What is hyperhidrosis?
When your body secretes sweat, it protects itself from overheating. Hyperhidrosis is only present when more sweat is produced than your body needs for cooling. In this case, you will start sweating even at low temperatures and with little physical exertion, without being able to influence this voluntarily. Their sweat glands are not enlarged and they have not increased in size – but they produce too much sweat. Doctors say they are “overstimulated”.
Excessive perspiration can extend over the entire body(generalized hyperhidrosis) or be restricted to a limited area(localized hyperhidrosis).
The most common forms of localized hyperhidrosis are
- Excessive sweating in the armpit (hyperhidrosis axillaris)
- Excessive sweating on the hands (hyperhidrosis manuum)
- Excessive sweating on the feet (hyperhidrosis peduum)
Hyperhidrosis – frequency and age
In Switzerland, around two to four percent of the population are affected by hyperhidrosis. Excessive sweating can begin in childhood, often between the ages of 6 and 16. Sweating of the hands often occurs before puberty; if other areas such as the feet or armpits are affected, the symptoms are more likely to appear at the beginning of or during puberty. Both sexes can be affected by hyperhidrosis, but women experience excessive sweating more frequently than men.
Hyperhidrosis: causes and risk factors
Doctors distinguish between two basic forms of hyperhidrosis:
Primary hyperhidrosis
It has no clearly identifiable cause. However, emotions are often involved in their occurrence and the trigger for the heavy flow of sweat is often a situation of emotional stress. For example, if you feel anxiety, stress or physical pain. This emotionally induced sweating is primarily controlled by the limbic system. This is the “emotional center” of the brain, located deep inside our head.
Primary hyperhidrosis is mainly characterized by excessive perspiration on the hands, feet, armpits or face. Primary hyperhidrosis is sometimes also called idiopathic hyperhidrosis or focal hyperhidrosis.
Secondary hyperhidrosis
Secondary hyperhidrosis usually has a recognizable cause. Sweating is caused by a disorder of the nervous system, which is involved in regulating the body’s heat. The center in the brain responsible for body temperature is called the hypothalamus.
If you suffer from secondary hyperhidrosis, this is most likely the result of another condition. The main diseases or disorders that come into question include
- High blood pressure (hypertension)
- Overactive thyroid (hyperthyroidism)
- Hormonal disorders (in women, for example, during the menopause)
- Neurological or mental illnesses
- Infections
- Obesity
- The side effects of medication (including cortisone, salicylic acid, parasympathomimetics) can also be partly responsible for secondary hyperhidrosis.
Symptoms: Hyperhidrosis
If you start to sweat during strenuous physical exertion or when the ambient temperature is high, this is completely normal. Hyperhidrosis is only present if the following characteristics are met:
- Intense sweating without any recognizable cause
- Excessive sweating occurs frequently (at least several times a week)
- Hygienic measures (washing, deodorant) do not provide any relief
- Excessive perspiration is unpleasant for you
Sweating as an alarm signal
Sudden and excessive sweating all over the body does not always indicate hyperhidrosis. It can also be a sign of a heart attack heart attack. This is especially true if the sweat is cold and if symptoms such as trembling, anxiety, chest pain, nausea, dizziness or shortness of breath are also present. Acute sweating associated with such symptoms may also occur in the following conditions:
- Withdrawal symptoms (after alcohol or drug consumption),
- Anxiety or panic attacks,
- Circulatory failure (for example in the case of poisoning, inflammation or after a vaccination).
Hyperhidrosis: Diagnosis by the doctor
If you frequently suffer from heavy sweating and therefore consult a doctor, he or she will first ask you where on your body the problem occurs and how often (medical history). He will certainly also ask you about your circumstances. He wants to clarify whether there are certain situations in which the heavy sweating occurs. Your doctor will probably also want to know if there are similar cases in your family. This is because primary hyperhidrosis can be caused by a genetic predisposition.
If the doctor’s consultation reveals that you sweat frequently in the armpits, on your hands or feet and that you have no other complaints, the diagnosis of “primary hyperhidrosis” is as good as established. If you have other complaints or an illness, you may have secondary hyperhidrosis. Tests are available from your doctor to obtain further information on this:
- Iodine-starch test: Parts of the skin are coated with iodine and a starch powder. If perspiration emerges from the treated areas, they will turn dark in color. In this way, sweaty areas of skin can be clearly visualized and precisely identified.
- Gravimetry: This uses filter paper and a very precise precision balance to measure the amount of sweat excreted over a certain period of time. There is no clearly defined quantity that could confirm or rule out hyperhidrosis. However, the test can help to document the difference in quantity before and after therapy. And thus the success (or failure) of the treatment.
Hyperhidrosis: prevention, early detection, prognosis
Hyperhidrosis can occasionally be limited by preventive measures relating to general lifestyle:
- Avoid alcohol, cigarettes, spices and large amounts of coffee completely or to a large extent. They can make you sweat.
- Try to lose weight if you are overweight.
- Try to reduce stress if it plays a major role in your life. There are a number of relaxation exercises and methods for this, for example meditation and autogenic training.
- Do not wear any textiles made of polyacrylic; they are not permeable to perspiration and can lead to increased sweating.
In the case of hyperhidrosis, there are no signs of the disease that become noticeable before the actual condition appears. There are therefore no blood tests or similar procedures that can be used for early detection by drawing attention to impending hyperhidrosis. However, if you have a family history of hyperhidrosis, there is an increased risk that you may also be affected by excessive sweating.
Progression and prognosis of hyperhidrosis
In many cases, hyperhidrosis is limited to puberty and early adulthood. Otherwise, the course and prognosis depend primarily on the therapy used to treat the chronic excessive secretion of sweat. If you suffer from secondary hyperhidrosis, where another disease is the cause of the heavy sweating, the first priority is to treat this disease.
If hyperhidrosis is not treated or if treatment is unsuccessful, the course of the disease may be accompanied by complications. This is often the case, especially with heavy perspiration on the soles of the feet. Open areas can easily form in the softened skin, where fungal infections can occur. Warts, skin fungus and nail fungus also occur.
Hyperhidrosis: effective treatment
As secondary hyperhidrosis is caused by other diseases or disorders, these should be treated first in order to stop the excessive sweating. The situation is different with primary hyperhidrosis , which occurs without a recognizable cause. Your doctor has a range of treatment options available to treat this form of the disease.
Topical therapy for hyperhidrosis
Your doctor will most likely start with a topical therapy. This is a treatment that is applied precisely to those parts of the body (and only there) where it is supposed to work (example: not a tablet, but deodorant or skin cream). In most cases, a step-by-step approach is used; if the therapy initially used does not work or has unacceptable side effects, treatment is continued with another method. Occasionally, different procedures are combined with each other.
The first choice is almost always an antiperspirant (deodorant) that contains aluminum chloride. This active ingredient is intended to close the sweat glands. If the use of such a deodorant is not successful for you, you should consult your doctor about other treatments for hyperhidrosis that may be suitable for you.
Anticholinergics – treatment of hyperhidrosis with medication
Medications that could reduce your sweating belong to the group of anticholinergics. An anticholinergic is an active substance that intervenes in the autonomic nervous system. Here it blocks the transmission of nerve stimuli – including those stimuli that activate the sweat glands. Anticholinergics are not suitable for long-term therapy, but could provide you with short-term relief if you want to avoid annoying sweating in certain situations.
Treatment of hyperhidrosis with iontophoresis
This therapy is intended to reduce the flow of sweat on the hands or feet by increasing the stimulation threshold of the sweat glands. They are therefore made less sensitive. This is done with the help of a water bath in which a weak direct current flows. After initial treatment in hospital, you can also use tap water iontophoresis at home. A short training course and the appropriate home device are required. Each application takes about 20 to 30 minutes and should initially be carried out several times a week. You can increase the spacing later.
Iontophoresis can also be used for underarm perspiration. Here, however, the application is more difficult (with a sponge) and often less effective.
Treatment of hyperhidrosis with botulinum toxin
In this therapy, your doctor uses the neurotoxin botulinum toxin A, also known as Botox for short. It is injected into the area around the sweat glands with several injections (pricks) in order to block nerve conduction. For example, under the armpits. The success rate of Botox therapy is high; it often has to be repeated after a few months.
Treatment of hyperhidrosis with physical methods
In this therapy, your doctor heats specific areas of skin (especially under the armpits) to damage the underlying sweat glands. The devices used here work with radio frequency, microwaves or ultrasound.
Treatment of hyperhidrosis through surgery
In severe cases, certain nerve cords that are responsible for the activity of the sweat glands can be surgically blocked or completely severed. In subcutaneous curettage or suction curettage, the sweat glands are sucked or cut out of the skin. During sympathicolysis or thoracic sympathectomy (also known as ETS for short), a neurosurgeon cuts the sympathetic nerve. This means that the nerve can no longer transmit the sweating signal sent by the brain to the sweat glands.
