Do you find yourself sweating excessively, even on cool days? Are you reluctant to shake hands because your palms are too slippery? Or do you avoid taking off your shoes around others due to foot odour?
Excessive sweating, known as hyperhidrosis, can lead to significant social embarrassment and is characterised by sweating that exceeds normal physiological needs for temperature regulation.
Hyperhidrosis can range from mild sweating to drenched clothing, making it difficult to grip objects, ruining socks and shoes, and leaving sweaty footprints on floors. It can restrict daily activities, strain social relationships, and negatively impact work life and emotional well-being, profoundly affecting a person’s quality of life.
Causes
Understanding the causes of hyperhidrosis is crucial, as this will influence treatment options. Hyperhidrosis is categorised into primary focal and secondary generalised types:
- Primary Focal Hyperhidrosis: This type involves an overactive sympathetic nervous system that causes excessive sweating in specific areas such as the armpits, palms, soles, scalp, and forehead. The exact cause of this overactivity is often unknown, but up to 65% of sufferers report a family history, suggesting a genetic link. Axillary hyperhidrosis (excessive armpit sweating) is the most common form.
- Secondary Generalised Hyperhidrosis: This type is often due to underlying medical conditions or medications. Conditions that can cause generalised sweating include perimenopause, menopause, endocrine disorders (such as thyroid disease and diabetes), infections (like tuberculosis), mental health issues (such as anxiety disorders), and substance abuse. A comprehensive evaluation with directed blood tests by a doctor can help identify any underlying causes.
Treatment Options
Treatment for hyperhidrosis can be categorised into non-invasive medical and more invasive surgical options, with the less invasive methods typically tried first.
- Antiperspirants: Many people use antiperspirants daily, but those containing aluminum chloride are more effective. Aluminum chloride works by plugging sweat glands and can provide temporary relief in milder cases. These are available in various forms such as gels, sprays, and wipes. Prescription-strength formulations, like 15 – 20% aluminum chloride hexahydrate or 2% topical glycopyrrolate for the face and scalp, can also be effective but may cause skin irritation.
- Iontophoresis: This non-invasive treatment is effective for palmar (hand) and plantar (foot) hyperhidrosis. It involves applying a mild electrical current through an ionised solution to the affected areas, which reduces sweat gland activity. Treatments usually consist of two to three shorter sessions or one longer session per week. A series of six to ten sessions can provide significant relief but will need to be repeated periodically.
- Botulinum Toxin: Botox, a popular and well-researched treatment, involves injecting a dilute solution of botulinum toxin into the skin (not the muscles, as in cosmetic wrinkle reducing treatments). It blocks the neurotransmitters that signal sweat glands, significantly reducing sweating for up to six months. Botulinum toxin is commonly used for axillary hyperhidrosis but can also be used for the face and forehead.
- Medications: When other treatments are ineffective, oral anticholinergic medications may be considered. However, these can have significant side effects, including dry mouth, palpitations, constipation, urinary difficulties, and blurry vision, making them a less favoured option.
- Newer Therapies: Microwave thermolysis and fractionated radiofrequency microneedling are emerging non-invasive treatments showing promising results.
- Surgery: Surgical options are generally considered as a last resort due to their potential for relapse and complications. Surgical excision of sweat glands and endoscopic sympathectomy (clipping nerves that stimulate sweat glands) can be effective but may lead to compensatory sweating in other areas.
Do I Need Treatment?
If your sweating disrupts daily activities or causes frequent embarrassment, it might be time to seek treatment. Dermatologists or doctors trained in aesthetic medicine can guide you through non-surgical options and refer you to a surgeon if necessary. Most people find relief through non-surgical treatments, and surgery is rarely required.
At Health with Heart, our doctors can consult with you about your hyperhidrosis, and Dr Janine Silberbauer offers Botulinum toxin injection therapy.
