Sweating It Out

Do you sweat excessively? If so, you're not alone. About 367 million people worldwide have a condition known as hyperhidrosis. In the U.S., an estimated 4.8% of the U.S. population sweat excessively. Why is sweating necessary?

Our bodies contain roughly 2.6 million sweat glands that regulate body temperature, keep us from overheating, and remove waste by secreting sweat on the surface of our skin. Our body's nervous system activates sweat glands.

Eccrine sweat glands, found on the soles of our feet, our palms and other places where our skin has no hair, produce an odorless, clear fluid that helps us lose body heat through evaporation. Apocrine sweat glands, located in the armpits and genital areas, create a thicker fluid when sweat from these places meets bacteria on the skin's surface, and body odor results.

Several things can trigger the body's sweat response: hot or humid weather, exercise, spicy foods, stress, anxiety, fear and side effects from certain medications. Many women sweat during menopause, and certain medical conditions can cause sweating.

Excessive sweating, though, is different than the regular amount of sweating for which our bodies are designed. When someone sweats excessively, it is uncontrollable and not because their body needs cooling.

It may be hard to turn a doorknob or use a computer if we're sweating excessively from our hands. We may need to change clothing more often, and if our skin is frequently wet, there's an increased risk of infection.

Bob Barletta, 75, a retired gourmet food salesperson in Atlanta, first noticed an issue with sweating when he was 42. "When I would meet with buyers so they could taste gourmet sample items, I'd start to drip sweat from my head a lot," he says. "I had to keep a hanky or small towel handy to wipe the sweat." 

A consult with a dermatologist confirmed he had hyperhidrosis (craniofacial) that causes excess sweat from the head, face and scalp.

Hyperhidrosis means excessive sweating. "By definition, hyperhidrosis is four times the necessary amount of sweating one needs to regulate body temperature," explains Adam Friedman, MD, professor and chair of dermatology at George Washington School of Medicine and Health Sciences. 

"Primary hyperhidrosis is defined by having two of the following: Average onset as early as 9 years old, a bilateral and symmetric pattern, sweating that impairs daily activities, sweating that occurs at least once per week, cessation during sleeping and a positive family history."

In primary hyperhidrosis, also known as primary focal hyperhidrosis, the individual doesn't sweat during sleep, and there is no apparent medical cause for the excessive sweating. In secondary hyperhidrosis, an underlying medical condition causes excessive sweating, so the hyperhidrosis is secondary to that condition. 

According to Friedman, these conditions include cardiovascular disorders, respiratory failure, infections, malignancies, endocrine/metabolic disorders, drugs, toxins and substance abuse. Excessive sweating during menopause can be considered a form of secondary hyperhidrosis. Friedman reports there is data that hyperhidrosis can run in families.

Unfortunately, many times, individuals with excessive sweating don't seek help. "Because sweating is a biological process we all do, it is difficult for many to identify when sweating is pathologic," Friedman explains. "And, there is a lot of shame, introversion and self-blame among those suffering."

Excess sweat affected Barletta's work life. "I always wondered, when will I start sweating today?" he explains. "People don't really like tasting foods when I'm sweating all over the place. Not very appetizing! It was hard to sell to people while they watched sweat pour from my head. It was like in the cop movies, when the perp starts to sweat, it means they're lying. I didn't want people to think I was lying about the product features I was selling."

While hyperhidrosis is not life-threatening, it can lead to fear of rejection, isolation and embarrassment. People who sweat excessively from their palms can have difficulty using touch phones, and greeting people with a handshake can be problematic.

Gale Steele, 73, of Murrells Inlet, South Carolina, has two children with hyperhidrosis, a grandchild and a nephew.

She has had craniofacial hyperhidrosis since she was 61. She reports it can be embarrassing. "You feel unclean and different. You know you don't look your best, so it hurts your self-esteem," she says. "I try to remain calm as it can be triggered by emotional or stressful situations. I meditate as I get ready to go out and try not to stress over sweating."

Treatments include antiperspirants, Botox injections, prescription cloth wipes to reduce underarm sweating, prescription oral medicines and surgery.

Barletta's dermatologist recommended Botox injections, but Barletta declined "because the cost was much too high."

Steele has tried several treatments but says the prescription creams and wipes irritated her skin and caused dry mouth. She also tried oral medications. "Botox injections are the only treatment that ever worked for me. But it's costly," she says.

What's promising in treatment? "There is a topical called sofpironium bromide that blocks the excessive signaling to the sweat gland we know occurs in hyperhidrosis," Friedman explains. "This active ingredient is designed to be broken down in the skin quickly so the one applying it does not experience side effects from systemic absorption such as dry mouth and dry eyes. It's currently approved in Japan."

Anticholinergics are oral medications used to treat various conditions, including hyperhidrosis. Side effects can include dry mouth, constipation and dry eyes. David M. Pariser, MD, professor of dermatology at Eastern Virginia Medical School in Norfolk, reports that anticholinergic treatments are generally "predictable, manageable and usually mild." 

However, Pariser and the International Hyperhidrosis Society advise patients over 65 to discuss anticholinergic use with their doctors because evidence suggests a possible link between long-term, high-dose use in older individuals and dementia.

Living with excessive sweating can feel daunting and requires vigilance. "You can manage your symptoms, but the condition doesn't go away," Steele says. 

Here are her tips: "Learn to live with it. Develop a sense of humor about the condition. Everyone does sweat – some just a whole lot more than others. I have a mantra: everybody sweats, and I repeat that over and over again to myself. When I go out, I always carry a beautifully embroidered handkerchief with me in the event I cannot stop the sweat."