Don't sweat it!

By N. Solish, MD, FRCPC and C. Murray, MD, FRCPC

If you have hyperhidrosis, it means that you sweat more than you need to in order to maintain a stable temperature. There is no formal definition, but for practical purposes, any degree of sweating that interferes with activities of daily living can be viewed as hyperhidrosis. This condition is much more common than once thought and there are a number of available treatment options. Learn more on www.Sweating.ca

Types of hyperhidrosis

• Primary or focal hyperhidrosis, which affects hands, feet, armpits and face
• Secondary hyperhidrosis, which results from another medical condition; sweating can occur all over the body or in one area.

The underarm (axilla) is the most commonly affected area, followed by the feet, palms and face. It typically starts during childhood or adolescence, and you have a higher chance of developing it if you have family members who also have it. The exact cause of primary hyperhidrosis is unknown, although it is believed to result from an overactivity of the sympathetic nervous system, which stimulate the sweat glands.

Social impact

Hyperhidrosis can have a very negative impact on your social life and work-related activities. Routine social interactions such as holding hands, shaking hands, or hugging can become awkward. You may feel a sense of humiliation and embarrassment associated with soaked or stained clothing, as well as with potential odours.

Diagnosis and Evaluation

Based on the location of the excessive sweating, associated symptoms, family history, age of onset and any specific triggers, your doctor can confirm if you have hyperhidrosis, determine if it is primary or secondary, and prescribe the appropriate treatments.

Treatment options

• Antiperspirants are considered to be an effective and often first line treatment for primary, mild hyperhidrosis of the armpit, but they don't work as well on the palms and soles.
• Medications, such as glycopyrrolate, help prevent stimulation of sweat glands, but are not widely used because of side effects such as dry mouth, blurred vision, constipation and problems with urination. They do help in some situations like treating sweating all over the body.
• Iontophoresis uses a gentle electric current in water to interfere with sweat gland activity. It can be effective in treating the palms and feet with very few side effects, however the procedure is time consuming.
• Botulinum toxin injections are used for moderate-to-severe cases. It is a safe and effective option that works by blocking the nerves that stimulate sweating. Re-treatment is required every 4 to 7 months depending on the areas affected. This works best in the axilla, but the hands, face and sometimes feet can also improve considerably. For more information click on www.BotoxFacts.ca
• Endoscopic thoracic sympathectomy (ETS) for palms should be considered as a last resort, since possible side effects can be severe and irreversible.

See your doctor to get the latest information on treatments available that are best for you.