Hyperhidrosis (hi-pur-hi-DROE-sis) is abnormally excessive sweating that's not necessarily related to higher temperatures or exercise. You may sweat so much that it soaks through your clothes or drips off your hands. Besides disrupting normal daily activities, hyperhidrosis can cause social anxiety and embarrassment.

Hyperhidrosis treatment usually involves prescription-strength antiperspirants on the affected areas. Rarely, an underlying cause may be found and treated. For persistent hyperhidrosis, you may need to try different medications or other therapies. In severe cases, your doctor may suggest surgery either to remove the sweat glands or to disconnect the nerves responsible for the overproduction of sweat.

Most people sweat when they exercise or exert themselves, are in a hot environment, or are nervous, anxious or under stress. The excessive sweating experienced with hyperhidrosis far exceeds such normal sweating.

The type of hyperhidrosis that usually affects the hands, feet, underarms or face causes at least one episode a week, during waking hours. And the sweating usually occurs on both sides of the body.

When to see a doctor

Sometimes excessive sweating is a sign of a serious condition. Seek immediate medical attention if your heavy sweating is accompanied by one or more of the following:

  • Chills
  • Lightheadedness
  • Chest pain
  • Nausea
  • A body temperature of 104 F (40 C) or higher

See your doctor if:

  • Sweating disrupts your daily routine
  • You suddenly begin to sweat more than usual
  • You experience night sweats for no apparent reason

Sweating is your body's mechanism to cool itself. Your nervous system automatically triggers your sweat glands when your body temperature rises. Sweating also normally occurs, especially on your palms, when you're nervous.

In hyperhidrosis the nerves responsible for triggering your sweat glands become overactive and call for more perspiration even when it's not needed. With stress or nervousness, the problem becomes even worse.

Often there is no underlying cause of heavy sweating; this condition is called primary hyperhidrosis. This type usually affects your palms and soles and sometimes your face. It may have a hereditary component, because it sometimes clusters in families.

If the sweating can be attributed to an underlying medical condition, it's called secondary hyperhidrosis. This type is more likely to cause sweating all over your body. Possible underlying health factors include:

  • Certain medications
  • Diabetes
  • Menopause hot flashes
  • Low blood sugar
  • Overactive thyroid gland
  • Some types of cancer
  • Heart attack
  • Nervous system disorders
  • Infectious disease

Complications of hyperhidrosis include:

  • Infections. People who sweat profusely are more prone to skin infections.
  • Social and emotional effects. Having clammy or dripping hands and perspiration-soaked clothes can be embarrassing. Your condition may affect your pursuit of work and educational goals.

You may start by seeing your primary care provider. He or she may refer you to a specialist in skin diseases (dermatologist). If your condition is not responding to initial treatments, your care may also involve a neurologist or a surgeon.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, you might want to list answers to the following questions:

  • Has anyone in your immediate family ever had similar symptoms?
  • Does your sweating stop when you're asleep?
  • What medications and supplements do you take regularly?

What to expect from your doctor

Your doctor is likely to ask you several questions, such as:

  • When did you first experience heavy sweating?
  • Where on your body does it occur?
  • Have your symptoms been continuous or occasional?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

During your appointment, your doctor will ask about your medical history and conduct a physical exam. If your symptoms are obvious, it may be relatively easy for your doctor to diagnose hyperhidrosis.

Lab tests

Your doctor may order blood or urine tests to determine if the excessive sweating is caused by another medical condition, such as an overactive thyroid (hyperthyroidism) or low blood sugar (hypoglycemia).

Sweat tests

A number of tests are available to pinpoint the areas of sweating and estimate the severity of your condition. These include:

  • Iodine-starch test
  • Thermoregulatory sweat test
  • Skin conductance

The goal of treatment for hyperhidrosis is to control your heavy sweating. Once any underlying medical conditions have been addressed or ruled out, your treatment will depend on the severity of the problem. Sometimes you may need to try a combination of treatments. And even if your sweating improves after treatment, you may later experience a recurrence and need ongoing therapy.

Medications

Drugs used to treat hyperhidrosis include:

  • Prescription antiperspirant. Your doctor may prescribe an antiperspirant with aluminum chloride (Drysol, Xerac Ac) as the first line of treatment. This product can cause skin and eye irritation. It's usually applied to the affected skin before you go to bed. Then you wash the product off when you get up, taking care to not get any in your eyes. If your skin becomes irritated, hydrocortisone cream might help.
  • Nerve-blocking medications. Some oral medications block the chemicals that permit certain nerves to communicate with each other. This can reduce sweating in some people. Possible side effects include dry mouth, blurred vision and bladder problems.
  • Antidepressants. Some medications used for depression can also decrease sweating. In addition, they may help decrease the anxiety that worsens the hyperhidrosis.
  • Botulinum toxin injections. Although best known for helping smooth facial wrinkles, botulinum toxin (Botox, Myobloc, others) injections can also block the nerves that trigger sweat glands. Your skin will be iced or anesthetized first. Each affected area of your body will need several injections. The effects last six to 12 months, and then the treatment needs to be repeated.

    Further study is needed on possible side effects of using this method to treat hyperhidrosis. One possible side effect is temporary muscle weakness in the treated area. One report tells of a patient whose heavy sweating improved, but she had trouble typing text messages on her phone for about six weeks after treatment.

Surgical and other procedures

Other types of hyperhidrosis treatments include:

  • Electrical current. In a procedure called iontophoresis (i-on-toe-fuh-RE-sis), a device is used to deliver a low level of electrical current to water-soaked hands or feet, and sometimes the armpits. You will likely need the treatment twice a day for three to four weeks. This may reduce your sweating for several weeks, and then the treatment needs to be repeated. You may need less frequent treatments during maintenance therapy.

    You may be prescribed a device to enable you to treat yourself. Or you can visit your doctor's office for therapy. In either case, your doctor will need to see you regularly to check on whether your condition is improving.

    This treatment is not an option for people who have a pacemaker or are pregnant.

  • Sweat gland removal. If excessive sweating occurs just in your armpits, removing the sweat glands there may help. Your doctor may use one of several techniques, such as making very small incisions through which the sweat glands can be removed by scraping (curettage) or liposuction.
  • Nerve surgery. If you have severe hand hyperhidrosis that isn't responding to treatment, your doctor might suggest nerve surgery. During this procedure, the surgeon cuts, burns or clamps the spinal nerves that control sweating in your hands. In some cases, this procedure triggers excessive sweating in other areas of your body.

Emerging treatments

New techniques for treating hyperhidrosis are being studied, including laser, microwave and ultrasound therapies.

The following suggestions may help you cope with sweating and body odor:

  • Use antiperspirant. Nonprescription antiperspirants contain aluminum-based compounds that temporarily block the sweat pore. This reduces the amount of sweat that reaches your skin. This type of product may help with minor hyperhidrosis.
  • Bathe daily. Regular bathing helps keep the number of bacteria on your skin in check. Dry yourself thoroughly, especially between the toes and under the arms.
  • Choose shoes and socks made of natural materials. Shoes made of natural materials, such as leather, can help prevent sweaty feet by allowing your feet to breathe. When you're active, moisture-wicking athletic socks are a good choice.
  • Rotate your shoes. Shoes won't completely dry overnight, so try not to wear the same pair two days in a row.
  • Change your socks often. Change socks or hose once or twice a day, drying your feet thoroughly each time. You may want to try pantyhose with cotton soles. Use over-the-counter foot powders to help absorb sweat.
  • Air your feet. Go barefoot when you can, or at least slip out of your shoes now and then.
  • Choose clothing to suit your activity. Generally, wear natural fabrics, such as cotton, wool and silk, which allow your skin to breathe. When you exercise, you might prefer fabrics designed to wick moisture away from your skin.
  • Try relaxation techniques. Consider relaxation techniques such as yoga, meditation and biofeedback. These can help you learn to control the stress that triggers sweating.

Hyperhidrosis can be distressing. You may have trouble working or enjoying recreational activities because of wet hands or feet or wet stains on clothing. You might feel embarrassed or anxious about your symptoms and become withdrawn or self-conscious. You may be frustrated or upset by other people's reactions.

Besides talking with your doctor, you may want to talk with a counselor or a medical social worker. Or you may find it helpful to talk with other people who have hyperhidrosis.

Aug. 18, 2015