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Excessive Sweating (hyperhidrosis)

What could cause excessive sweating and why does it happen?

Sweating is a physiological body function that helps to regulate body temperature when we are hot. In some people, the amount of sweating is more than what is needed for temperature control. Sometimes this could be due to an underlying medical condition such as infection, medication side effect and an imbalance in hormones such as thyroid, or oestrogen in women (menopause). However, a large number of people who suffer from excessive sweating don’t have a medical condition. The exact reason for this type of sweating is not known but it is due to an overactivity of nerves that regulate sweating.

Are there any practical tips for excessive sweating?

Use an antiperspirant instead of a deodorant since the latter only masks the smell but does not help the sweating process.

Try wearing loose-fitting clothes made from natural fibres such as cotton and linen to allow your skin to breathe. Both dark and light colour clothing help to disguise sweat patches, and special sweat resistant underarm pads and undershirts are available to protect your clothes and prevent stains. Absorbing sports socks help to keep your feet dry.

Spicy food, alcohol, caffeine and stress often worsen sweating in some people so reducing these can help.

Are there any recommended treatment to manage it?

If the usual deodorants don’t help, try those containing Aluminium Chloride since they block the sweat glands. They are available over the counter and on prescription and should be worn overnight.

Sometimes using special deodorants is not enough to control sweating. If this is the case, you should see a specialist, usually a dermatologist for advice on further treatment. You should ensure that any potential medical reason for your excessive sweating has already been excluded.

One of the safest treatments for excessive sweating of hands, feet and armpits is Ionthophoresis. This is a machine that passes a weak electrical current via tap water to the skin while you immerse your hands or feet in water, or wear a wet pad in your armpits. The sweating is reduced after a few treatments but maintenance treatment is needed for sustained results.  The machine is available in some dermatology centres and can be purchased for self-treatment.

Another option is an injection of botolinum toxin (Botox) under the skin. This works best for armpits but can also be done in hands and feet. Multiple injections with a small needle are placed in the area and the effect lasts 3-6 months. Injections in the hands and feet are more painful and there is a risk of muscle weakness as a side effect.

If the topical options don’t work, a group of medications called anticholinergic drugs can be prescribed by an experienced doctor to reduce sweating. These are not licensed for excessive sweating but can work by blocking the chemicals in nerve endings that regulate sweat glands. Blocking of these chemicals can affect other parts of the body supplied by the same nerves, leading to side effects such as constipation and dry mouth.

Sweat glands can be permanently destroyed using non-surgical devices that generate electromagnetic energy (microwaves) with long-lasting results.  Invasive surgery for excessive sweating can also remove sweat glands permanently. A more extensive surgery called sympathectomy involves cutting the nerves that supply the sweat glands. These invasive procedures are left for severe cases, thanks to the available safe and non-invasive options.

Excessive Sweating (hyperhidrosis) Consultants

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