Sweating at the gym is good; sweating outside during a St. Louis summer is unavoidable. And hot flashes are in a class of their own. But sweating uncontrollably when there’s no obvious reason, such as physical exertion, temperature or stress, is a problem.
Fortunately for the 2 to 3 percent of Americans who suffer from excessive sweating, there is help. However, most people with this condition, known as hyperhidrosis, don’t seek treatment.
“Chronic idiopathic hyperhidrosis is a condition that can significantly affect an individual psychologically, physically and socially,” says Dr. Daniel Gaitan, an endocrinologist with West County Medical Specialists. “The cause is not due to significant pathology and does not represent a serious medical problem, though it is viewed as one from a personal and social standpoint.”
There are two main types of hyperhidrosis: focal hyperhidrosis is the most common type and affects only localized parts of the body, typically hands, feet and armpits; generalized hyperhidrosis causes diffuse sweating, and may be due to an underlying condition, such as hyperthyroidism, spinal cord injury or certain medications. “There are different treatment modalities, and one should first try over-thecounter remedies. If this approach is not successful, he or she should talk to their doctor,” Gaitan advises. Non-prescription antiperspirants that contain 10 to 15 percent aluminum chloride are typically the first approach to controlling the condition. Stronger antiperspirants are available by prescription.
Dr. Michael P. Heffernan, a dermatologist at Central Dermatology in Clayton, describes the typical scenario for treating hyperhidrosis of the hands: “We tend to use a 20 percent aluminum chloride solution and have the patient use that every day, usually at bedtime. If, after a week, that’s not sufficient, we go to using it in the morning as well. We do that for another week. If that’s not sufficient, many times we’ll have them put it on and wear gloves over it. That’s probably effective in more than 90 percent of patients.”
More persistent cases may respond better to prescription medications, such as Robinul, Heffernan adds. However, these drugs may have unpleasant side effects, most notably dry mouth and constipation.
A step up the treatment ladder is iontophoresis, an FDA-approved procedure that uses electricity to temporarily turn off the sweat gland. “Treatment consists of the administration of ionized substances, by way of direct current, to the areas involved,” Gaitan says. “Small devices are available for home use and typically used for palm and plantar (foot) hyperhidrosis. Eighty-five percent of individuals report some improvement.”
Armpits tend to respond better to Botox injections, which block nerve impulses to the sweat glands. Botox also may be used for hands or feet, although many patients find the injections particularly painful in those areas. The treatment must be repeated about every six months for most patients, and insurance may not cover the treatment, Heffernan notes.
The most extreme treatment is Endoscopic Transthoracic Sympathectomy Clamping (ETS-C). ETS-C is an outpatient surgical procedure. Working through two small incisions in the armpits, the surgeon places a tiny, titanium clamp over the sympathetic nerve, which restricts its ability to send the signals that trigger sweating. The procedure can be reversed because the nerve is left intact.
“People develop shame around this condition, and it keeps them from doing things. I really think people should understand that it’s not curable, but it is treatable,” Heffernan notes. “When you treat it, people can return to doing everything everybody else does.”