesityTumors
Generally, treating these underlying conditions also helps control excessive sweating due to secondary generalized hyperhidrosis.
Hyperhidrosis Treatment Options
According to a variety of recent studies, the vast majority of people with hyperhidrosis go years before seeking treatment — if they do at all. But Glaser urges everyone who experiences excessive sweating to talk with their doctors, because there are effective treatment options that can be tailored to each person. Traditional excessive sweating treatments include:
Antiperspirants: When applied to the skin, a dermatologist-approved formula can plug sweat ducts, which can in turn make you sweat less. They work under your arms but can also be effective on hands, feet, and the hairline. Side effects may include skin irritation.Injections: When antiperspirants don’t work, botulinum toxin type A injections, approved by the Food and Drug Administration (FDA), can treat excessive underarm sweat. The local injections effectively turn off sweating at the injection site. One caveat: This does not cure excessive sweating; the injections are usually effective for several months and then need to be repeated. This treatment is sometimes used to stop sweating in the hands, face, and feet as well, but side effects like muscle weakness and drooping eyelids have been reported.Prescription medication: Anticholinergic drugs, like glycopyrrolate, help prevent stimulation of the sweat glands. However, these medications were not specifically designed to treat hyperhidrosis, so it’s important to talk to your doctor about your health history to see if this is the right hyperhidrosis treatment for you, as they may be linked to the development of dementia or brain atrophy when used long-term. Other classes of oral medications, like beta blockers or benzodiazepines, can also help reduce sweating related to stress.Iontophoresis: This procedure involves submerging the affected area, usually your hands or feet, in a shallow pan of water that’s connected to a small machine that sends a mild electrical current through water. It’s believed that the electricity and the minerals in the water work together to slightly thicken the top layer of skin to block the flow of sweat to the skin’s surface. Several iontophoresis sessions are needed to help hands and feet sweat less. Eventually, people are put on a maintenance schedule of once a week or once a month, depending on their individual needs.Surgery: If you don’t find relief from other medications, you may be a candidate for one of two types of surgery for hyperhidrosis treatment. One procedure involves having your sweat glands in the affected areas surgically removed. Another procedure called endoscopic thoracic sympathectomy (or ETS) is used to disrupt signals coming from spinal cord nerves to the sweat glands. This is considered a treatment of last resort as it is a major surgery that carries a risk for severe complications.
However, even newer treatments are now available. Many people have found relief with just one or two treatments from a handheld device that emits electromagnetic energy, which destroys sweat glands. And most recently, the FDA has approved a type of topical anticholinergic medication in wipe form that can be used at home.
The Benefits of Treating Excessive Sweating
Wastler finally got treated for her excessive sweating when she was 31 years old. A combination of injections and iontophoresis has not only gotten her hyperhidrosis under control, she says, but the treatments literally changed her life. “I felt so invincible that I left my secure job [as a public school teacher] and started my own company,” she says. It’s called the “Starz Program!” and teaches dance, cheerleading, and sports to children in preschools, daycare centers, and private schools worldwide. Although Wastler is doing great now, she believes she waited too long to get treated and wants to warn others against making the same mistake. “I strongly suggest that anyone who thinks they have hyperhidrosis get treated right away,” she says. “After I got treated, it was like a veil was lifted and I could start living and have more confidence in my life.”
