Excessive Sweating

As summertime temperatures and humidity soar, we expect to sweat, especially when we’re engaged in outdoor activities. But for those who suffer from excessive sweating (hyperhidrosis) no matter what the season, summer only makes matters worse, and sometimes miserably worse.

Sweating is an essential and normal body function, our natural air-conditioning system. Evaporation of sweat helps keep our bodies cool and regulates body temperature. Normally, sweating is triggered by emotional factors (feeling stressed or nervous), physical factors (engaging in strenuous activity), or environmental factors (hot, humid weather).

But there’s a big difference between normal sweating and excessive sweating. While normal sweating can sometimes be embarrassing, it is usually a passing phenomenon and doesn’t interfere with social or professional activities. Excessive sweating, which usually occurs on the face, underarms, hands, and feet, is another matter. When you’re dripping with sweat most of the time, it is difficult to shake hands, make a presentation, or enjoy social and intimate relationships.

Many people don’t realize excessive sweating can be treated, so they don’t seek help. But there are effective solutions, so consult a board-certified dermatologist to learn more about effective options. From antiperspirants applied to affected areas to prescription medications and Botox® injections, there are a number of treatments that do work.

Antiperspirants
Start with the easiest approach: topical applications of antiperspirants, either over the counter (CertainDri® and Maxim®) or prescription strength (Drysol®). These inexpensive and easy-to-use products can be used anywhere on the body. You’ll get the best results by applying antiperspirant to clean, thoroughly dry skin just prior to going to bed. Application to wet skin increases the risk of irritation, the most common side effect. Antiperspirants may not be effective for everyone, but they are safe and inexpensive long-term solutions.

Oral Medication
If topical antiperspirants don’t work for you, another medical option to try is a prescription oral medication (eg, Robinul®). Taken several times daily, oral medication treats excessive sweating throughout the body and is considered safe for use by younger people who are in good health.

The drawbacks are possible common side effects that may limit suitability for long-term use: constipation, dry mouth, drowsiness, blurred vision, and urinary retention. In rare instances, the drug may cause cardiac arrest, arrhythmias, or heat stroke due to decreased perspiration. It is best to start with low doses and increase gradually to find the best results at the lowest dose.

Botox Injections
You may know that Botox is the most common anti-wrinkle treatment, but it is also approved for excessive sweating. Because this therapy requires multiple injections to cover the application, it is best for small areas such as underarms or hands. Botox essentially “turns off” injected sweat glands, offering a quick, safe, long-lasting (6–12 months), and effective treatment. While this approach is more expensive and requires office visits for injections, there is a very high satisfaction rate among patients. Insurance may cover the cost if other treatments have failed.

Iontophoresis
This remarkably easy and safe treatment has been successfully used for more than 50 years. Patients put their hands or feet into treatment basins, and a mild electrical current passes through tap water to temporarily shut off sweat glands. It works, but beginning treatments are time consuming. It could take up to 10 separate 40-minute in-office treatments 3 times a week to become effective. But once sweating has normalized, it may require only weekly or monthly treatment to maintain its effectiveness, and your dermatologist can prescribe a home unit for self-administered maintenance. Side effects are minimal, and this method has high success and satisfaction ratings. However, because of the technique, it is not a great option in the treatment of underarm or facial sweating.

Surgery
The very last option to consider, if all other attempts have failed to control excessive sweating in underarms and hands, is an invasive surgical procedure called endoscopic thoracic sympathectomy (ETS). In this major surgery, the sympathetic nerve in the chest is cut or clipped to interrupt the transmission of nerve signals from the spinal column to the sweat glands. This is a permanent solution, but it also carries risk of long-term side effects, including serious, irreversible compensatory sweating (ie, hyperhidrosis in other body parts, including the trunk, buttocks, and lower extremities).

So, there are remedies if you sweat heavily and the dog days of summer make life even more miserable. You can spend the summer comfortably free of perspiration, and your board-certified dermatologist can help you do it.