What is hyperhidrosis?

Hyperhidrosis is excessive sweating that most commonly occurs in the hands (palmar hyperhidrosis), axillae or armpit (axillary hyperhidrosis) and feet (plantar hyperhidrosis). This occurs in about 3 percent of the population and 6 percent of the Asian population. In 40 percent of patients, other members of the family also suffer with hyperhidrosis.

The excessive sweating is usually intermittent, but can be continuous and usually increases with stress and elevated temperature.

Hyperhidrosis is overactivity of the sympathetic nervous system. This leads to narrowing of arteries and excessive stimulation of sweat glands. This limits blood flow to the hands, making them cold and clammy.

What causes hyperhidrosis?

The cause of hyperhidrois is unknown, although obesity and increased thyroid function may be responsible in most patients.

What are the symptoms and effects of hyperhidrosis?

Palmar hyperhidrosis can be a severely debilitating problem. Wet hands are embarrassing when shaking hands, and it interferes with social and business activities.

Axillary sweating can be so severe that sufferers often need to change their shirts several times a day, wear only dark colors that do not show the sweat as much, and avoid certain materials, such as silk, can be ruined by the sweat.

Plantar hyperhidrosis (foot sweating) may be so severe it can cause the foot to slip off the brake when driving a car, a slip in a sandal to cause a twisted ankle, or fill a shoe with sweat so that the shoe cannot be worn on consecutive days.

How is hyperhidrosis diagnosed?

Diagnosis is usually made on the basis of the symptoms and a physical examination. There is no blood test or X-ray to diagnose hyperhidrosis. A starch test can be performed on the hands, but this is rare.

How is hyperhidrosis treated?

Nonsurgical treatments
  • Drysol: (brand name for aluminum chloride hexahydrate): This medication is commonly prescribed for hyperhidrosis. Generally, treatment is repeated nightly until sweating is under control. This may happen after as few as two treatments. Thereafter, you can apply Drysol once or twice weekly or as needed.
  • Botox: Botox injections have been used for the hands and the armpit area. The treatment requires many injections of Botox during a single session. These are usually effective in reducing the sweat, and the effect will last for three to six months.
  • Iontophoresis: This treatment involves placing hands or feet in water with low-voltage DC electrical current.
  • Anti-anxiety drugs: These types of drugs have been tried but they have very little role in the treatment of hyperhidrosis.  While sweating may increase with tension and anxiety, these symptoms do not necessarily point to hyperhidrosis.
  • Psychotherapy: Psychotherapy has been tried but seems to play little role in the treatment of hyperhidrosis, because while the sweating may increase with tension and anxiety, these symptoms do not necessarily point to hyperhidrosis.
  • Drying medicines: There are pills that can be taken to dry up the sweating, but these medicines can cause dry mouth and dry eyes.
Surgical treatment options

Surgery for hyperhidrosis has been performed for 70 years. The procedure is performed with minimally invasive surgery and on an outpatient basis. There are several methods for surgical treatment of hyperhidrosis, including cutting the affected nerve, clipping the nerve and removing the nerve.

Almost all patients have substantial reduction in sweaty hands after the operation, however, improvement in the armpit and plantar (foot) sweating is much less consistent and predictable.

While the procedure is usually performed with low risk on an outpatient basis, there are risks to every procedure, including bleeding, infection and collapsed lung. Normally, patients have mild chest pain for a few days (though it can last longer or be severe). But they are normally able to work after a few days.

After surgery, most patients experience compensatory hyperhidrosis, which means they experience increased sweating in other areas of the body, such as the scalp, chest wall, thighs or feet. The increased sweating may decrease in the months following the operation, and patients usually do not mind mild increased sweating because the hand sweating has improved so much.

About 5 percent of patients experience severe compensatory sweating. Some patients may find this so severe that they are unhappy that they underwent the procedure.

Horner’s Syndrome (droopy eyelids) occurs in about 1 percent of people undergoing the procedure. If this occurs, it may be temporary or may require eye surgery to correct the droop.

Key points

  • Hyperhidrosis is excessive sweating that most commonly occurs in the hands, armpits and feet.
  • Hyperhidrosis in the hands can be severely debilitating, especially in social situations. In the feet, it can be dangerous during activities such as driving and walking.
  • Nonsurgical and surgical treatment options are available.
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