Resolving Hyperhidrosis and Sweat Issues

Hyperhidrosis – What is it?

Hyperhidrosis is a medical condition that involves excessive and often uncontrollable sweating. Sweating is a natural response enabling the body to moderate temperature and stay cool. It happens as a result of warmer weather, exercise, or situations causing anger, fear, stress or anxiety.

However, for those with hyperhidrosis, excessive sweating occurs in the absence of triggers like this. It is thought to be due to overactive sweat glands, producing as much as five times the normal excretion of sweat. The disorder can be embarrassing and even disabling, impacting the quality of virtually every facet of life. Discomfort from extreme and unpredictable sweating can be both physical and emotional in nature, leading to the disruption of both a person’s social and professional life. It can result in emotional issues, including loss of confidence, depression, and social isolation. Career choices limiting interaction with others may be favoured, and work productivity may suffer. Overgrowth of bacteria or fungi, infections, and skin disintegration (called maceration) are some difficult physical outcomes. Studies have shown that hyperhidrosis affects people in a manner comparable to or worse than other dermatological conditions like severe acne or psoriasis.

On a global level at least 3% of the population has to deal with hyperhidrosis. This translates to a staggering 220 million people around the world who suffer with this disorder. Therefore the good news is that you are not alone. While how to reduce sweating has not received much attention in the medical literature, a recent breakthrough in treatment options has led to increasing awareness in the healthcare community. Only about 38% of hyperhidrosis sufferers will actually seek medical advice. It appears strange, but most simply do not know that the condition is treatable.

Understanding Sweating

Temperature control is critical to maintaining normal body functioning. Sweat is key to cooling the body and can safeguard us against overheating. We have millions of sweat glands in different areas of our body. Largely, they are ‘eccrine’ sweat glands, located in the armpits, the palms, the soles of the feet, the forehead and cheeks. They produce a watery, odourless fluid, that assists with temperature management via heat loss from evaporation. Typically, hyperhidrosis is a result of eccrine sweat.

A minority of sweat glands are of another type called ‘apocrine’ glands. Apocrine glands exist in the genital area, and also in the armpits. They are responsible for the ‘body odour’ created when their thick secretion encounters bacteria on the surface of the skin. Both types of sweat glands are controlled by nerves in reaction to a range of stimuli such as:

  • indications of overheating from the brain
  • hormones
  • emotions
  • physical activity or exercise.

People who suffer from profuse sweating have overactive sweat glands (eccrine glands in particular) that produce a bigger response to stimuli than is required. It’s as if their sweat glands are permanently ‘on’. Sweat does not function to rid the body of toxins as is the common perception. In fact, sweat consists mostly of water with small amounts of carbohydrates, salt, urea, and protein. It is the kidneys and liver that carry out detoxification for your body.

Types of hyperhidrosis

There are different types of excessive sweating. Sometimes it can signify serious cause for concern, so understanding how to reduce sweating becomes paramount. The two types of hyperhidrosis are primary focal hyperhidrosis and generalised secondary hyperhidrosis.

Primary or focal hyperhidrosis involves extreme sweating of specific regions such as the hands, feet, armpits, and head or face. It may start in childhood or adolescence, occurs on both sides of the body to a similar degree, and often in more than one area. Incidents may take place weekly, but rarely does it happen during sleep. Generally, no reason can be identified. It appears to be a common affliction to members of a family, possibly hereditary or due to similar environmental exposure. Unfortunately it is seldom discussed in the family due to severe embarrassment.

When the sweating is the outcome of another illness or a side effect of a medication, it is referred to as secondary generalised hyperhidrosis. The sweating may be widespread covering the whole body or it may be localised to a particular area. An important difference between the two types is that secondary hyperhidrosis frequently takes place during sleep. Another difference is that this type usually begins in adulthood. The first step in treating it is discovering the underlying medical problem or medication producing the symptoms. Consulting with an experienced physician, such as a specialist in internal medicine, can provide valuable insight to flesh out the overall medical situation. Some disorders leading to secondary hyperhidrosis are:

  • Over production of growth hormone
  • Anxiety conditions
  • Cancer
  • Carcinoid tumour secondary symptoms
  • Abuse of certain substances or drugs
  • Glucose control disorders
  • Heart disease
  • Hyperthyroidism
  • Lung disease
  • Menopause
  • Parkinson disease
  • Adrenal neuroendocrine tumours
  • Spinal cord injury
  • Stroke
  • Tuberculosis or other infections.

Odour and Sweat

In the previous section we discussed the two different kinds of sweat glands, eccrine and apocrine, and their different secretions. It is notable that people affected with ‘true hyperhidrosis’ generally do not have issues with body odour. This is due to the large quantity of sweat created being from their eccrine glands, and it washes away both surface bacteria and apocrine sweat. But, body odour happens when a person sweats intermittently and the sweat dries on the skin. In such a situation, apocrine sweat has a chance to interact with bacteria on the skin resulting in a characteristic odour.

If you are facing issues with odour, accompanied or not by hyperhidrosis, knowing how to reduce sweating and keep a particular body area dry is very important. This is achieved by use of antiperspirants, absorbent powders, and periodic clothing changes. Regular bathing with an antibacterial soap is the next point to observe. Deodorants may aid in masking odour, they are a component of many antiperspirants. Diet modifications may also be helpful. Dermatologists should be consulted as they have expertise in handling persistent odour issues.

However, when severe foot odour is experienced, the body’s ‘regular’ bacteria and moisture may not be the only culprits. Undue foot odour is often a result of the overgrowth of another type of bacteria. This type of bacteria favours a warm, damp atmosphere like that of the feet. The solution is to tackle both the bacteria and the moisture situation. Moisture can be managed by regular changing of shoes and socks, use of absorbent powders or antiperspirants. Bacteria can be controlled by washing with an antibacterial soap. A dermatologist or podiatrist can assist with further methods to handle foot moisture, a topical or oral antibiotic may be prescribed. Foot odour can be a source of embarrassment, but help is available. Happy feet may be only steps away.

Treatment for Hyperhidrosis – How to Reduce Sweating

People suffering from profuse uncontrollable sweating may feel like they’ve tried every possible solution. But there is cause for optimism in the quest for relief from the debilitation of excessive sweating.

Besides medical treatments there are several high-tech options available to aid in the management of hyperhidrosis. Conventional treatments such as antiperspirants and iontophoresis are now much more effective. More recent treatments, like miraDry, muscle relaxing injections, and lasers are providing relief to those who’d lost hope. Healthcare practitioners and patients are exploring treatment combinations with good results. Oral medications have a role especially when treating large or multiple areas of the body, or as a short-term solution, but side effects prevent their long-term use.

Surgical options for under-arm like liposuction are now more sophisticated but less aggressive treatments need to first be considered. Endoscopic thoracic sympathectomy (ETS) surgery has been much touted, though it is only warranted for severe cases of palmar hyperhidrosis (profuse sweating of the palms) when other treatments have not worked.

Antiperspirants

What is it?

Antiperspirants are the first line of defence for hyperhidrosis of the underarms, hands, feet, and sometimes face. They are recommended as the initial option for how to reduce sweating as well as being the least invasive. Additionally they are inexpensive and easy to use. They are topical, meaning they are applied to the top of the skin. Both over-the-counter and prescription forms are available in different strengths, offering progressively better sweat reduction.

How does it work?

The most common active ingredient in antiperspirants is a metallic salt (eg aluminium zirconium trichlorohydrex). Clinical strength antiperspirants have higher concentrations compared to regular over-the-counter products. Prescription antiperspirants usually contain the active ingredient aluminium chloride hexahydrate, which makes them very effective. Higher concentrations are needed to combat sweaty hands or feet as compared with sweaty underarms.

After application, antiperspirant particles are dissolved by perspiration in the underarm. They are drawn into the pores forming plugs. When the body realises that the sweat duct is plugged, it generates a feedback mechanism that halts the production of perspiration. This can work for up to 24 hours after which the plugs get washed away.

The recommendation is to start with the most gentle over-the-counter product, gradually moving to clinical strength, followed by stronger prescription formulations until relief is achieved.

What about side effects?

Skin irritation is the most encountered side effect, and its avoidance is the key to success with both prescription and non-prescription versions. Carefully follow product guidance and your dermatologist’s instructions. Apply the antiperspirant at bedtime versus just in the morning, and be sure to apply to totally dry skin.

Iontophoresis

What is it?

Iontophoresis is especially helpful for people who’ve tried clinical strength and prescription antiperspirants to no avail. It has been around as a treatment since the 1940s, and can dramatically reduce sweating for those with palmoplantar (hands and/or feet) hyperhidrosis. Studies have shown that iontophoresis assisted 80–90% of such patients. It is less effective in treating underarm hyperhidrosis, as the skin in the armpits is more susceptible to irritation by the process. The procedure involves a medical device used to pass a mild electrical current through water (with shallow pans for hands or feet) and past the skin’s surface.

How does it work?

Directions for iontophoresis devices differ but, typically patients have hands and/or feet submerged in shallow trays filled with tap water for 20 to 40 minutes, while a low electrical current is passed through the water. This is usually repeated three times per week until anticipated results are attained. When the desired outcome of dryness is reached, patients are moved to maintenance treatments once per week. For ongoing sweat relief iontophoresis treatments should be performed regularly. If tap water doesn’t have enough electrolytes to conduct the electric current, additing a teaspoon of baking soda to the water does the trick.

These devices can be for home-use and although they may seem expensive, they can be used for many years. Success is dependent on patient motivation, the major constraint of iontophoresis is the time requirement, especially at the outset. Some are too bothered by this, while others appreciate the independence of handling their own therapy with great results. It is helpful to be coached by a professional for a few sessions.

What about side effects?

There are no major side effects and the benefits are long-term if a regular weekly schedule is maintained. A gentle tingling is felt during the process. The electric current used is not enough to cause a shock, but if hands or feet leave the water the effect could be alarming. Avoid iontophoresis if you are pregnant, have a cardiac condition or epilepsy, have a pacemaker, or have a metal implant in the treated area. Scratches, and nicks in the skin may be covered with petroleum jelly prior to treatment. However, this creates a barrier to iontophoresis, so should be used minimally. Skin irritation or redness post-treatment can be addressed with 1% hydrocortisone cream. A moisturiser helps with excessive dryness after treatment.

MiraDry

What is it?

miraDry is a very recent electromagnetic technology developed to combat underarm hyperhidrosis through destruction of the sweat glands. Sweat glands do not grow back after treatment so the outcome is immediate and enduring. Electromagnetic technology has long been used in other fields of medicine including cardiology, cosmetics, general surgery, urology, and oncology.

The device was cleared by the US safety governing body in 2015 as a permanent solution for undesired underarm hair of all colours. This makes it the first safety approved device for both unwanted underarm hair and sweat control. It is effective regardless of the colour of skin or hair, this is a significant advantage compared with laser hair removal.

Recent studies have shown that miraDry is efficient in treating not only underarm hyperhidrosis but also underarm osmidrosis (foul-smelling sweat). Over 80% of underarms treated demonstrated remarkable improvement. Foul odour was much reduced in over 90% of cases. Unfortunately miraDry cannot be used to address excessive sweating in other areas since the device has been designed particularly for the contours of the underarms.

How does it work?

It uses carefully controlled electromagnetic energy delivered via a non-invasive handheld device to permanently treat underarm hyperhidrosis. The specific region where sweat glands are situated is targeted, resulting in their elimination by thermolysis (decomposition by heat). Concurrent with the sweat glands being destroyed the superficial layers of the skin are cooled and protected. Best results are obtained when treatments are spaced three months apart.

The miraDry procedure is carried out by a physician under local anaesthetic, and takes approximately an hour. Minimal discomfort is felt during the procedure with little recovery needed subsequently. Over-the-counter pain medication suffices, and ice packs are suggested for several days. Patients are generally able to return to work and activities immediately following treatment, though it is advised to hold off on exercise for a few days.

What about side effects?

Side effects of miraDry are minor including swelling, tenderness, and redness of the underarm region for several days. Numbness and tingling in the area may occur lasting for about five weeks. Although sweating is a key function for temperature moderation, the underarms are home to only about 2% of the body’s sweat glands. Experts are of the opinion that learning how to reduce sweating through removal of sweat glands should not impact body thermoregulation.

Muscle Relaxing Injections

What is it?

Muscle relaxing injections can also be used to treat severe primary focal underarm hyperhidrosis and have been widely approved globally. Patients unable to obtain relief by more conventional modalities have found these injections highly effective.

Studies have shown that muscle relaxing injections, such as those used at Shine, are safe and effective for treating excessive sweating of the armpits, hands, feet, head and face, and other small body areas (like under the breasts). When used for underarm hyperhidrosis it reduces sweating by close to 90%. Results may be observed within 2–4 days post-treatment with the full effects seen within two weeks. Relief can last up to 12 months, sometimes even as long as 14 months. Repeat treatments have also proven safe, restoring quality of life and daily functioning for those afflicted with excessive sweating. Permanent hair reduction treatment is a helpful complement when underarm hyperhidrosis is being addressed.

Research demonstrates that this treatment is 80–90% effective for treating palmar (hand) excessive sweating. Results may last for six months. It also is effective on the head and face, but a skilled and experienced practitioner is needed.

Sweating is a key body function for temperature moderation, but most body areas only contain a small proportion of the body’s sweat glands (eg the underarms are home to less than 2% of the body’s sweat glands). Therefore temporary suspension of sweat glands’ functioning has minimal impact on thermoregulation.

How does it work?

Muscle relaxing injections use a naturally occurring protein that blocks the release of the chemical that activates the body’s sweat glands. Interrupting this chemical signal switches off sweating at the area where it is injected. Small amounts of the muscle relaxer are injected just below the skin using a very fine needle. The injections are administered in a grid pattern all over the areas of excessive sweating. Treatment is relatively painless. Any discomfort can be alleviated through local anaesthetic, ice, or a topical numbing agent, however this is rarely needed.

Injections can be carried out in a short time, experienced professionals can inject both underarms in under 10 minutes. Constraints on work or other activity are minor, avoid intense exercise or sauna use on the day of the injections. It’s best not to shave before injections in the underarms. In fact, three to four days of hair growth preceding treatment is preferable.

Follow-up with your practitioner in 1–2 weeks is strongly recommended. This is very helpful because it allows ‘touch-up’ of some areas making sure that maximum benefit is received.

What about side effects?

A possible side effect of these injections in the face is asymmetry, especially of the forehead. This can occur if some of the neurotoxin spreads into the facial muscles. Any asymmetry is always temporary and can be easily fixed by further injections. Transient pain and weakness in the hands may be produced when palmar hyperhidrosis is being treated.

Treatment of the underarm area is extremely safe. The only possible side effect is minor bruising

Laser Therapy

What is it?

Laser therapy is commonly used for treating varicose veins, performing delicate eye surgery, and removing skin lesions. It can also be used to treat underarm hyperhidrosis. Precise targeting of particular areas is possible without endangering adjacent tissue, as the beam can be very narrowly focused. This precision makes laser therapy a highly valued surgical alternative.

The heat produced by the laser assists with minimising the risk of infection, and enables cauterising blood vessels to avoid bleeding. Thus procedures can be completed rapidly with shorter recovery compared to other treatments. They are often done in a doctor’s office, making it possible to return home, or perhaps even to work shortly after. However, laser technology can be quite expensive and, therefore is only offered by just a few physicians and dermatologists.

How does it work?

Tiny incisions (so small sutures are not required) are made in the underarm region to facilitate inserting the laser tool beneath the skin. The heat from the laser specifically targets and damages the sweat glands located mainly in a certain layer of the dermis below the underarm skin. Local anaesthestic administered to the underarms decreases discomfort during the operation. The procedure usually takes less than an hour to complete. Studies of laser treatment for excessive underarm sweating have involved rather few patients, and so their effectiveness for this purpose is not well documented.

What about side effects?

Side effects include bruising, swelling, and numbness, but these dissipate within a couple of weeks. It has been determined that both the eccrine glands (that produce watery, odourless sweat) and the apocrine glands (that produce potent sweat when in contact with the skin’s bacteria) in the underarms are destroyed by laser treatment. Sweat glands are not thought to regrow after they have been eliminated so the results of laser treatment are believed to be permanent.

Everyone’s experience with hyperhidrosis varies. Patience is important in finding out how to reduce sweating, consider different options, investigate combinations of options, and collaborate with your doctor to identify the optimal treatments for you. Remember, that research is ongoing, and new treatments are constantly being discovered, as well new applications for existing treatments.

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