Excessive perspiration can be very distressing for some people. Are you having a problem with perspiring too much? Learn the name of the condition, what causes it and what you can do about it.
Sweating is a normal physiologic reaction of our body needed to assist in thermoregulation (to control body temperature), skin hydration and fluid and electrolyte balance.
Excessive sweating or hyperhidrosis is the secretion of sweat in amounts greater than physiologically needed. It is a common condition that affects 1 to 5 percent of the population and can cause serious emotional or social distress in the person who has it.
Most commonly, hyperhidrosis is a chronic primary condition, but can also be secondary to medications or medical conditions.
Primary focal hyperhidrosis is commonly localized, usually affecting the armpits, palms or soles. It may also affect the face, scalp, inguinal area or under the breasts. Patients normally develop the symptoms as children or adolescent and they persist throughout life. It is made worse by heat and emotional stimulus. Patients commonly complain of staining clothing and maceration of the skin.
To be diagnosed with hyperhidrosis the symptoms should be present for at least six months, with one episode of excessive perspiration weekly; the onset should be before age 25. Commonly there is a family history. The symptoms are bilateral, should impair daily activities and do not present during sleep.
Secondary hyperhidrosis can be due to some medications or systemic diseases. Common medications that cause excessive sweating include certain antidepressants, anti-migraine drugs, antipyretics (acetaminophen, aspirin, NSAIDs), insulin, beta blockers, calcium channel blockers, niacin, morphine, omeprazole, opioids and tramadol. It can also be caused by several disease processes such as tuberculosis, HIV, endocarditis, lymphoma, hyperthyroidism, carcinoid syndrome or pheochromocytomatous.
With regard to primary focal hyperhidrosis, the treatment depends on location, patient’s expectations, safety concerns, disease severity, cost and treatment availability.
For axillary hyperhidrosis, the major therapeutics options are antiperspirants (OTC and prescription strength), botulinum toxin, oral medication and even surgery to remove the sweat glands.
The first line of treatment is over the counter antiperspirants that contain a low dose metal which physically blocks the opening of the sweat glands and are usually effective in very mild hyperhidrosis.
Another treatment would be prescription antiperspirants, such as 20 percent aluminum chloride hexahydrate, which may help patients that do not respond to OTC antiperspirants. Normally, they are used daily for the first week or so, and then weekly for maintenance.
Second line therapy would be reserved for patients who do not respond to local antiperspirants. These patients may benefit from local botulinum toxin injections. These injections can safely and effectively improve axillary, palmar or feet hyperhidrosis. Most studies have used either Botox or Dysport for these conditions. The US Food and Drug Administration approval for botulinum toxin for hyperhidrosis is limited to Botox for axillary hyperhidrosis.
The response to treatment is usually observed within two to four days and it may persist anywhere from three to nine months or longer.
The application of the botulinum toxin is made with several tiny injections in the affected area. The most common complaint is the pain with the injections, but it can be ameliorated with topical anesthetics, ice therapy or vibration.
If you are having problems with hyperhidrosis call your doctor for a consultation to see which therapy is the best one for you.
Dr. Ana Pere is a medical doctor at Mercy Health – Shawnee Family Medicine and the Mercy Health – Rejuvenation Spa. To schedule an appointment with Dr. Ana Pere, please call 419-996-5700.