Hyperhidrosis (excessive sweating): Facts You Should Know

Hyperhidrosis (excessive sweating): Facts You Should Know

Excessive sweating can be due to other diseases of the body but can also be a condition in itself. It can lead to a significantly reduced quality of life.

People with hyperhidrosis are often ashamed to show wet parts of the body. It leads to avoidance behaviour, isolation and many times a poor performance in work, school or social life.

Researchers at Uppsala University have studied a congenital but rare condition that means a total lack of sweating ability. And they could identify the underlying gene mutation, namely a specific channel, called InsP3R2 encoded by the mutated gene, needed to start sweating. Homo Species have the most sweat glands and therefore has the greatest ability to lower body temperature. We, humans, have endurance in physical activity that is unparalleled among other animals living on land. The sweat glands and the fact that we lack fur gave our ancestors the ability to move during long workouts, for example, when hunting or fleeing.

What is Hyperhidrosis?

Sweating is needed to regulate the body’s internal temperature, especially with increased physical activity. Excessive sweating, known as hyperhidrosis, is a condition where sweating is not in proportion to the body’s need to cool down. The condition can be divided into local (focal) and generalized (general) hyperhidrosis. Depending on the cause, it can also be divided into primary hyperhidrosis, with no known cause, and secondary cause

Studies have shown that about 3% of the population has problems with hyperhidrosis. Both genders are affected equally often. The primary, local form often arises in childhood (especially hands) to early adulthood (especially armpits). General sweating without apparent cause usually occurs between the ages of 40-60. Night sweats, where sweats are most pronounced at night, are also common.

Symptoms

Common areas with a lot of sweat are hands, armpits, feet, face/head and groin, abdomen and buttocks. 25% of all people with focal hyperhidrosis have problems from one area, such as the armpits, 50% from two, three areas of the body and 25% from four or more areas. The problems look different depending on where you are sweating.

 
AreaSymptoms, trouble
Hand Wet paper, computer mouse and more. Pencil and tools slip out of hand. Embarrassing to greet, to dance, to hold hands. Try to wash your hands or wipe your hands on your pants before contact. Avoid health which can be perceived as unfair. Reduced self-confidence after greeting or taking in someone with a wet hand. In tests, the papers become wet and bulky, pencil and ink are blotted out by the wet hand. Difficulty with professions where the affected person has to take in others (for example, nurse, masseur or salesperson). Problems with initiating relationships and cohabitation. Hands can become cold with white fingers. Hand eczema.
Feet Embarrassing to put wet imprints on the parquet. Odour problems. Dare not take off the shoes at work because of the smell, at the same time you sweat more with the shoes on – step 22! Must discard shoes. Uncomfortable with wet feet, for example, cohabitation often has socks on. Freezes feet. Eczema and fungal infections. Slips. Do not want to go home to others without first changing socks.
Armpits Puts large stains on sweaters/shirts. Can soak through double layers. Often goes to the toilet to wipe off, stuffs paper in the armpits, changes sweaters at school/work. Wear most black or white to make the stains appear as little as possible. Has cardigan/sweater/jacket to hide stains even on hot summer days. Gives a changed movement pattern with the arms along the sides. Difficult to raise your hand. Afraid it will smell, settles a bit away from other people.
Groin/buttocksWet down underwear and sometimes even skirts/pants, especially in the summertime. Can put stains on chairs. Avoid sitting on plastic chairs, leather sofas or materials where wet spots are visible. Dark trousers, preferably denim, to hide sweat stains. Some patients are incorrectly investigated for incontinence. Feeling refreshed. Interrupted cohabitation. Eczema and fungal infections can be prevalent.
Face/scalpHeat sensitive. Running sweat from the face can occur even with little effort such as vacuuming or walking downstairs. The sweat causes fog on glasses, makeup that runs, hearing aids that are destroyed etc. Looks like you have come out of the shower. The affected person is experienced as nervous, perhaps dishonest or ill when the sweat flows from their face during typical conversation situations. Avoid meetings, speaking or otherwise being at the center. Nervousness and stress cause even more sweating. Many patients opt out of professions and managerial positions because they are unable to stand at the center with the sweat running from their face. Takes extra time to avoid sweating, goes to work earlier, avoids cycling and other efforts. Going from cold to hot like on a bus or subway on a winter day,
Thoracic spineHeat sensitive. A little exertion or heat can cause wet clothes. The sweat can soak through double layers. Uncomfortable to have wet clothes. The victim is embarrassed to wear wet clothes in social situations where everyone else is dry. Can’t hurry or stress without sweating. Goes earlier to work to be able to move slowly and to be ready to sweat. Includes extra sweaters. Hides with double layers. Eczema or fungal infections under the breasts.

Pronounced sweating can ruin clothes and shoes and can cause odour problems. People with hyperhidrosis are often ashamed to show wet parts of the body. It leads to avoidance behaviour, isolation and many times a poor performance in work, school or social life. Focusing on hiding the sweat takes energy from what is essential. At the same time, the symptoms get worse, with even more sweating in stressful situations. Anxiety over starting to sweat leads to more stress leading to even more sweating – a vicious cycle that many people end up in. Constantly planning to hide their sweats is time-consuming and described by a patient as “living with the handbrake”.

Cause

Primary hyperhidrosis (without any other disease that explains the condition) is due to increased activation of the sweat glands. This is because the parts of the brain that regulate sweating ability are “mis-calibrated” and simple stimuli such as vacuuming, getting into a hot bus, or taking in hand render in an abnormally large number of nerve signals to the sweat glands. This “miscalibration” or vulnerability is partly hereditary (genetically) conditional. Many people with hyperhidrosis know that they have a relative with the same problem.

Secondary hyperhidrosis can be due to many different diseases. Examples are infections, diabetes, hyperthyroidism, heart failure, COPD, obesity, cancer diseases, anxiety, alcohol intake and use of certain drugs. 

People with hyperhidrosis do not have more or diseased sweat glands than people without hyperhidrosis.  

Diagnosis

The diagnosis is often made with the help of a thorough medical history. Primary, local forms of hyperhidrosis are often hereditary, symmetrical, long-lasting, with reduced sweating at night and usually occur under 25 years of age. 

If there are symptoms or signs of a second disease, or if the course goes against a primary form of hyperhidrosis, a more thorough investigation should be made. Often, blood tests and x-rays or other imaging are included.  

Night sweats, especially if pronounced (wet bedding) should be investigated more carefully as they can sometimes be explained by underlying illnesses. 

Treatment of hyperhidrosis

Today, it is possible to improve the quality of life of most people with hyperhidrosis with the following treatments:

  • Aluminium chloride is similar to deodorant, is non-prescription and is available in pharmacies. It can be tested mainly in hyperhidrosis in restricted areas such as hands, feet and armpits. Aluminium chloride interacts with the protein in the sweat gland exit, leading to a mechanical barrier that the sweat cannot pass. The preparation must be applied to dry skin before going to bed and can be rinsed off in the morning after that. If the skin is moist, the risk of side effects in the form of burning, itching and eczema increases. Initially, it can be applied every day, but with side effects and/or good effect, it can be reduced in frequency.
  • Botulinum toxin type A works well in treating smaller areas such as hands, feet, armpits or groin/buttocks. Botulinum toxin acts in the skin and prevents the nerve signal from the nerve end to reach the sweat gland. For two to five months, three out of four patients have a good effect. Local temporary muscle weakness is seen in the treatment of hands and forehead.
  • Botulinum toxin type B works great in treating multiple body parts or large areas such as the head, chest or back. Works similar to type A but has few side effects in the doses needed to treat hyperhidrosis on large surfaces.
  • Tablets with anticholinergics, beta-blockers or calcium blockers can be tested for whole-body sweating or to prolong the effects of botulinum toxin. Anticholinergics are medicines for stomach upset or incontinence but also help against hyperhidrosis by preventing the nerve impulse to reach the sweat gland. Side effects such as dry mouth mean that the drugs cannot be used in everyone. Beta-blockers can be tested for stress-induced sweating. Calcium blockers are mainly used in heart disease but also block the signalling system inside the sweat gland, which can reduce sweat production.
  • Iontophoresis is a time-consuming but sometimes well-functioning treatment, especially of hyperhidrosis of the hands and feet, but also armpits. Hands or feet are immersed in moderately flowing water for 20-30 minutes. Probable mechanism is that ions such as OH – (hydroxide ion) enter the sweat exits and cause a mechanical barrier that the sweat cannot pass (as with aluminium chloride). The treatment must be repeated, initially every two days and then every two weeks. A variant of treatment is also available for armpits.
  • Axillary evacuation is an operation in which the sweat glands are operated away in the armpits. More or less invasive surgical techniques are available.

Forecast

Hyperhidrosis mainly causes a mental illness but also a physical one. Hyperhidrosis is a physical (somatic) disease that causes mental disorders and is not due to mental illness (social phobia/panic disorder), teenage problems or menopause. Examples of physical symptoms that may occur are eczema, fungal infections and white fingers/tears (Raynaud’s phenomenon).

The prognosis is unclear, but the condition can both improve, deteriorate and change over time. If the condition is due to another illness, the prognosis depends on the treatment of the underlying disease. 

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