Hyperhidrosis Overview

There are two main types of hyperhidrosis: secondary and primary. Secondary hyperhidrosis happens when another medical condition or a medication causes a person to sweat excessively. When the excessive sweating is the medical condition, a person has primary hyperhidrosis. Typically, people with secondary hyperhidrosis experience sweating over their entire bodies, whether they are awake or asleep. People with primary hyperhidrosis sweat in specific focal areas, mainly when they are awake.

Main focal areas include:

Researchers haven't nailed down exactly what causes a person to sweat excessively, but they have discovered a genetic link in some cases. Around 40 to 60 percent of the time, the condition affects multiple members of the same family. As for the rest, clinical trials and research continue to look into what might cause the brain to trigger such an extreme reaction.

Currently, it's estimated that hyperhidrosis affects 1 to 3 percent of the population. Many people report experiencing their first symptoms of hyperhidrosis as adolescents (although the condition can start in childhood). Though cases of hyperhidrosis beginning in adulthood are rare, they are not unheard of.

So what exactly is happening in the body of someone who has hyperhidrosis, and how is it different from normal sweating? Read the next page to find out.

In most people, low-level sweat production is a constant process, and much of that sweat doesn't even come out of the sweat glands; it's simply reabsorbed by the body. High-level sweat production is another matter. The process can kick off from exercise, high temperatures or stimulation from nerves in response to an emotion, like anxiety or fear. To learn more about how the body's sweat glands function, read How Sweat Works.

The nerves that react to stress get their cues through the sympathetic nervous system, which in turn is part of the autonomic nervous system. The sympathetic nervous system is responsible for preparing the body to respond to dangerous or stressful situations. When something of this nature occurs, the sympathetic system readies the body in a number of ways -- including increasing sweat production. It does this by stimulating the sweat glands with a chemical neurotransmitter called acetylcholine. This chemical rests in tiny sacs located between the nerves and sweat glands until it is needed. When released, this chemical forces the sweat glands into action, and the glands will continue to react until the acetylcholine has been depleted. (If the perceived threat hasn't passed at that point, more acetylcholine is released for the reaction to continue.)

For people with hyperhidrosis, the nerves that serve the sweat glands in certain portions of the body will go into overdrive from time to time and produce sweat for no reason at all. The frequency, duration and strength vary by person. There is no conclusive evidence as to why the nerves do this, but they will bombard sweat glands with unnecessary acetylcholine, causing a very sticky situation for some people.

So what is it like to have hyperhidrosis? Do you just slather on some extra deodorant as you head out the door? Go to the next page to find out what life with hyperhidrosis is like.

Hyperhidrosis isn't life-threatening, but it can affect every aspect of someone's life, and the effect on his or her psyche can be devastating. The worst part may be that while some triggers -- like spicy food or hot weather -- can be avoided to a greater or lesser extent, hyperhidrosis doesn't need a trigger. It can happen at any time with no warning at all.

It's no surprise that people with hyperhidrosis often report depression, social anxiety, decreased confidence levels, difficulty forming close relationships, frustration at daily activities, reduced work performance and a self-imposed isolation. Furthermore, the same social embarrassment and anxiety someone with hyperhidrosis may get from sweating can cause them to sweat even more, creating a vicious cycle that seems impossible to break.

Hyperhidrosis has a financial impact as well. People with hyperhidrosis might spend more money on:

Patients may have to visit the doctor's office frequently to receive treatments (discussed later in this article), which some health insurance plans may not cover. Financial assistance may be available from health insurance providers if the person proves that the treatment is a medical necessity.

But there is light at the end of the tunnel. Next, we'll look at some of the treatment methods for those who experience extreme sweating.

People with hyperhidrosis can experiment with a variety of treatment methods until they find one that works well for their particular situation and lifestyle. Doctors typically advise patients to start with the simplest, least invasive options available and work their way up as needed.

Using antiperspirants is the easiest way to treat sweating. Antiperspirants come in a range of strengths, both over-the-counter and prescription. They work by blocking the duct openings that lead to the sweat glands, preventing sweat from reaching the surface. Their active ingredients are metallic salts, most commonly aluminum compounds such as aluminum chloride hexahydrate, which is popular in prescription antiperspirants. Many people with hyperhidrosis can also use antiperspirants on other parts of their bodies besides their armpits, such as their feet, to lessen sweat production (although this can irritate the skin). To learn more about how this process works, read What is in an antiperspirant that stops sweat?

If antiperspirants don't do the trick, a treatment called iontophoresis is typically the next step. Iontophoresis can be used for palmar, plantar and axillary hyperhidrosis, though no one is really sure exactly how or why the process works. For some people -- possibly as much as 80 percent of those who try it -- iontophoresis provides good results. In many cases, the treatment drastically reduces sweat levels or temporarily stops sweating [Source: International Hyperhidrosis Society].

Reported to have been used as early as 1740 in order to treat arthritis, iontophoresis is a simple process [Source: International Hyperhidrosis Society]. Hands and feet are placed in shallow, water-filled trays, and an electrical current charges the water at a level comfortable for the user. The process sends a light electrical current through the tray contents to ionize the particles in the water, which then pass into the skin. Treatments can be performed by a dermatologist, or people can purchase iontophoresis machines and self-administer treatments at home.

Theories abound as to how the ionized particles interfere with the sweating process. Some ideas are that the ionized particles may plug the sweat gland or interrupt the nerve signal, but as for a definite conclusion, the jury is still out.

Iontophoresis treatments take between 20 and 40 minutes and need to be repeated frequently at first. Over time, follow-up treatments may be needed only every week or every month, depending on the person. Padded electrodes can be used to treat armpit sweating, too.

People with hyperhidrosis who may want a more low-maintenance treatment --albeit one that's more expensive -- can get Botox injections to stop sweat production in their armpits. In both the U.S. and the U.K., Botox has been federally approved for the treatment of axillary hyperhidrosis, although it can also be used on the feet, hands and face. Botox, a purified botulinum toxin protein, blocks the nerve endings that would signal the sweat glands into overdrive. The length of time Botox injections can stay effective ranges from three to 16 months. Follow-up injections may be needed soon after the primary one, if some spots were missed.

Other lines of attack include astringents and topical or oral medications.

More invasive treatment options exist for those who have severe hyperhidrosis and seek more permanent relief. We'll examine those next.

For the most extreme cases of hyperhidrosis, surgery is a possible route, although it is also generally viewed as the riskiest treatment. Endoscopic Thoracic Sympathectomy (also called Endoscopic Transthoracic Sympathectomy or ETS) disables specific nerves responsible for sweating in certain parts of the upper body by cutting or clamping them. ETS is most successful and most commonly performed in cases of severe palmar hyperhidrosis. In the lower body, a similar procedure called lumbar sympathectomy can be performed for plantar hyperhidrosis.

The different treatments for hyperhidrosis attack excessive sweating in various ways.

Other surgical approaches can include localized procedures, like cutting, scraping or suctioning the sweat glands out, or they may involve a combination of these techniques. Along with the previously described methods, most of these carry some risk of side effects, so a competent doctor should be consulted concerning each.

A particular dissatisfying side effect from surgery is compensatory sweating. Because the body already has an inclination to sweat excessively, it believes it must produce the same amount of sweat after surgery and finds new areas to release that sweat. A patient who undergoes ETS, for example, may be disappointed to find that although his hands no longer sweat excessively, now his back and stomach are overcompensating for that loss of sweat. Researchers are seeking ways to tweak these treatments in order to decrease occurrences of compensatory sweating and other side effects.

For more information about hyperhidrosis and how the body works, visit the links on the next page.