Types of excessive sweating

How to Not Sweat

Hyperhidrosis or excessive sweating can affect many areas on the body. Some patients will have ‘focal’ or isolated areas of sweating, such as the hands, under arm sweating, feet or face. In other cases, multiple areas may effected.

No matter how severe your condition, treatment options are always a possibility.

Axillary hyperhidrosis – underarm sweat

Excessive under arm sweating or axillary hyperhidrosis (HH), is a common condition that affects up to 4% of the Australian population. The onset is usually before puberty, and in most cases persist into adult life. Everyone sweats under their arms, so how do we know if sweating under the arms is normal or excessive? Generally only two questions need to be asked. Firstly, are you embarrassed to lift your arms up for fear of sweat patches? Secondly, does underarm sweating limit what you wear? Most patients with severe underarm sweating limit their clothing choices to black. There are many treatments for axillary HH, including antiperspirants, creams, tablets, injections and surgery. The most effective treatment is with Botox injections. This method of treating severe underarm HH has recently been approved
under the PBS and Medicare.

Treatment options for excessive underarm HH

Sweaty palms – palmar hyperhidrosis

Sweaty palms or palmar hyperhidrosis is one of the most debilitating forms of excessive sweating. This condition usually starts in school and affects both hands. In some cases there maybe a family history of this condition. Palmar HH can have a significant impact on schooling, work, as well as self-confidence and relationships. Mild forms of sweaty palms can respond to topicals (lotions) such as Driclor, however moderate to severe sweating can be controlled with cognitive behavioural therapy, iontophoresis with glycopyrrolate and surgery. We view Endoscopic thoracic surgery as last line treatment for palmar HH due to side effects such as rebound or compensatory HH.

The combination of cognitive behavioural therapyAND glycopyrrolate iontophoresis can have a success rate in the order of 80% for the management of moderate to severe hand – palmar sweating. This form of treatment is free of long-term side effects, and can be performed in patients of all ages.

Botox as the primary treatment for sweaty palms is not advisable due to costs, side effects such as muscle weakness, and the relatively short duration of activity. (Botox in the hands usually lasts 3 months, compared to 6 month for the treatment of sweaty underarms).

Treatment options for sweaty palms

Antiperspirants for sweaty palms
Iontophoresis
Cognitive Behavioural Therapy
ETS surgery for sweaty palms (last resort)

Sweaty feet- plantar hyperhidrosis

Excessive sweat production on the feet is known as plantar HH, and this condition maybe associated with sweaty hands, or sweating elsewhere. Unlike other forms of HH, this can be difficult to treat. Sweaty feet can be associated with medical conditions such as infection and malodour. The use of simple techniques such as Condy’s soaks, cotton socks, absorbable innersoles and foot hygiene can reduce the incidence of complications.

Treatment options include lotions, creams and iontophoresis with glycopyrrolate. ETS surgery is NOT an option for the management of sweaty feet.

Treatment options for sweaty feet

Sweaty face and scalp areas – craniofacial hyperhidrosis

Facial and scalp sweating is a debilitating condition which can occur in isolated areas, or it can be generalised. Focal areas such as the nose, upper lip, forehead or scalp are commonly involved. It can also be associated with facial flushing, and blushing. The cause of facial and scalp sweating is multifactorial, including overactivity of the sympathetic nervous system, with emotional inputs.

Flushing and blushing may secondary to drugs, hormonal changes or a condition known as rosacea. Treatments are aimed at reducing sympathetic input, reduction of sweat activity, reduction of blood vessels (in cases of flushing and blushing) and managing emotional influx.

Focal areas of excessive sweating respond very well to Botox. Examples include the forehead and scalp area. Generalised areas are much harder to treat and a team approach including psychotherapy, and medical intervention gives the best results. ETS or endoscopic thoracic sympathectomy can treat both flushing/blushing and excessive sweating, however the risks of compensatory HH and surgery will need to be carefully considered.

Treatment options for sweaty face and scalp

Sweat everywhere- generalised hyperhidrosis

This form of excessive sweating is very rare, and secondary causes such as infections, diabetes, thyroid disease, drugs and other medical conditions will need to be excluded. Finding a physician to exclude underlying problems is very important. Once secondary causes are excluded, a combination of treatments can reduce the severity of generalised sweating including psychotherapy and anti-cholinergic tablets.

Additionally, treatments can be tailored according to which areas are most problematic, for example, iontophoresis for sweaty hands, and Botox injections for sweaty underarms and facial areas.

Treatment options for generalised sweating

Sweating after ETS- Compensatory hyperhidroisis

This form of sweating is commonly seen after ETS, and can occur in up to 50% of patients following surgery. The most commonly involved areas include the trunk, limbs and face. Uncommon causes of compensatory sweating include nerve trauma and chest injury. Treatment options depend on the areas involved. Smaller areas respond well to focal injections of Botox, whilst larger areas can be treated with Glycopyrrolate wipes and creams. Tablets can be helpful in some situations, however side-effects are commonly seen. Compensatory sweating can be challenging to treat.

Treatment options for Compensatory Sweating

This article published on Jun 20, 2012. View related Articles

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