How Do Dermatologists Treat Excessive Sweating and Hyperhidrosis
If you sweat excessively even in cool temperatures or soak through clothes more than you can recall, you may have excessive sweating also known as hyperhidrosis. This common medical condition causes abnormal, excessive perspiration affecting quality of life for many of our patients. In this dermatologist guide, we will review this condition including the science, the diagnosis, and latest treatments that are evidence-based.
What Is Hyperhidrosis?
Hyperhidrosis is a medical condition marked by sweating beyond what’s necessary for normal body temperature regulation. Everyone sweats in hot temperatures or after a certain degree of physical activity, but people with hyperhidrosis have overactive sweat glands producing up to 4-5 times more perspiration than average. The excessive moisture can occur selectively in specific body areas or generally affect the whole body unpredictably.
Primary focal hyperhidrosis affects around 3% of the population, most often involving underarms, palms, feet and the facial area. Secondary causes arise from an underlying condition like infections, endocrine or neurologic disorders.
Hyperhidrosis Signs and Symptoms
Signs of excessive sweating seen in hyperhidrosis include:
Visible sweat stains soaking through clothing
Frequently needing to change garments during the day
Discomfort that disrupts normal activities
Slipping grip of objects from wet hands
Not alleviated by over the counter antiperspirants
This goes beyond normal “getting sweaty” during heat, exercise, or anxiety-producing situations. Hyperhidrosis is essentially random overactivity of eccrine sweat glands. For instance, some of our patients visibly sweat from their palms in the examination room. As a result, along with physical symptoms, hyperhidrosis takes an emotional toll causing embarrassment, low confidence and difficulties in relationships or work settings due to unpredictable copious moisture.
What Causes Excessive Sweating?
In most with primary focal hyperhidrosis (e.g. idiopathic), the root cause remains unknown. It seems to involve overstimulation of sweat glands rather than overt glandular abnormalities. Contributing factors like family history, environment, hormones and emotions likely play some role activating triggers.
Secondary generalized hyperhidrosis arises from:
Medications – antidepressants, hormone therapy (menopause)
Low blood sugar episodes
Neurologic conditions
Diseases – malignancy, infections, tuberculosis, HIV
Pinpointing an origin guides appropriate treatment. Idiopathic primary hyperhidrosis follows different management than determining and addressing an underlying medical issue provoking symptoms.
Hyperhidrosis Diagnosis
The best way to have this formally diagnosed is to visit a dermatologist. At this visit, you can discuss your sweating patterns, lifestyle impact, and past treatments tried to distinguish normal perspiration from hyperhidrosis. Things that may occur at this visit include the following:
Examining areas of visible wetness like underarms, palms, soles etc.
Ruling out secondary causes by assessing medications used, medical history, family history and indicators of neurologic disease
Considering conditions causing similar signs like anxiety, menopausal flushing, infections
Confirming hyperhidrosis rather than alternate diagnoses
Some tools that can help with the diagnosis include:
Starch iodine test helping visualize sweat distribution/intensity on skin
Skin conductance tracking sweat gland activity
Thermoregulatory sweat test analyzing body responses
However, these are rarely performed because the clinical diagnosis is fairly straightforward and obvious during a visit, and is frequently supported by ample patient history.
Hyperhidrosis Treatment Approaches
A range of hyperhidrosis management techniques exist from clinical therapies like medications or surgery to helpful at-home hacks controlling dampness day-to-day:
Prescription Antiperspirants (good for underarms)
This is typically the first line of treatment and the lowest in the therapeutic ladder. Your dermatologist may prescribe an extra-strength aluminum chloride (Drysol) antiperspirant used several times a day, which helps plug sweat ducts.
Recently, we have found topical glycopyrrolate (Qbrexza) to be an effective solution. This is a topical version of the oral anticholinergic (discussed below) that works with much fewer side effects. However, insurance approval is challenging.
Other treatments below often work best alongside these special antiperspirants to maximize results and they are not often used in isolation.
Iontophoresis (good for palms and soles)
Iontophoresis involves running a mild electrical current through taps or trays of water immersing hands/feet about 20 minutes daily to turn down activity in sweat glands. It takes around 5-10 sessions to see benefit then tapered to maintenance, and you may need a specialized device for this. Minimal side effects exist making it great for underarm/hand/foot sweating. However, it is not great for sweating from the axilla as this cannot be easily targeted. Select companies sell this online but you should check with your dermatologist.
Botox Injections (good for underarms)
Botox injections temporarily paralyze overactive nerves and muscles triggering sweat glands for several months relief per session. Often used for underarm sweating combined with antiperspirants. Requires repeating injections for ongoing control. Potential side effects include localized pain or irritation after treatment.
While this is a reasonable form of treatment for palmar and plantar hyperhidrosis, the pain level is typically not easily tolerated for most patients.
MiraDry Microwave Treatment (good for underarms)
The MiraDry device is an FDA approved non-surgical treatment to address underarm sweating. It works by delivering electromagnetic energy to destroy underarm sweat glands through localized heating. Permanent sweat reduction seen in about 80% with minimal adverse effects beyond temporary soreness, swelling, numbness. Significant sweat loss can persist 5+ years.
Oral Medications (good overall, but with side effects)
Oral anticholinergic tablets can be tried modulating chemical signals excessively activating sweat glands, though side effects like dry mouth often limit use. In our experience, this is best for someone who has excessive sweating in multiple locations of their body that is affecting their day to day functioning. We typically start at the lowest dosage of the anticholinergic of choice, and gradually increasing the dose and frequency as needed.
Surgery (last resort)
Surgical options like removing underarm sweat glands (sympathectomy) or scraping off the top skin layers laser ablating glands (curettage) offer more invasive routes for stubborn hyperhidrosis. Compensatory sweating in untouched areas remains a possible post-surgical complication. This is typically performed by a surgeon.
Coping with Hyperhidrosis: At Home Remedies and Tips
Wear loose-fitting, breathable moisture-wicking fabrics allowing air circulation
Use absorbent underarm pads preventing visible wet marks
Carry extra garments when out if excessive soaking expected
Apply OTC antiperspirant liberally before bednightly
Avoid triggers like spicy foods, caffeine or anxiety-producing situations
Aluminum chloride antiperspirant
Aluminum chloride spray
Summarizing Hyperhidrosis
Hyperhidrosis is defined by sweating excessively beyond temperature/situational needs
Manifests as visible sweat stains/dampness with lifestyle disruption
Caused by overstimulation of sweat glands themselves
Diagnosis includes exams, cause assessments, sweat mapping
Prescription antiperspirants, Botox, iontophoresis, miraDry, surgery treatment options
Secondary hyperhidrosis clues reveal an underlying provoking condition
Home care techniques like breathable moisture-wicking fabrics can help you cope
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What is hyperhidrosis?
Hyperhidrosis is a medical condition characterized by excessive sweating beyond what is necessary to regulate body temperature. This can occur in various parts of the body, including the armpits, hands or feet, or even the entire body.
What are the types of hyperhidrosis?
Hyperhidrosis is generally classified into two types: primary focal hyperhidrosis (which has no identifiable cause and often begins in childhood or adolescence) and secondary generalized hyperhidrosis (which is caused by an underlying medical condition or is a side effect of medication).
How is hyperhidrosis diagnosed and treated?
Diagnosis of hyperhidrosis typically involves a thorough medical history, physical examination, and may include tests such as the starch-iodine test or gravimetric test. Treatment for hyperhidrosis may include topical treatments, oral medications, botulinum toxin injections, iontophoresis, or even surgery in severe cases.
What are the symptoms of hyperhidrosis?
The main symptoms of hyperhidrosis include excessive sweating that significantly impacts daily activities, sweating that occurs bilaterally and symmetrically, and a positive family history of hyperhidrosis.
Can hyperhidrosis be treated to reduce sweating?
Yes, hyperhidrosis can be treated to reduce sweating, with various treatment options available to help manage and control the excessive sweating associated with this condition. Numerous medications are now first-line to treat excessive sweating, which can also reduce body odor as results from sweating of the affected areas of your body.
What are the possible side effects of hyperhidrosis treatment?
Common side effects of hyperhidrosis treatments may include localized pain, temporary weakness or paralysis, and rarely, allergic reactions. It is important to discuss potential side effects with a healthcare professional before undergoing any treatment.
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