Some people would argue that sweating is enough of a problem all by itself. It's a necessary evil -- one of the less-attractive aspects of human physiology that we try to avoid dealing with as much as possible. Sweating is simply your body's way of cooling down when you get overheated. Sure, it can be gross and annoying. It runs into your eyes, melts your makeup, leaves marks on your clothes and makes you smell bad. But you shower it off, put on antiperspirant/deodorant to keep down the moisture and odor, and go about your day. For an unlucky few, however, sweating is more than just something that happens when they exercise or hang out by the pool in the summer. At best, it's incredibly embarrassing and uncomfortable. At worst, it's life-threatening.
When you finish reading through this list, you may not be quite as disgusted by a little perspiration on occasion.
When you think of hot flashes, you probably think of menopause, but that's not the only thing that causes them -- some medications and therapies, such as chemotherapy, can do the same thing. Most hot flashes are the result of changes in hormone levels, which confuse the hypothalamus -- a part of the brain that links the nervous system to the endocrine system -- into thinking that the woman's body is overheating when it isn't.
Typically, hot flashes begin as a sudden sensation of intense heat in the face and neck, often spreading to the rest of the body. Women often get an uncomfortable feeling, or "aura," that indicates that they're about to experience one. The skin can become very hot to the touch and appear red, sometimes called a "hot flush." These symptoms can last anywhere from a few seconds to several minutes, leaving a woman literally dripping perspiration from her face and neck. Some women experience their hot flashes as night sweats and describe waking up in pools of sweat.
And, lest you get the wrong impression, hot flashes mean more than simply getting hot and sweaty without any exertion. A rapid heartbeat, dizziness and nausea are fairly common companions to a hot flash.
Some triggers for hot flashes are hard to avoid -- stress, caffeine, alcohol, spicy food and hot weather. Wearing breathable fabrics like cotton and using fans and cold packs can help, and hormone therapy and vitamin E supplements are common treatments.
It's normal to sweat when we're in situations that make us feel anxious, such as job interviews and first dates. They invoke our "fight or flight" response, which is what happens when the body decides that you'll soon need to move quickly to react to some kind of threat, either by confronting it or running away. Obviously, an interview or a date isn't an actual threat, but your nervous system doesn't know that. It sends a message to your sweat glands to produce perspiration so your body can remain cool (and slippery) during this supposedly dangerous encounter. Of course, if you're already feeling nervous, sweating will only make things worse because you'll start worrying about whether your sweat is noticeable to others.
Most of us just feel a little sweaty or get clammy hands when this happens, but some people experience extreme sweating because of social anxiety, social phobias or panic attacks. If your social sweating is accompanied by other physical symptoms such as shortness of breath or nausea, or you find yourself avoiding social situations, it may be more than just basic nervousness. The good news is that social anxiety can be treated effectively with behavioral therapy and antidepressants or anti-anxiety medications. You might also want to try meditation and breathing exercises.
If you've ever worked up a sweat and found yourself wondering about that particular smell emanating from your body, you've experienced some level of bromhidrosis. It's the medical term for body odor, or "B.O." Sweat itself doesn't actually smell like anything. Body odor comes from bacteria that live on the skin in areas where a specific type of sweat gland is located. Apocrine glands are in the areolae, genital area and armpits, and (as opposed to the eccrine glands everywhere else) the sweat that they produce is full of protein and fatty acids. Apocrine sweat serves as food for the bacteria, which in turn create that distinctive odor when they metabolize the sweat.
We all have apocrine sweat, so why do some people produce very little body odor while others get really stinky really quickly? Genetics plays a part; some people just have sweat that's more attractive to bacteria, or have more sweat-eating bacteria. Diet comes into play -- eating lots of garlic, for example, can result in greater body odor -- and some medications can cause an unpleasant smell as well. Men also tend to have stronger body odor than women.
If you're worried that your body odor is abnormally strong, try using an antibacterial soap and showering more frequently. A stronger antiperspirant/deodorant will not only help cover up the smell, but cut down on the sweat in the first place.
Sweating in Colors
Sweat as most of us know it is clear, although it can leave yellowish stains on our clothing thanks to those pesky bacteria. If your sweat suddenly came out, say, green, you'd probably think that something was wrong with you. (This would be correct.) Luckily, this rare condition, known as chromhidrosis, isn't typically a sign of a serious problem. It does, however, result in stained clothing, not to mention confusion.
There are two different kinds of chromhidrosis: One affects the apocrine glands, and the other takes on the eccrine glands. People with apocrine chromhidrosis may have black, blue, brown, green or yellow sweat. How does it work? It starts with a pigment granule called lipofuscin, which is produced when unsaturated fatty acids are oxidized in certain types of cells. A buildup of lipofuscin can result in the color being excreted in sweat. Heavily oxidized lipofuscin appears brown or black, while less oxidized granules are lighter. No one knows why some people get this buildup.
Eccrine chromhidrosis is even rarer, and it's caused by eating mass quantities of foods or medications that contain dyes. For example, one often-cited study of a nurse who had reddish sweat showed that she often ate a snack food that listed paprika and tomato powder among its ingredients. (Beware your snacks.)
Treating eccrine chromhidrosis is easy once you've determined what's to blame and cut it out of your diet. Apocrine chromhidrosis treatment is more difficult, since we don't even know why it happens.
Extra, Extra Sweatiness
Upon first learning that hyperhidrosis means excessive sweating, you might wonder how much of a problem it could really be. Just use more antiperspirant/deodorant, right? But people with hyperhidrosis don't just get really sweaty when they exercise. They sweat excessively while just sitting around inside, and can produce up to five times as much sweat as the average person. And we're not talking about some unattractive armpit sweat circles -- some people report difficulty driving due to slippery palms and changing clothes several times a day because shirts and pants get soaked through quickly.
For unknown reasons, people with hyperhidrosis have sweat glands that work overtime, far beyond what they need to stay cool under normal conditions. It's a life-altering problem, one that keeps some people in their houses, depressed and socially anxious, because they're ashamed of their condition.
People with hyperhidrosis often buy numerous over-the-counter products in the search for a cure, but in many cases, a visit to the doctor is in order. Prescription antiperspirants can help, and so can Botox injections. A more permanent solution is surgery, which consists of cutting or clamping nerve connections responsible for sweating in specific areas of the body. This solution often applies to people who have excessively sweaty palms. It's risky, however, and a potential side effect is that the body will send signals to start sweating more in another area of the body to compensate.
Colored sweat, as we discussed a few pages back, is unusual enough. Even stranger is a sweating condition called hematidrosis in which a person actually sweats blood. Some cases are caused by other diseases or high blood pressure, but most of 75 or so reported cases in the last hundred years have occurred while the person was experiencing extreme stress, anxiety and fear. A couple of examples: a prisoner sentenced to death and a person living in London during the Blitz.
According to former medical examiner and forensic expert Dr. Frederick Zugibe, hematridrosis is an extreme side effect of the fight or flight response. The anxiety and fear is so strong that it causes the small blood vessels supplying the sweat glands to tightly constrict, and then dilate so widely that they hemorrhage blood. The blood mixes with the sweat already being produced in larger amounts due to stress, and it appears as blood on the skin's surface. If it sounds painful, it is. Since the condition is so rare and the few who have exhibited the symptoms have generally only had one episode, bloody sweat remains a puzzle.
No Sweat at All
Not sweating at all might sound like a good thing given the problems we've discussed so far. But as we've pointed out, sweating is necessary to keep our bodies cool, so not being able to sweat is potentially dangerous. Some people lack this ability to sweat, a condition known as anhidrosis or hypohidrosis.
People with anhidrosis may get dizzy, flushed, nauseated and weak when exerting themselves, but barely sweat at all. A person with a mild case sweats less than what's considered normal, or perhaps sweats in fewer areas. Extreme cases affect the entire body.
Anhidrosis is caused by malfunctioning sweat glands, and there are many potential causes. Children born with it don't develop sweat glands at all, or develop very few of them. Nerve damage is another culprit. Diabetes, for example, can damage the nerves that control the sweat glands, and so can skin diseases like psoriasis. Other possibilities: certain medications and genetic disorders such as hypohidrotic ectodermal dysplasia (see sidebar).
What does it feel like? People with anhidrosis get painful muscle cramps known as heat cramps. They're also likely to experience heat exhaustion or get heat stroke, which occurs when the body's core temperature reaches 104 degrees Fahrenheit (40 degrees Celsius). Without swift treatment, heat stroke is life-threatening -- it can lead to a coma or death. Minor cases of anhidrosis can be alleviated by avoiding extreme temperatures and taking great care to stay hydrated and cool during strenuous activity. People with severe cases may have to avoid exercise or going outdoors altogether when it's hot.
An Allergy to Your Own Sweat
People with cholinergic urticaria are essentially having an allergic reaction or hypersensitivity to their own sweat or body heat after a rise in temperature. The condition manifests as an outbreak of hives -- small, itchy, red bumps that may also feel like they're burning or stinging -- that can appear anywhere on the body. That bump in temperature is caused by the usual suspects, such as strenuous activity and eating spicy foods. The rash can last for hours after the initial rise in temperature or outbreak of sweat, and it's very uncomfortable and painful. Those who have the disorder often feel the rash coming on before it happens, and can sometimes stop it by taking a cool shower or applying cold packs to the areas most commonly affected.
The cause of cholinergic urticaria is unknown. It can be aggravated by other conditions and may also be hereditary. The disorder rarely travels alone, either. Instead, it brings along its buddies -- other types of rashes, eczema or allergies. It isn't consistent company, often coming and going over the course of a person's life.
Tips for those with cholinergic urticaria: Try to avoid extreme temperature changes and excessive heat, stay cool in hot weather, and be cautious during strenuous exercise. Some have found relief through antihistamines, steroids and alternative therapies like acupuncture.
Hidradenitis suppurativa, a severe form of acne, affects the apocrine sweat glands as well as the sebaceous (oil) glands located in the genital area and armpits. These aren't tiny zits -- we're talking clusters of blackheads, painful lesions and large cysts. The lesions may leak pus and remain open sores, resulting in scars. The cysts sometimes burst due to the pressure and skin-on-skin contact, draining pus and developing into open wounds that are difficult to heal. The bumps and lesions can last for months or years and cause serious skin infections.
Hidradenitis suppurativa typically begins at puberty, when sweat and oil production both ramp up. These fluids, along with dead skin cells, become trapped in the pores and hair follicles, leading to serious inflammation. We don't know exactly what causes this extreme acne, but it can be triggered by excessive sweat and oil production as well as other factors like obesity and stress. Women are more likely than men to develop it, and often have flare-ups around their menstrual cycle. It may also have a genetic component.
The most extreme treatment for this type of acne requires removing the affected skin completely and replacing it with a skin graft from elsewhere on the body, but that's a last resort. Antibiotics, steroids and medications to slow down or stop oil production in the affected area are the first line of treatment. Deep cysts may need to be lanced and drained.
Historical Sweating Sickness
We'll end this list of sweating problems with one that hasn't been spotted in hundreds of years. Known as the "sweating disease" or "sweating sickness," this mysterious illness swept through Europe beginning in the mid-1400s. The first mention of the disease coincides with the beginning of King Henry VII's reign, and the last comes from a book published in 1551 by an English doctor named John Caius.
According to Caius, those stricken with the disease first went through a brief "cold" stage, with shivers, aches and pains. Within minutes or hours, the "hot" stage set in, with copious amounts of sweating, extreme thirst and heart palpitations. Unlike other epidemics of the time, there was no skin outbreak or rash, and it didn't appear to affect children. It also hit the upper classes and wealthy harder than the poor. Many people in Henry VIII's court came down with the disease when it came through England for a fourth time in 1528. Not all of the affected died, but those who did sometimes went through several rounds of it before collapsing. Others died within hours.
One of the most unique things about the sweating disease was how quickly it spread; it generally only affected a particular area for a few weeks. It appeared only in summer, which gives today's researchers some clues as to its cause. One possibility is relapsing fever, a bacterial infection spread by lice and ticks, while others have suggested that it was a type of hantavirus, but neither of these diseases match up exactly to the descriptions. Perhaps we'll never know.
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