Excessive sweating

Excessive sweating is usually seen in the palms, soles, face, head, or armpits. Other visible symptoms include:

• Excessive body odor
• Sweat-soaked clothing
• Sweating even while sitting
• Difficulty in holding objects
• Extremely soft and white skin
• Skin peels off easily
• Skin infections
• Psychological symptoms

• Increased heart rate
• Palpitations
• Gastric disturbances

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Our body has a mechanism to regulate sweating. However, in excessive sweating (hyperhidrosis), this mechanism may not work properly. The negative feedback to the hypothalamus, a structure deep within your brain, which tells it to stop signaling the sweat glands, may be impaired. As a result, the body ends up sweating more than necessary to cool down.

Excessive sweating is a general feature seen during hot and humid conditions. However, if it is chronic, it can lead to discomfort. There are certain triggers that can lead to excessive sweating, including:

• Genetics: Several studies suggest that primary hyperhidrosis has a genetic component, as demonstrated by the high frequency of positive family histories.
• Fever: A fever or febrile illness is commonly associated with excessive sweating. Managing children with fevers can be quite challenging.
• Certain Conditions: Secondary hyperhidrosis can occur in the following conditions:
  • Diabetes mellitus
  • Hyperthyroidism
  • Parkinson's disease
  • Neurologic disorders
• Medications: Drugs that can induce hyperhidrosis or excessive sweating include:
  • Antidepressants
  • Dopamine agonists
  • Selective serotonin reuptake inhibitors (SSRIs)
  • Antipsychotics
  • Insulin
• Menopause: The excessive sweating associated with menopause is considered a form of secondary hyperhidrosis and is generally known as hot flashes.
• Anxiety: Studies have shown that excessive sweating is a potentially disabling symptom, often triggered by social anxiety disorder (SAD), which involves an intense, persistent fear of being watched and judged by others.
• Chronic Excessive Alcohol Consumption: Excessive sweating in the palms and soles is frequently observed in patients with a clinical history of chronic abnormal alcohol intake.
• Tumors: Excessive sweating can occur in cancer or cancer treatment. Tumors such as pheochromocytoma (a rare tumor that usually forms in the adrenal glands) and lymphoma (cancer of the lymphatic system) are known to cause hyperhidrosis.

To diagnose excessive sweating, it is important to first determine whether the source is primary or secondary, which can be done through a thorough history. The diagnosis consists of the following:

1. History and Physical Examination: Diagnosis of excessive sweating is usually made by visual inspection. A family history and medical history can help determine primary or secondary hyperhidrosis. Primary hyperhidrosis is more commonly seen in the younger population. Symptoms that present later in life are mostly linked to a secondary cause.
2. Starch-Iodine Test: In this test, iodine solution is applied to the skin, followed by starch powder. When these substances come into contact with sweat, they turn violet. The distribution pattern of the color (or absence of it) helps identify excessive sweating.
3. Quantitative Sudometry: The quantitative sudomotor axon reflex test (QSART) is a quantitative test that assesses sweat glands innervated by small nerve fibers.
4. Filter Paper Test: This test is suitable for detecting excessive sweating in the armpits. A pre-weighed filter paper is inserted into the armpit for a defined time period (60 seconds or 5 minutes) and then weighed again. The difference corresponds to the amount of sweat released in mg/time, which can help diagnose hyperhidrosis.
5. Other Tests: If a secondary cause is suspected, a complete work-up is performed to rule out infection, kidney dysfunction, malignancy, diabetes mellitus, thyroid disease, inflammatory disorders, or connective tissue disease. Some of these tests include:
   • Complete Blood Count (CBC)
   • Basic Metabolic Panel
   • Thyroid-Stimulating Hormone (TSH)
   • Erythrocyte Sedimentation Rate (ESR)
   • Antinuclear Antibody
   • Hemoglobin A1C (HbA1C)
   • Chest X-ray

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Here are a few things that you can adopt and a few you can avoid to prevent generalized excessive sweating. They include:

Do's

• Wear loose-fitting, breathable clothes to minimize signs of sweating.
• Wear socks that absorb moisture.
• Change your socks at least twice a day if possible.
• Eat smaller, frequent meals.
• Keep your moisturizers in the fridge to get a cooling effect during summer.
• Get a small handy fan to avoid sweating during hot weather.

Don'ts

• Do not wear tight clothes or synthetic fabrics like nylon.
• Refrain from wearing enclosed boots or sports shoes that may cause your feet to sweat more.
• Avoid spicy food.
• Limit alcohol and caffeine consumption.

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There are several treatment options available to manage or treat excessive sweating. These include:

1. Topical applications

   Generally, topical applications are suitable only for cases of focal hyperhidrosis. The most commonly used ones include:

   • Antiperspirants: These products are designed to reduce sweat or perspiration on the skin. They are available in creams, powders, and sprays. Aluminum salts are added to many topical antiperspirants.
   • Astringents: These act by contracting or tightening body tissues. In cases of excessive sweating, they work by constricting the skin's pores, reducing sweat production, and providing a drying effect.
2. Oral Medications

   Oral medication is reserved for treatment-resistant cases or generalized hyperhidrosis. Medications used include:

   • Anticholinergics: These are the most commonly used oral medications. Examples include:
     • Glycopyrrolate
     • Bornaprine
     • Methantheline bromide
   • Alpha-adrenergic agonists: These are used to treat localized types of excessive sweating. Clonidine is the most commonly used drug.
   • Calcium channel blockers: Calcium channel blockers like diltiazem inhibit the calcium-dependent release of acetylcholine and help to reduce sweating.
   • Other drugs: Beta-blockers (like propranolol) and benzodiazepines (like diazepam) are used to reduce anxiety-related excessive sweating.
3. Iontophoresis

   This process involves passing a weak electrical current through the skin to block the sweat glands. The current is applied usually for 10-20 minutes per session, initially with 2 to 3 sessions per week, followed by maintenance sessions at 1 to 3 week intervals, depending on the patient's response. Iontophoresis may sound painful but is not.

4. Botox injections

   Injection of botox (botulinum toxin) is an effective therapy for excessive sweating of the armpits, hands, feet, and face. It works by inhibiting the release of acetylcholine, the chemical that activates sweat glands. The injections can be uncomfortable, but the use of a very small needle helps to minimize discomfort. They usually provide around six months of relief from sweating.

5. Surgery

   This is the last resort when all other treatment modalities show no positive results. These include:

   • Endoscopic thoracic sympathectomy: This surgery is used to treat sweating of the palms or face. The sympathetic nerves control sweating. A sympathectomy is an irreversible procedure during which at least one sympathetic ganglion (relay station between the nerves) is removed.
   • Removal of axillary (armpit) sweat glands: Sweat glands in the armpit (axilla) are removed by means of axillary curettage (removal of tissue) or liposuction (removal of fat).

The following home remedies are traditionally known to manage excessive sweating and gain some control over perspiration. However, make sure to take consent from your healthcare provider before trying these.

• Apple cider vinegar: This is a natural astringent that tightens skin pores and helps control sweat production. It can also help eliminate odor caused by bacteria by balancing the pH level.
  How to use it: Soak a cotton ball in apple cider vinegar and apply it to your problem areas at night just before you go to bed. Wash it off in the morning.
• Sage tea: It contains a natural astringent called tannic acid that constricts and shrinks skin and pores to reduce sweat. Sage also helps tackle body odor in the armpits and feet.
  How to use it: Add two sage tea bags to two cups of boiling water and let it cool. Dab a clean towel in it and wipe your underarms, arms, and feet. Repeat two or more times daily for best results. You can also soak your feet in warm water with sage tea bags.
• Black tea: It is a great natural antiperspirant due to its high levels of tannic acid.
  How to use it: Add two bags of black tea to four cups of boiling water. When the water is cool enough, soak your palms or feet for 20 minutes.
• Potatoes: These can absorb excess sweat on the body and act as a natural antiperspirant.
  How to use it: Take a small piece of potato and rub it on your sweat-prone areas. Let the potato residue dry completely before getting dressed.
• Baking soda: Baking soda can be used to eliminate body odor.
  How to use it: Mix equal parts baking soda and cornstarch. Add lavender essential oil for fragrance and apply the mixture with a damp cloth to clean the underarms. Rinse it off after 20-30 minutes.
• Chamomile tea: Chamomile is one of the best herbs for eliminating stress and promoting relaxation, which can help reduce sweating.
  How to use it: Drink two to three cups of chamomile tea each day to stay calm and refreshed.

Excessive sweating may not be a life-threatening condition, but it significantly impacts the quality of life. Some of the general complications include:

• Skin problems: Excessive sweating can lead to several skin complications due to prolonged moisture and the breakdown of the skin's natural protective barrier. These include:
• Body odor
• Skin infections
• Dermatitis (redness, itching, and irritation of the skin)
• Friction between moist skin surfaces
• Eczema
• Acne breakouts
• Unusually soft or moist skin
• Skin discoloration

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• Social embarrassment: Visible sweat stains and unpleasant odor can make individuals self-conscious, affecting their confidence in social interactions.
• Emotional distress: Negative body image and increased anxiety arise from concerns about appearance and social interactions.
• Psychological distress: Feelings of embarrassment, shame, and self-consciousness can lead to anxiety, low self-esteem, and negatively impact overall mental well-being.
• Work or school-related disability: Excessive sweating can interfere with productivity, concentration, and performance due to constant discomfort, distraction, and the need for frequent clothing changes at school or work.

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There are few alternative therapies that have shown good results in recent times to manage excessive sweating. They include:

• Microwave thermolysis: This is a non-invasive method that causes local destruction of sweat glands through microwaves. It is used to treat excessive sweating in the armpits.
• Cryotherapy: Topical cryotherapy uses a surface nitrous oxide cryoprobe applicator to freeze-damage the sweat glands.
• Microneedle radiofrequency (MNRF): The mechanism of action is the destruction of the sweat glands by heating. The radiofrequency generated by microneedles targets both the odor-producing and the water-producing glands. The results of this treatment last a long time.
• Photodynamic therapy: This therapy involves using a photosensitizing agent. When the photosensitizer is exposed to specific light wavelengths, it generates reactive oxygen that targets and destroys sweat glands. It is a safe and effective treatment for excessive sweating, particularly in areas like the armpits and palms.
• Laser therapy: It is used for the treatment of underarm sweating, where lasers can precisely target, heat, and destroy the sweat glands. It is a safe, effective, and minimally invasive solution for excessive sweating.
• Ultrasound: Micro-focused ultrasound is also an effective and well-tolerated treatment for excessive sweating in the armpits. It works by delivering focused ultrasound energy to the deeper layers of the skin, targeting and reducing sweat gland activity.

Living with excessive sweating can be challenging, as it can affect one's confidence and social interactions. However, with proper management, support, and understanding, individuals can lead fulfilling lives and minimize the impact of excessive sweating on their daily activities. Tips that can help include:

• Pay attention to personal hygiene: Individuals affected by hyperhidrosis should bathe daily and pay special attention to drying affected areas of skin, particularly the feet, to reduce the risk of infections. Affected feet should be aired regularly. Changing clothing once it is sweat-soaked is also advisable.
• Use absorbent pads: Individuals with excessive sweating, especially in the armpits, may benefit from using absorbent pads to prevent sweat from soaking through clothing.
• Select proper footwear: For individuals with excessive sweating of the feet, it is recommended to wear thick socks made from cotton or wool and to regularly change both socks and shoes. Optimal footwear options include leather, mesh, or canvas materials, while it is advisable to avoid synthetic materials.
• Maintain a sweat journal: Individuals who sweat excessively may react to specific conditions. Heat, anxiety, and certain foods are common triggers that can cause excessive sweating. Identifying triggers is crucial, as they can be avoided to prevent sweating.
• Focus on hydration: Excessive sweating can lead to dehydration if fluids are not replenished. Therefore, maintaining adequate hydration is important for managing the condition and preventing its negative effects.
• Stay calm and relaxed: Practicing relaxation techniques may help individuals cope with emotional stimuli that trigger sweating. Other psychological therapies to consider include:
• Psychotherapy: Hypnosis, psychotherapy, and biofeedback can be effective for some individuals, leading to improvements in quality of life.
• Behavioral therapy: These therapies can help individuals overcome anxiety, benefiting those with anxiety-related sweating.

Tips for Parents

Each child's experience with excessive sweating may vary, so it's essential to be patient, empathetic, and proactive in finding strategies that work best for your child's individual needs. Keep in mind the following:

• Talk openly with your child about excessive sweating to help them feel less self-conscious.
• Explain that it's a common condition and reassure them that they are not alone.
• Opt for lightweight, breathable fabrics such as cotton to help keep your child cool.
• Encourage your child to maintain good hygiene by showering regularly and using an antiperspirant or deodorant suitable for their age.
• Teach them proper skincare routines to prevent skin irritation.
• Ensure your child drinks enough water throughout the day.
• Pack an extra set of clothes, including socks, for your child to change into if needed at school.
• Provide them with sweat-absorbing pads or talcum powder to help manage excessive sweating.