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Hyperhidrosis | Excess sweating

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Photo: Wix

What is hyperhidrosis?

Excess sweating, also called hyperhidrosis, can be either primary or secondary.

  • Primary hyperhidrosis is from our sympathetic nervous system (the part of our nervous system activated by the "fight or flight" response) being overactive.

  • Secondary hyperhidrosis is when sweating is from another cause such as a medication, hormonal changes, heart problems, cancer, infections, or neurological problems.

Primary hyperhidrosis is more likely to:
  • last longer than 6 months

  • primarily involve the underarms, palms, soles, head, and neck area

  • affect both sides of the body symmetrically

  • sweating episodes happen at least weekly

  • not sweat during sleep

  • start before the age of 25

  • have a family history of sweating

  • affect day-to-day activities

Think of secondary hyperhidrosis as having a cause- so if the onset was sudden I look for
  • Is anything new in terms of medications?

  • Are there other symptoms such as fevers, chills, fatigue, night sweats, and shortness of breath?



What is considered "normal" in terms of sweating?

Normal sweating can range from about a half liter a day to as much as 10 liters with intense exercise or heat (about 1 Liter per hour extra).
"Normal and not" when it comes to excessive sweating is very subjective. We do not really measure directly the amount of sweat produced to make the diagnosis. The real question I ask my patients is how much is this affecting them.
  • Does sweating interfere with your daily activities?

  • Do you find your sweating embarrassing?

  • Do you find yourself choosing clothing based on your concern about how much the sweat will be noticeable?

  • Do you avoid certain activities because you are concerned about sweating?

If the answer to any of these is yes, then we need to come up with a game plan to address it.
I look for any other associated symptoms that occur at the time of sweating to determine if it could be a worrisome sign. Shortness of breath, racing heart rate with minimal activity, fevers, chills, night sweats, fatigue, etc. If any symptoms pop up as a concern, then further workup for any underlying cause is important!

How can hyperhidrosis be treated or managed?

There are several ways to control sweating. If it’s secondary hyperhidrosis from an underlying condition or medication then treating the cause will help the sweating.

For primary hyperhidrosis, the treatment options range from
  • topical medications such as aluminum chloride or glycopyrrolate solution

  • an oral medication called glycopyrrolate

  • botulinum toxin injections

  • a medical device called the drionic that can reduce sweating

  • laser device called miraDry

It is so common for patients to say that they had no idea that something could be done about their sweating. Talk to your Dermatologist, we have numerous options to try to fit your lifestyle. When it comes to combating stress sweat the first thing to remember is to know what you are up against. Sweat triggered by stress is not in your control. Sweat triggered by your nervous system is truly a reflex. With that in mind, it’s not worth just hoping it won’t be an issue- you should be ready to handle it! There are a number of tricks and tips and treatment options.
If you were really on top of things and talked to your dermatologist ahead of time then you probably have some great tools. If your sweat is localized to underarms, hands, etc, then using a prescription topical such as topical aluminum chloride or topical glycopyrrolate may already have your sweat well controlled. If you sweat "all over", then an oral medication called robinul (glycopyrrolate) can also help control sweating from head to toe. Injections of botulinum toxin are extremely common for underarms and hands to control localized sweat for months. Remember to ask about insurance coverage as hyperhidrosis is a medical condition and we often find that many insurances may cover the treatment.

Why do we sweat in the first place?

Anything that drives up your body temperature can cause you to sweat. Sweating, after all, is our body’s way of regulating our body temperature. If the temperature rises, sweat is produced so that as it evaporates off the skin it serves to cool the skin.
It is absolutely normal to sweat more when you increase your exercise level or when it’s hot or humid out. Sweat is our natural way of cooling itself off!

Normal sweat is about half a liter to a liter a day with minimal activity. However, again, we do not really measure this. The ‘normal’ amount of sweating is the amount that does not interfere with your day-to-day activities but still regulates your body temperature effectively. In other words, as long as you are sweating to the point you notice it and you are not overheating, then you are probably doing well!
Drinking water is always important. If you plan to exercise then you will likely lose more fluid through sweating so it would be important to replace this fluid by drinking water. If your body is well hydrated then it may not have to work so hard to regulate your body temperature so this will likely reduce some of the excess sweat.

The other key thing to remember for people who sweat excessively is to avoid some foods that may incline them to sweat more. An example of this would be spicy foods or hot foods.

Is it normal to sweat while sleeping?

There are a number of causes for sweating in your sleep. Here are examples of some common ones to consider.
Example 1 | Infection
I recently had a 74-year-old gentleman come in with a complaint of night sweats for 3 months. He told me he had been to 4 doctors and had a full malignancy workup that included a CT scan of his chest/ abdomen/ pelvis and exhaustive bloodwork. He was told he just has to live with it. He was becoming depressed because he would routinely wake up drenched and feeling very cold afterward. He just wasn’t having a restful night. As he was talking I noticed these small pink and red spots on his fingers, a few had scabbed over. He hadn’t really paid much attention to them but said sometimes they were sore. I biopsied one and it revealed something called septic emboli. This is a sign of infective endocarditis- I ordered an echocardiogram of his heart and he had bacteria on his heart valve. These were spreading to his skin to cause the red spots (called Osler’s nodes) AND causing his night sweats. I put him on antibiotics and he cleared very quickly and was happy to finally get some rest at night within a couple of days of starting antibiotics.
Example 2 | Cancer

One of the earliest signs of cancer, lymphoma, in particular, can be night sweats. I think of night sweats as a ‘check engine light’ that can tell you to look for an underlying cause. Sometimes the sweats will be one of several symptoms such as chronic itching, fatigue or tiredness, and shortness of breath.
Example 3 | Hormones

One of the most common complaints from women going through menopause is going to bed cold and then feeling like they have to throw the sheets off in the middle of the night and feeling drenched! As hormonal levels fluctuate it’s really common for our body temperature to change. I also remind women that this can mean they go to bed with clear skin, have a hot flash that flares their rosacea, and they wake up with a breakout. So frustrating!



Are there other ways to help control sweat other than medications and treatments?

If you didn’t know to talk to your dermatologist or you are in a bind there are some tricks that people do... One of the quickest things at our disposal these days is hand sanitizer. These are mostly alcohol-based. If you can quickly rub some under your arms or on your hands, you can get some quick action drying effects. It won’t last too long but it can give a little relief.
In terms of lifestyle changes, avoiding spicy foods and caffeine can help some people. Choose clothing made with fabrics that have high porosity- they breathe- or ones made with cooling crystals- they can cool your skin!

Can I use natural deodorants to control sweating?

I would be cautious of natural deodorants if sweating is a major issue. These products only mask the odor but do not stop or block sweating. I have many patients that just don’t realize this and feel like they must have something causing the sweat but don’t realize they have made a switch to a product that doesn’t work on sweating.
Related: Read more about sweating I cannot tell you how often a patient mentions this in passing and has no idea that we not only can help but we have very effective life-changing options to help! It’s also important to have an evaluation by your dermatologist simply because excess sweat can be secondary to other medical conditions, especially if it’s new onset. Underlying infections, cancers, and endocrine disorders have been known to trigger excessive sweating as well.


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