Heavy Sweating and its management (medically known as hyperhidrosis)

Hyperhidrosis is where a person suffers from excessive sweating. Excessive sweating is not considered a serious health problem, but can be a source of embarrassment and anxiety and can affect confidence. 

Types

Hyperhidrosis can sometimes only affect specific area of the body, generally the armpits, face, hands or feet. If hyperhidrosis affects the whole body, it is referred to as generalised hyperhidrosis. Generalised hyperhidrosis may be due underlying medical condition like overactive thyroid gland or a side effect of medication such as an anti-depressant. In the case of hyperhidrosis that affects the armpits primarily, there is usually no obvious cause. This is referred to as primary hyperhidrosis.

Treatment

Lifestyle changes

Certain changes to daily routine can improve symptoms including: Specialised antiperspirant sprays (rather than deodorants); Soaps may irritate the affected skin. If so, use a bland soap substitute such as an emollient (moisturiser) ointment or cream (eg) Aqueous Cream, Emulsifying ointment; Get to know triggers that make your sweating worse. Common examples include spicy foods and alcohol; Tight, restrictive clothing and man-made fibres like nylon or lycra make sweating worse so should be avoided; Black or white clothing mask signs of sweating better than other colours; Armpit shields can be used to absorb excessive sweat; Thick and soft socks made of natural fibres can absorb moisture better (eg) Cotton.Avoid socks made from man-made fibres and change socks regularly (more than once daily if required); Wear shoes made from natural material like leather or canvas rather than man-made material; Aternate pairs of shoes daily to allow them to dry fully; Avoid wearing trainers or boots as they tend to be less breathable than normal shoes; Use absorbent foot powder twice daily if sweating of the feet is an issue.

Aluminium chloride antiperspirants

Strong aluminium chloride antiperspirants work by plugging or blocking sweat glands. Aluminium chloride antiperspirant needs to be applied at night just before bed (as sweat glands are less active at night). Wash the aluminium chloride off the next morning. Mild skin irritation, itching and tingling in the areas where applied are the most common side effects of aluminium chloride. Brands available in pharmacies include Anhydrol Forte^® and Driclor^®. When it comes to using aluminium chloride antiperspirants, less is more; they are less effective if too much is used at each application. It should be used once every one to three weeks for best effect. It can take a few weeks initially to build up its effect.

Iontophoresis

Iontophoresis is only done under a specialist and works best for hands and feet. Hands and feet are placed in water and weak electric current passes through the water; the electric current has the effect of helping block the sweat glands. Iontophoresis is not painful but the electric current can cause a slightly uncomfortable sensation and skin irritation. Each treatment of iontophoresis takes about 20 to 40 minutes and person normally gets two to four treatments each week. Improvement occurs after about two weeks and it should be continued for a month after improvement is seen. 80 to 90% of people notice improvement in symptoms due to iontophoresis.

Botulinum toxin

Botulinum toxin (botox for short) blocks signals from the brain to sweat glands thus reducing sweating. Botox injections work particularly well for armpit sweating. It is not recommended for sweating of the palms and face due to the risk that botox may block nearby small muscles. Costs of this treatment depend on the part of the body being treated. Treatment needs to be repeated every 4 to six months. Botox is only effective for between two and twelve months so treatment must continually be repeated.

Anti-cholinergic drugs

Anticholinergic drugs include prescription drugs such as oxybutynin hydrochloride and glycopyrronium bromide. They only control generalised hyperhidrosis. Their success is variable so they are not used very often. Side effects can include drowsiness, dry mouth, dry eyes, blurred vision and constipation.

Surgery

Surgical options are available if the above options fail. They include Video-assisted thoracic sympathectomy (VATS), Shelley's procedure (removing sweat glands), Retrodermal curettage, Laser sweat ablation (LSA) and Body jet liposuction. Contact Whelehans for more details on surgical options.

Disclaimer: Information in this article is general; consult with your healthcare professional before making any changes recommended.

This article is shortened. For more detailed information, logon to www.whelehans.ie or contact Whelehans at 044 93 34591 or info@whelehans.ie and we will forward you a more detailed copy for free

By Eamonn Brady MPSI, pharmacist and owner of Whelehans Pharmacy, 38 Pearse St, Mullingar