How to know if you sweat too much and what to do about it

Do you think you sweat too much? Most of us do, but some of us feel we sweat more than anyone else on the planet. Truth be told, most of us perspire on the heavy side and it’s perfectly normal. However, hyperhidrosis is a not-too-common condition in which people sweat excessively. When it occurs it is challenging to know what’s causing it and how to solve the problem.

What causes unwanted sweating?

Excessive sweating is more than just a bother. It can create a serious psychological and emotional disability. As such it has even been referred to as the ‘silent handicap.’ Let’s consider the types of hyperhidrosis and the many causes.

Excessive sweating most commonly occurs as primary hyperhidrosis. This means that it is not caused by some other medical condition or medication side effect, but just happens. It occurs symmetrically (both sides equally) on specific areas of your body, usually underarms, hands, feet, head or face.

Although the textbooks will tell you that there is no known underlying cause of primary hyperhidrosis, there must be a cause. If you consider how the human body works, we know that the sympathetic nervous system stimulates sweat glands and whenever you are faced with a “fight or flight” situation, these nerves are activated.

You can imagine the life situations that could trigger this, from emotional upset or sudden fear, to prolonged nervousness or worry. In fact, any anxiety-provoking situation such as public speaking, stage performances, or any special event such as a wedding will do it. Therefore, as much as you want to tell yourself you are not nervous when you have unwanted sweating, your sweat glands may be proving otherwise. All told, mental-emotional causes are the most reason behind hyperhidrosis.

As you can imagine, there are several other less-common causes of hyperhidrosis to consider. We call these “secondary hyperhidrosis” and can be treated by simply discovering and eliminating the underlying cause.

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Secondary hyperhidrosis

This is caused by something you can eliminate, usually a medical condition or medication. It will be a generalized sweating (not limited to specific body areas). The list of causative health conditions is quite long, from hyperthyroidism or heart failure to menopause or obesity. These diseases are known to cause hyperhidrosis: Diseases and Conditions that Can Cause Hyperhidrosis.

The list of medications known to cause hyperhidrosis is even longer, from anti-hypertensive and anti-depressants, to antibiotics and prednisone. I remember how prednisone which I took for ulcerative colitis made me sweat (armpits only) at the slightest provocation of stress! These medications are known to cause hyperhidrosis: Drugs/Medications Known to Cause Hyperhidrosis.

Certain foods or drinks can trigger hyperhidrosis too, such as nicotine, caffeine, and certain aromatized chemicals. Topical Vaseline which contains glycerin, lecithin and propylene glycol makes skin moist and will cause increased sweating at the site of repeated use. It makes me wonder if even more common foods such as gluten (wheat), dairy, or artificial chemicals/dyes/preservatives can cause hyperhidrosis as the “allergic reaction” effect.

Treatment for hyperhidrosis

To determine the best treatment for hyperhidrosis, experts have created (and validated with studies) the hyperhidrosis disease severity scale, or HDSS. Your score will range from 1 to 4 based on how you would rate the severity of your sweating:

1. My sweating is never noticeable and never interferes with my daily activities
2. My sweating is tolerable but sometimes interferes with my daily activities
3. My sweating is barely tolerable and frequently interferes with my daily activities
4. My sweating is intolerable and always interferes with my daily activities

The treatments for primary hyperhidrosis are one or more of the following:

• Antiperspirant products containing aluminum chloride you can buy off the shelf
• Prescription medications: Anticholinergics such as oxybutynin, benztropine, propantheline, and glycopyrrolate can dry up your sweat glands but they also can commonly cause dry mouth, urinary retention, constipation, or visual disturbances.
• Iontophoresis: this works best for hands and feet hyperhidrosis. Using a medical device, mild electrical current is passed through water in a shallow pan and through your skin’s surface to the sweat glands. It is done weekly to be effective. It is safe, and can be rented to be used at home for $100 to $150 per month (see http://www.rafischer.com/share/MD-Rental-Form.pdf for more information).
• MiraDry^®: This is a non-invasive electromagnetic heat delivery by a handheld device to decompose sweat glands. Simultaneously the top layers of your skin are cooled and protected. You can expect almost immediate results, and a second treatment three months later is usually recommended. It has been shown to be safe and effective in more than 6000 procedures so far. A small study reports “83.3% of the underarms treated were determined to have experienced a 2 point improvement in the HDS Scale.” ^[1] Watch the short (1.5 minute) video on YouTube about MiraDry: https://www.youtube.com/watch?v=0UF2LPyMyvY
• Botox^® injections: blocks neural control of sweat glands and lasts 3 to 9 months. See your local aesthetic practitioner for more information.
• Lasers: precisely target, heat, and destroy sweat glands. This can be done by minimally invasive incisions or non-invasively. See your local aesthetic practitioner for more information.
• Liposuction surgery: while this is definitely more invasive than lasers, this is a definitive treatment that is an option if these other methods are ineffective.
• Endoscopic thoracic sympathectomy (ETS) surgery: finally, if needed, a surgeon can destroy the sympathetic nerves that lead from your spinal cord to your sweat glands while you are under general anesthesia. He’ll insert a miniature camera into your chest under the armpit as one lung is temporarily collapsed. This is certainly not an easy option.

If you’ve felt like you’ve suffered from this condition but have not been able to get your physician to take you seriously, hopefully this information will help you.

To feeling good and staying on top of your health,

Michael Cutler, M.D.
Easy Health Options

[1] International Hyperhidrosis Society