Excessive sweating (hyperhidrosis)

Sweat is essential to human survival as it cools the body's temperature and protects it from overheating. Excessive sweating (or hyperhidrosis) occurs when the sweat glands produce more sweat than is necessary to regulate body temperature. Regardless of the area affected, hyperhidrosis can have a detrimental effect on one's quality of life, as it can interfere with daily activities and undermine self-esteem.

Causes and aggravating factors

There are two types of hyperhidrosis: primary hyperhidrosis and secondary hyperhidrosis.

While the exact cause of primary hyperhidrosis is unknown, it may be related to over-activity of the central nervous system. It usually affects at least one of the following areas:

• Underarms
• Hands
• Feet
• Face

This type of hyperhidrosis, which appears to have a genetic component, usually develops during childhood or adolescence and continues through adulthood. Emotions (stress, fear, etc.) and heat may worsen symptoms. Sweating caused by heat (face, chest and back) can occur at any time, but emotionally-induced sweating (hands, feet and underarms) usually does not occur while sleeping.

Secondary hyperhidrosis is caused by another underlying medical condition such as menopause, thyroid disorders, obesity, or certain types of drugs. Unlike with primary hyperhidrosis, those with secondary hyperhidrosis experience generalized sweating, meaning it is not limited to certain areas of the body, and symptoms can occur while sleeping. Lastly, in those with secondary hyperhidrosis, excessive sweating usually starts in adulthood.

Treatment

The treatment for secondary hyperhidrosis is to eliminate the underlying cause. Primary hyperhidrosis however, is a chronic condition, which means it cannot be cured completely. However, there are a variety of over-the-counter antiperspirants on the market.

If a traditional antiperspirant is not enough, your pharmacist may be able to recommend an antiperspirant that contains aluminum chloride (e.g. Drysol) at a concentration ranging from 6.25% to 20%. Contrary to popular belief, aluminum-based antiperspirants are not associated with an increased risk of developing breast cancer or Alzheimer's disease.

Good personal hygiene is essential to preventing excessive sweating in patients with hyperhidrosis. The following measures can be taken to avoid episodes of excessive sweating and/or unpleasant odours:

• Wash daily with an antibacterial soap or cleanser.
• Wear clothing made from natural fibers that are breathable.
• Avoid alcohol and spicy foods.
• Dry feet thoroughly after washing and use absorbent powder once or twice a day.

Application of an antiperspirant containing aluminum chloride

The following measures may help to reduce the risk of irritation associated with antiperspirants that contain aluminum chloride:

• Apply to completely dry skin once a day, at bedtime.
• Treated areas must be washed in the morning.
• Once excessive sweating is reduced (usually after 3 days), reduce application to once or twice a week.
• Areas treated with aluminum chloride should not be covered as this may increase the risk of skin irritation.

If irritation occurs with the use of a product containing aluminum chloride despite these precautions, a hydrocortisone cream (e.g. Cortate) may be applied on the affected area.

When to seek medical advice

• When hyperhidrosis symptoms appear to determine whether an underlying medical condition is responsible.
• If excess sweating impairs your daily activities.
• If over-the-counter products are not having the desired effects.

For more information:

• International Hyperhidrosis