Medical Edge Newspaper Column

Excessive Sweating: Treatments Are Available

August 6, 2007
Dear Mayo Clinic:
Since she was a child, my 25-year-old daughter has had a problem with excessive sweating, affecting her hands, feet and armpits. Triggers include stress, nervousness, hot weather and even being asked to write. Some friends have suggested that my daughter's symptoms are consistent with hyperhidrosis. Is this what she has? Is there any treatment or a specialist that you could recommend? -- Chicago, Ill.

Answer:
It's natural and healthy to sweat under some conditions, for example, when you're exposed to heat, when you exercise, or when you're experiencing emotional stress. Sweating helps the body stay cool. However, for some people sweating can be excessive and unpredictable. Based on your description, your daughter may be suffering from a well-known condition called primary or essential hyperhidrosis, or excessive sweating.

Although primary hyperhidrosis is not yet fully understood, research has indicated that it is most likely caused by hyperfunctioning in areas of the brain that control the sympathetic nervous system. There seems to be a genetic element, too. Approximately 60 percent to 80 percent of patients with primary hyperhidrosis have a first-degree relative (parent, sibling or child) suffering from the same condition.

From what you've shared, it doesn't sound like your daughter has secondary hyperhidrosis, which can be a symptom of chronic infections, tumors, neurologic and endocrine disorders, spinal cord injury, medications and other causes.

As your daughter has experienced, sweating is often worse during periods of anxiety and stress. During intense episodes, the sweating is often accompanied by cold, clammy skin. Excess sweating can cause complications such as athlete's foot, bacterial infections, warts and extreme embarrassment. Clammy hands and smelly feet don't make a very good impression.

The good news is, there are several treatment options:

Antiperspirants: Antiperspirants block the sweat ducts with aluminum salts, reducing the amount of perspiration. Prescription strengths are available if the drug store varieties don't provide enough help.

Oral anti-cholinergic drugs: These medications block the chemical messenger in the body that stimulates sweat glands. The medications can cause side effects including dry mouth and eyes, blurred vision and difficulty with urination.

Iontophoresis: A dermatologist uses a battery-powered device to deliver a low current of electricity to the affected areas. The procedure is painless and safe but may not offer any more relief than antiperspirants.

Botulism toxin injections: Botox -- yes the same substance that fends off wrinkles -- can be used to block the nerves that trigger sweat glands. The injections are directed at the areas of increased sweating. The benefit wears off after about four months, but additional injections can be given.

Local excision: If the armpits are the primary problem area, sweat glands can be surgically removed.

Surgical sympathectomy: In this procedure, the surgeon cuts the nerves that carry the messages from the sympathetic nerves to the sweat glands. Surgical sympathectomy has been used for more than 70 years, particularly in severe forms of hyperhidrosis and for patients who don't respond to other treatments.

In the past, this operation required major surgery including large incisions on the chest or back to reach the sympathetic nerves. Now, newer endoscopic techniques and minimally invasive incisions make this procedure easier on the patient and can produce excellent lifelong results in a majority of patients. This procedure has a high success rate for sweaty palms but it less successful for the armpits and feet.

It would be a good idea for your daughter to see a dermatologist or neurologist with expertise in hyperhidrosis to confirm the diagnosis and discuss treatment options. A skilled physician in this disorder can help your daughter decide which strategies would be most beneficial for her.

-- John L.D. Atkinson, M.D., Neurologic Surgery, Mayo Clinic, Rochester, Minn.