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1. What is hyperhidrosis?
Sweating is a normal physiological response. Hyperhidrosis is excessive sweating. All of us sweat and when it is hot or we are embarrassed or anxious we sweat more. In most individuals, normal or even heavy sweating can be controlled by using anti-perspirants, deodorants or aluminium chloride, which can be purchased over the counter. When sweating is excessive and cannot be controlled by normal measures, it is termed "hyperhidrosis". Generalised hyperhidrosis may be the result of systemic disease such as chronic infection or an over active thyroid. Localised sweating confined to the armpits or hands is not usually associated with any generalised disease.
Hyperhidrosis usually presents in young adults but other age groups can be affected. Hyperhidrosis typically affects the hands (Palmar Hyperhidrosis) and/or the arm-pits (Axillary Hyperhidrosis). The feet, groins, face, head and neck can also be affected.
Hyperhidrosis can be highly debilitating with many patients reporting extreme social embarrassment, ruined clothing, an adverse affect on personal relationships and compromised employment opportunities.
2. Where does sweat come from?
There are thousands of little glands in the skin that produce sweat. Sweat is one of the ways which the body uses to cool itself. The amount of sweat depends on how hot it is and on stimulation of the sweat glands by the nerves that supply them. Hyperhidrosis usually occurs due to overactive sweat glands or overactivity of the sympathetic nervous system.
3. Do I need treatment?
Excessive sweating is not harmful in itself. Therefore treatment is only required if the sweating is so severe that it is causing embarrassment or difficulties at work. Some people suffer from severe facial blushing and/or sweating. This can also be treated.
4. What treatment is available?
You may initially be prescribed a strong antiperspirant called aluminium chloride. This is applied at night and washed off in the morning. Antiperspirants work better in the armpits than on the hands. If medical treatment is unsuccessful in controlling the sweating, then an operation to divide the sympathetic nerves that supply the sweat glands may be needed (Endoscopic Thoracoscopic Sympathectomy - ETS). Alternatively, Botulinum Toxin injections (Botox) into the skin may be used. Botox is particularly useful for treating armpit sweating.
Patient information prepared by Mr S. Ashley MS, FRCS, Consultant Vascular Surgeon
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