Summer’s well under way, and, for most of us, the idea of warm sunshine and thinner clothes is a pleasant one. However, we all recognise the discomfort of feeling sweaty, and worrying about damp patches under the arms….. Sweating is completely natural, and an important part of the complex biological mechanism by which we cool down – but, for an unfortunate 1% or so of the population, it is a real pain! Hyperhidrosis is the medical term for excessive sweating – sweating which causes the sufferer real problems – and, while it can be considered an “extreme variant of normal” (that is to say, not an illness – the body is doing what it is supposed to do, just rather too well!) it can feel like anything BUT normal to those affected. People suffering from hyperhidrosis can find their bodies – particularly armpits, hands and feet – sweating so much that clothes become soaked and hands drip. Children with hyperhidrosis can be bullied at school, and dread removing blazers in the classroom; adults with hyperhidrosis may avoid shaking hands, or other professional or social situations where their problem may be apparent and cause embarrassment. Hyperhidrosis is no fun at all! The good news is, there is much that can be done – approach a sympathetic GP for advice in the first instance, rather than suffer in silence.
What characterises hyperhidrosis?
The first thing that your doctor should do is to determine that the problem is, in fact, hyperhidrosis and not anything else. This is usually quite quick and easy to do, with a thorough history-taking. The sweating of hyperhidrosis is always symmetrical, affecting both sides of the body. Also, as sweating is regulated by the parasympathetic nervous system, which is “turned down” as dusk falls, hyperhidrosis is never a problem at night. If the pattern of excessive sweating doesn’t seem to “fit” with the usual clinical picture of hyperhidrosis, your doctor will want to consider alternative diagnoses. An overactive thyroid is a relatively common cause of excessive sweating in younger people (and almost all people with hyperhidrosis-type symptoms will begin to experience problems by their early twenties), and so your GP may want to carry out some blood tests to exclude this, and some other, much rarer and potentially serious, conditions such as Cushing’s disease, carcinoid tumour, heart disease, cancer, diabetes and so on. It must be stressed, however, that in the vast majority of cases the problem is caused by an overactive sweat mechanism (“simple” hyperhidrosis) and nothing more complicated or sinister. Blood tests are often not necessary. A basic physical examination to rule out a cause of any fever might be advisable.
Other causes of excessive sweating
The next thing for the doctor to do is to determine whether there are any other possible causes of excessive sweating – generalised anxiety, for example, can often be responsible, and a sensitive exploration of mood by the doctor may reveal an issue that needs addressing. Many prescription drugs can cause excessive sweating, and your doctor can go through your medicines with you to find out if there are any likely culprits, as well as suggesting alternatives which might cause less of a problem. You can expect your GP to want to discuss your intake of alcohol, as well as any recreational drug use and use of opioid painkillers, as these can lead to sweating (either by using them or withdrawing from them) – again, it must be emphasised that hyperhidrosis is NOT a clear-cut sign of a drug or alcohol problem, and patients ought not to be discouraged from seeking help because of worries about judgmental questions regarding lifestyle. Your doctor is there to help you in any way he or she can.
First line treatments for hyperhidrosis
When any other causes of excessive sweating have been ruled out, and a diagnosis of primary hyperhidrosis has been arrived at, your doctor can work with you to suggest ways you can manage the problem. Many sufferers will already have tried some over-the-counter strong antiperspirants, based on aluminium chloride. There is also a product called “Sweatstop” available, which is based on aloe vera. Your doctor might recommend you check out disposable underarm pads and absorbent insoles to soak up excess moisture, and be able to give you some more useful advice regarding fabrics to wear (thin, natural materials are best). On prescription, there are stronger antiperspirants available, again based on aluminium chloride (such as Driclor or Anhydrol Forte) – these can be irritating to the skin, so a steroid cream might be helpful to be co-prescribed. There are also tablets which can help – a medicine called propantheline bromide can help dry up the sweating, and is licensed for that use – some patients prefer to use another medicine called oxybutynin, which is not licensed to treat hyperhidrosis but which can, under the expert guidance of your GP, be extremely useful.
Specialist treatment for hyperhidrosis
Most people with hyperhidrosis can expect significant improvements in their symptoms using the above treatments – and this can represent a huge relief. However, a small number of patients find that their excessive sweating persists despite them, and your GP can refer you on for specialist secondary care. There is a treatment available called iontophoresis, in which a small electrical current is passed between two surfaces of the body which sweat – it’s not completely obvious how this works, but many people find it beneficial. Iontophoresis is carried out via a machine, which patients may wish to consider purchasing for their own use. Botulinum toxin (Botox) injections into the armpits can relieve sweating there foe up to three months, and may be worth considering. Many patients are keen to explore the possibility of a “once-and-for-all” cure such as surgery, but this is often accompanied by problems (including “rebound” sweating which is worse that it was before!) – your doctor can talk you through all the available options. And the situation is evolving all the time – there is another new treatment, based on microwave therapy, called MiraDry, which is currently only available in a few centres in the UK but which may well become more mainstream.
So please, if you’re worried about hyperhidrosis, don’t sweat it – see your GP, and you may well be able to look forward to a summer of feeling cool, calm and collected instead of hot and bothered.
For support from fellow sufferers, or for more information, please visit www.hyperhidrosisuk.org