You Don’t Have to Live with Excessive Sweating from Hyperhidrosis
If you are old enough to remember the 1980s movie Broadcast News, I am sure you recall the scene where the desperate-to-get-promoted news reporter (played by Albert Brooks) gets his big chance. On camera, delivering the news, he begins to sweat…and sweat…and sweat. His suffering was painful to watch, but the scene graphically showed what it can be like to have primary hyperhidrosis — a medical condition that causes excessive sweating unrelated to thermoregulation. About 5% of the population, both male and female, has primary hyperhidrosis, and estimates are that about 50% of people with it do not seek medical help — a shame, because there is plenty of help to be had, much of it natural.
WHAT IS HYPERHIDROSIS?
Hyperhidrosis is way worse than the kind of sweating that a person without the condition would normally experience in, say, Arizona in August. It is diagnosed in people who, at least once a week for at least six months, have visible, excessive sweating without apparent cause in one or more specific sites — usually on the soles of the feet (plantar), the palms (palmar), the underarms (axillae) and sometimes the face and head (craniofacial). Onset of the apparently lifelong condition occurs as early as infancy, often in adolescence and sometimes as late as the mid-20s. Hyperhidrosis is caused by distorted communication between the brain and the sweat glands, and sadly there’s no cure, though, as mentioned above, new and more effective treatments are being developed to keep symptoms at bay.
NEW TREATMENT SHOWS PROMISE
The first-line treatment is bedtime application of aluminum chloride antiperspirant to the affected area nightly or every other night, which is then washed off the next morning. The most common side effect, skin irritation, is vastly reduced with a new version that contains salicylic acid, Dr. Glaser said. In a recent (albeit small) study of 10 patients, all reported sweating 75% to 100% less when they used this new preparation.
Another treatment is to have Botox injections in the affected area. This works by blocking nerve endings from communicating with sweat glands in a specific area. It is becoming more popular because the treatment lasts several months and can theoretically be used for the rest of a patient’s life. However, Botox is expensive. Oral medications, such as glycoprrolate (Robinul) and, occasionally, Inderal or clonidine, also can be helpful.
Surgery can be a solution, too, but it has problems. Endoscopic thoracic sympathectomy involves clipping the nerve responsible for the oversweating stimulation. This technique has worked well for patients with palmar sweating in particular, but Dr. Glaser says it can cause a serious postsurgical complication called compensatory sweating — 40% to 80% of patients report developing new sweating that takes place in other areas of the body. This can arise anytime, even years after the procedure.
“CURRENT” THERAPY: IONTOPHORESIS
An excellent option for hand and foot sweating, which has been around more than 50 years, is called iontophoresis. For this the patient plunges the affected body part (it works best for hands and feet) into a bowl of water infused with chemicals (anticholinergics) that inhibit the miscommunication between brain and body and then applies a low-level direct electrical current (about equivalent to a flashlight battery) to the water. Dr. Glaser explained that the current forces the mineral and ions in the water to plug up the sweat ducts. It takes 20 to 30 minutes, and patients start with three to four sessions per week. It usually takes six to 10 treatments to get sweating down to an acceptable level, and maintenance treatments are required in intervals of one to four weeks. Patients occasionally take oral anticholinergics, but Dr. Glaser says that these reduce sweat production throughout the body, which is undesirable, especially for people who are active and need to sweat for the usual reasons.
It is known that heat, spicy foods, crowds and humidity may trigger episodes, so it makes sense to avoid those whenever possible. Also, Dr. Glaser told me that anxiety and stressful situations are known triggers. As in Broadcast News, “a person may become anxious about possibly sweating in, say, an interview and then gets nervous about that and starts to sweat as a result, which causes more anxiety, causing more sweating and on and on,” says Dr. Glaser. Episodes may come in spurts, disappear for a few days and then reappear. Biofeedback and other relaxation techniques may be helpful.
If you believe you may have hyperhidrosis, see a dermatologist — Dr. Glaser suggests finding one who has a special interest in the condition. Visit the website of the International Hyperhidrosis Society, SweatHelp.org, for names of doctors near you who treat the condition.