Hyperhidrosis (excessive sweating)

Hyperhidrosis, or excessive sweating, is a condition that is believed to affect around a million people in the World.

Although it is not a serious or life-threatening health problem, it can cause significant upset and embarrassment to people suffering with it, and men and women are equally affected by it. Although there is no strict definition as to what constitutes hyperhidrosis, as a general point if you have sweating to a level that is interfering with your normal daily activities then you have hyperhidrosis.

There are three main categories of the condition;

Generalised – this affects the entire body. Usually caused by medication, or certain medical conditions. Medications include antidepressants, some beta blockers, and pilocarpine eye drops. Many medical problems can cause this including heart or respiratory failure, infections, lymphoma and other malignancies, thyrotoxicosis, Parkinson's disease, the menopause and hypoglycaemia. Withdrawal from alcohol or substance abuse can also be triggers, as can anxiety.

Primary – this is common and affects the axillae (armpits), palms of the hands, soles of the feet and the scalp. It can occur at any age, but usually starts during childhood or the teenage years.

Secondary focal – this type only affects certain parts of the body and is less common. Certain conditions are often implicated in this type, including cerebrovascular disease, diabetic neuropathy, spinal injuries and tumours, Raynaud's phenomenon and rheumatoid arthritis.

How is hyperhidrosis treated?
This partly depends on the cause – any underlying medical condition needs to be treated and this is often enough to stop the problem.

For primary hyperhidrosis there are a number of things that can be done as general advice;
use soap substitutes rather than soap to reduce the possibility of skin dryness and irritation
change clothing and shoes frequently and try to avoid heavy boots or sports shoes
change your socks at least twice a day and alternate shoes every day to allow them to dry out thoroughly
wear loose-fitting clothes and try to avoid man-mad fibres such as nylon
use an antiperspirant rather than a deodorant and consider using armpit sweat shields to absorb excessive sweat.

What treatments are available?

Doctors usually start with the least invasive treatments such as strong anti-perspirants.

The usual one is 20 per cent aluminium chloride hexahydrate in alcohol solution, applied to the armpits, feet, hands or face (avoiding the eyes) at bedtime and then washed off in the morning.

This is initially applied every day until the condition improves and then gradually reduced to once or twice a week and can be used safely in the long-term if necessary.

If this does not work then specialist referral may be required. Specialist treatments available include Iontophoresis – where the affected areas are immersed in warm water and weak electrical currents passed across the area – and intradermal injections of botox (Botulinum A toxin) which are safe and effective.

Surgery is usually only considered if other treatments have failed and involves either resecting the sweat glands (under local anaesthetic) or having a sympathectomy, where the sympathetic nerves over the neck of the ribs are cut under general anaesthetic.