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Hyperhydrosis

Hyperhydrosis Overview and Treatment Options

This is a surprisingly common condition. It can affect different parts of the body and potentially has many causes. Sweat glands are designed mainly to cool your body. A special sort of nerve fibre turns on your sweat glands. A number of different things make you sweat. Heat is the main one. The sweat glands in your armpits, palms and soles are also turned on by various emotional events (but again by the small nerves entering your skin).

There are many different causes of excess sweating. They include:

  1. Fevers – these are common causes of brief “sweats”.

  2. The commonest form affects mainly the skin in the armpits, palms or soles. This form often runs through families, starts in childhood or as a teenager and may persist for years. It tends to finally go away by the age of 20 to 35 or so, but may not. It has no identifiable cause. Hormones do not seem to be a cause, nor do foods. It commonly occurs when your body heats up (for various reasons) but emotional factors can also be important. Many sufferers find they may also sweat for no reason at all.

    It can be bad enough to make writing hare by constantly wetting the paper. Gripping objects can sometimes be tricky. Socially it is often quite embarrassing. The foot and armpit sweating may allow offensive odours to develop or cause staining of clothing. Roll-on antiperspirants may only work for a little while.

    On the feet, sweating in your shoes makes for a very moist area. This allows certain bacteria to flourish (these bacteria are normally found in small numbers on everyone’s feet). They are responsible for the pungent odour. The bacteria also cause a common condition called pitted keratolysis. Here the feet, especially around the toes, balls of the feet and heels, have small holes on the surface of the skin. These holes tend to join up to make large areas of eroded soggy skin. It can be painful. These holes are due to damage of the outer dead part of the skin surface and are not dangerous. It is not tinea.

  3. Menopause. The typical hot flashes of menopause are usually associated with sweating.

  4. Sometimes too much production of thyroid hormone makes the skin sweat too much. A simple blood test will identify this problem, but usually this won’t be done unless there is evidence of the other problems of too much thyroid hormone like muscle tremors, feeling ‘hyped up’ and a too rapid pulse rate. Occasionally other hormone problems can cause it.

  5. Some drugs cause sweating. One is methadone and other opiates, usually at high doses.

  6. There are many other possible causes of too much sweating – these include some diseases of the nervous system. None are common.

Treatment of Common Hyperhidrosis:

  1. Antiperspirants:- there are a number of different forms available. The common roll-on or spray-on products at the supermarket usually contain salts of aluminium. These work by altering the tiny electrical currents in the sweat glands. They are effective to some extent but are not strong enough to sufficiently reduce profuse sweating of the armpits, hands or feet.

  2. Driclor:- this is also a roll-on antiperspirant (it contains 20% aluminium chloride hexahydrate in an alcohol base). Driclor is more effective than the commonly available anti-perspirants but has to be used properly to work. It works more quickly for the armpits than the palms or soles. Guidelines:
    • Do not put too much on and do not rub it into the skin(it may irritate the skin)
    • Do not shave skin before Driclor applied (it will irritate the skin)
    • Apply to dry skin (do not wash before applying it, a hair dryer can be used to dry the skin before it is applied)
    • Apply only at night (sweating usually less then). Try twice a week for a start.
    • If skin not dry enough in the evening sometimes you can take Pro-Banthine (15mg) 1 tablet, 2 hours before bed to dry the skin. This may also help you sweating problem. It can cause a dry mouth, constipation or blurred vision.
    • When you wake up, shower or wash off the Driclor. If you do not, the Driclor left on your skin may stain your clothing.
    • If your skin gets sore or quite itchy, apply 1% hydrocortisone cream (like Sigmacort or Egocort) twice a day. Once the irritation settles, use the Driclor every second or third night.
    • If after a week the treatment does not work, apply the Driclor but cover the treated skin with a plastic wrap like a Glad-wrap. If you are treating the armpits, keep the Glad-wrap in place by wadding held in by a T-shirt. This treatment works by making the Driclor penetrate into the sweat glands better. It may worsen irritation.
    • Once your sweating is controlled, apply the Driclor once a week if treating the armpits or two or three times a week for the palms or soles.
    • If the irritation is too much for you, refer to your doctor.

  3. Drionic device:- this is a small battery powered unit. It works by delivering a small electric current which temporarily slows the sweat production from your sweat glands, but only in the area treated by the pads of the device. Treatment is done 3 times a week till the sweating settles then as needed to maintain control.
    You buy units with moulds designed for armpits, palms or soles. The moulds last a few months before needing replacement. This can make the treatment expensive. It does not always work.

  4. Iontophoresis:-It is like the Drionic device but instead is a shallow water bath into which you put your feet or hands. A small electric current is passed through the water bath. It can cause a burning sensation during treatment. Treatment is best given twice weekly for about 2 to 4 weeks, then as needed to keep the sweating under control. This varies but it is often monthly.

    The effectiveness of the treatment can be increased by adding a chemical, Glycopyronium bromide, to the bath. The electric current pulls the chemical into your sweat glands. The chemical slows down the nerve impulses that drive your sweat glands.

    Glycopyronium bromide also works as a medicine taken by mouth but the iontophoresis technique gets more into the skin where it is needed. The chemical can have similar side effects to Pro-Banthine (see above).

    The treatment causes a decrease in the production of body fluids which is most marked in the first few hours following treatment.
    • Dryness of the mouth may occur. Take care when eating dry or spicy food after the treatment. Sucking on an ice cube or using a sugarless chewing gum can help with this.
    • Dry eyes. Contact lenses may become uncomfortable to wear for the rest of the day, as there is a reduction in tear production. If this is a problem artificial tears can be purchased at the pharmacy and used as required for comfort.
    • As sweating is reduced over the entire body, you should not play strenuous sport or do aerobics on the day of treatment.
    • In hot weather, you should be aware that your body temperature regulation may be altered as you are unable to sweat and therefore adjust what you are doing accordingly.
    • Some people may have difficulty urinating for the first few hours following treatment. If this is a problem, it is best to void immediately prior to treatment to avoid discomfort.

    Other problems that are occasionally encountered are palpitations. This is an awareness of your heart beating fast. This can be accentuated, particularly by drinking coffee immediately prior or after the treatment. If you have a pre-existing heart problems, make sure that you inform the doctors prior to therapy. Similarly, if you are on any medications for your heart, make sure the doctors are informed of this.

    Some people develop a rash around their wrist when their hands are treated. This can be quite itchy but usually settles within a few hours.

    Treatment is available from a clinic based at the Alfred Hospital. Also many home use machines are available but these are expensive and not returnable. We are aware of few patients who have found these useful.

  5. Surgery:- there are two main surgical options:
    1. Sympathectomy:- this is useful for armpit or palm sweating. It can be done in a number of different ways. The nerves that make the sweat glands work are a special sort called ‘sympathetic nerves’. This operation aims to cut these nerves near the sweat glands. While often long lasting, the effect is not always complete or permanent.

      One form of sympathectomy commonly performed now uses the “endoscopic’ technique. This means only a very small cut is made.

      The side effects of the surgery should be explained to you in detail by the surgeon offering the surgery. The commonest side effect is called ‘compensatory sweating’ seen in up to half the people who have a sympathectomy. Here, even though sweating of the arm on the side of the operation is reduce, there is more sweating on other parts of the body.
    2. Surgical removal of the armpit skin:- this is also done by a surgeon and only settles armpit sweating. It is best if special dyes are used to work out which bits of armpits skin are sweating the most. This skin is then cut out and the hole closed with stitches. This treatment can work very well. Apart from the discomfort of the operating, occasional problems are infection of the armpit or a contracted scar limiting full movement of the arm. It is a rare operation today.

  6. Other treatments:- some of which may help.
    1. Diltiazem – a tablet used mainly to treat high blood pressure or heart problems can sometimes help.
    2. A technique where affected armpit skin is frozen with a cold gas. It is done with a local anaesthetic to numb the skin but causes the treated skin to blister – it settles in a few weeks. The treatment can be effective for a number of years.
    3. Liposuction of armpit skin. A large bore needle is pushed into the local anaesthetic numbed skin. The fatty tissue under the skin in the armpit is sucked out. It takes many of the sweat glands with it.
    4. Psychological treatment if emotional stimuli are a big factor in the sweating.
    5. Biofeedback techniques.
    6. Botox. With a few tiny injections Botox enters the specific glands in the underarms responsible for excessive sweating. There, it blocks the release of the chemical that signals the perspiration. The procedure is simple and safe and takes about 10 minutes. The effect can last on average 7 months. It is safe but expensive (eg $1.5k p.a.)