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The Hyperhidrosis FAQ

What is Hyperhidrosis?

Hyperhidrosis is a medical condition in which a person sweats excessively and unpredictably, in excess of that required for regulation of body temperature. People with hyperhidrosis may sweat even when the temperature is cool or when they are at rest.

Causes: Sweating helps the body stay cool. In most cases, it is perfectly natural. People sweat more in warm temperatures, when they exercise, or in response to situations that make them nervous, angry, embarrassed, or afraid. However, excessive sweating occurs without such triggers.

Those with hyperhidrosis appear to have overactive sweat glands. The uncontrollable sweating can lead to significant discomfort, both physical and emotional. When excessive sweating affects the hands, feet, and armpits, it's called primary or focal hyperhidrosis. Primary hyperhidrosis affects two to three percent of the population, yet less than 40% of patients with this condition seek medical advice.

In the majority of primary hyperhidrosis cases, no cause can be found. It seems to run in families.

Treatments may include:

Antiperspirants Excessive sweating may be controlled with strong antiperspirants, which plug the sweat ducts. Products containing 10% to 20% aluminum chloride hexahydrate are the first line of treatment for underarm sweating. Some patients may be prescribed a product containing a higher dose of aluminum chloride, which is applied nightly onto the affected areas. Antiperspirants can cause skin irritation, and large doses of aluminum chloride can damage clothing. Note: Deodorants do not prevent sweating, but are helpful in reducing body odor.

Medication Anticholinergics drugs, such as glycopyrrolate (Robinul, Robinul-Forte), help to prevent the stimulation of sweat glands. Although effective for some patients, these drugs have not been studied as well as other treatments. Side effects include dry mouth, dizziness, and problems with urination. Beta-blockers or benzodiazepines may help reduce stress-related sweating.

Iontophoresis This FDA-approved procedure uses electricity to temporarily turn off the sweat gland. It is most effective for sweating of the hands and feet. The hands or feet are placed into water, and then a gentle current of electricity is passed through it. The electricity is gradually increased until the patient feels a light tingling sensation. The therapy lasts about 10-20 minutes and requires several sessions. Side effects include skin cracking and blisters, although rare.

Botox Botulinum toxin type A (Botox) is FDA approved for the treatment of severe underarm sweating, a condition called primary axillary hyperhidrosis. Small doses of purified botulinum toxin injected into the underarm temporarily block the nerves that stimulate sweating. Side effects include injection-site pain and flu-like symptoms. If you are considering Botox for other areas of excessive sweating talk to your doctor in detail. Botox used for sweating of the palms can cause mild, but temporary weakness and intense pain.

Endoscopic thoracic sympathectomy (ETS) In severe cases, a minimally-invasive surgical procedure called sympathectomy may be recommended when other treatments fail. The procedure turns off the signal that tells the body to sweat excessively. It is usually done on patients whose palms sweat much more heavily than normal. It may also be used to treat extreme sweating of the face. ETS does not work as well for those with excessive armpit sweating.

What Is Compensatory Sweating?

Compensatory sweating (CS) is the most common, expected and significant side effect of Endoscopic thoracic sympathectomy (ETS). It is a condition where the heat loss or sweating is redirected from the hands, armpits, face and scalp to the upper and lower back, lower chest, abdomen, groin and backs of the thighs. The brain transfers the sweat to a different location in order to rid the body of excess heat. Basically the body redirects the signal to sweat. The symptoms of Compensatory sweating may occur intermittently or be constant throughout the day. What matters is the severity of the syndrome.

Mild Compensatory sweating creates moisture on the trunk, buttocks, groin or legs, but does not penetrate through clothing.

Moderate Compensatory sweating involves moisture in the same areas, but does show through clothes. Most people tolerate it.

Severe Compensatory sweating causes profuse sweating between the breast, below the breasts to the lower chest, abdomen, upper and lower back, groin, buttocks and the backs of the thighs and knees. The sweat stains the shirts and pants.

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