Excessive Sweating: A Sticky Subject

WebMD goes to the experts to find out what may cause this embarrassing yet common condition and what can be done to treat it.

Medically Reviewed by Brunilda Nazario, MD on July 09, 2009
5 min read

For Crystal Barry, excessive sweating wasn't just a nuisance. It shaped her daily activities, even her personality.

Barry, 24, a student from St. Louis, avoided team sports and crowded events. She never wore tank tops or sheer fabrics and often had to bring extra shirts to school after her first shirt was soaked through with sweat. She shied away from social situations, especially ones involving the opposite sex. "I don't like to be around people if I stink," she tells WebMD. "I get real quiet."

Scientists aren't sure what causes excessive sweating, but the condition is more common than once believed. A variety of treatments are available, but many people who suffer from excessive sweating never learn about these treatments. In a 2004 study, two-thirds of those who routinely suffered from excessive sweating (known medically as hyperhidrosis) had never talked to a health professional about it.

"This is truly an embarrassing thing for people," says dermatologist Dee Anna Glaser, MD, of Saint Louis University, one of the study authors. Sweat still has "a lot of connotations in our society," including deviousness and poor hygiene, "so you can imagine how someone who sweats excessively feels about themselves and how they fear others feel about them."

Anyone who sweats more than is needed to regulate body temperature is sweating excessively, Glaser says. Those with the condition known as hyperhidrosis sweat excessively from certain areas such as the hands, feet, underarms, or face. The condition often emerges in adolescence but may not be recognized as a problem until a few years later. Based on the 2004 study, Glaser estimates that nearly 8 million Americans -- or nearly 3% of the U.S. population -- suffer from hyperhidrosis.

The sweat glands in people with hyperhidrosis are normal in size, number, and location, Glaser says. "It seems the center inside the brain that normally tells you when to sweat for heat balance is sending signals to sweat excessively from a localized area," she says. "Why that signal is occurring, we don't know." About half of patients have a family history of hyperhidrosis, suggesting a genetic component to the condition, Glaser says.

Often, the sweating episodes have no obvious cause, doctors say. Though hyperhidrosis is not caused by anxiety, anxiety about sweating can cause or exacerbate a sweating episode, Glaser says.

Before treating excessive sweating, Atlanta dermatologist Harold Brody, MD, says he checks for other medical conditions for which sweating is a symptom, such as diabetes and hyperthyroidism. Sweating can also be a side effect of many drugs.

Brian Olds, an information technician from St. Louis, said his excessive sweating stopped within six days of getting Botox injections under his arms. No more massive sweat stains under his arms, no more bringing two shirts to work. "I'm ecstatic with the results," he says.

Commonly thought of as a wrinkle treatment, Botox has "revolutionized" sweating treatment because it is so effective and can treat almost any area of the body, Glaser says. More people who do not suffer from hyperhidrosis are starting to use Botox cosmetically. Glaser has used it on brides-to-be who don't want to stain their wedding dresses on their big day.

Botox is only a temporary solution, however, and injections must be repeated about once every six months. And even though the FDA has approved Botox for use under the arms, some insurance companies do not cover it. Barry says Botox helped her "dramatically" when she took it as part of a study. But when the study ended, her insurance wouldn't cover the injections, which can cost as much as $1,000 per session.

Other available treatments for excessive sweating include:

  • Special Deodorants. This is the typical first-line treatment. Over-the-counter antiperspirants that offer "clinical strength" usually have aluminum zirconium as an active ingredient and are often applied at night. These are "a little stronger" than typical antiperspirants, and many find them effective, Glaser says. Prescription-strength Drysol (containing aluminum chloride) is also effective in some people, but it can irritate the skin.
  • Iontophoresis. This painless procedure uses water to conduct an electrical current through the skin. Some iontophoresis machines can be used at home; others must be used at a doctor's office. Iontophoresis can be effective, but only on the hands or feet, and the procedure typically must be repeated two or three times a week.
  • Oral Medications. Drugs known as anticholinergics stop sweating as a side effect. Glaser will sometimes prescribe anticholinergic medications such as Robinul. But the pills can stop all sweating, making them inappropriate for athletes or people who work outside. Barry controls her sweating with Robinul, but she suffers from dry mouth, a common side effect.
  • Surgical Tumescent Liposuction. This is a cosmetic procedure in which surgeons use tiny instruments to remove the sweat glands. It is performed as an outpatient procedure under local anesthetic, and its effects are generally permanent. It is only used to treat sweating under the arms.

In a controversial procedure known as a sympathectomy, a surgeon cuts a portion of a nerve inside the chest, permanently interrupting the nerve signal that causes the body to sweat excessively. Joseph Coselli, MD, a surgeon at Baylor College of Medicine in Texas, says his patients are amazed to wake up from surgery with their hands completely dry for the first time in years. Unlike other treatments, a sympathectomy is designed to be a one-time, permanent procedure.

In the past, a sympathectomy was a major surgery because it required opening up the chest or back. Today, it is performed with tiny instruments and a camera that are inserted into the body through a small incision, a method known as endoscopy. This has turned it into an outpatient procedure. But the surgery remains controversial because of a phenomenon called compensatory hyperhidrosis. While sweating may have disappeared from the hands and armpits, sweating may increase elsewhere in the body, such as chest, back or legs. In people with hyperhidrosis, says Coselli, "the sympathetic nervous system is hyperactive. When you knock out part of it, other parts rev up and take over."

Glaser says the surgery should be considered a treatment of last resort because half or more of sympathectomy patients suffer from compensatory sweating. "Some people wish they'd never had the procedure," she says.

But Whitney Burrows, MD, a surgeon at the University of Maryland Medical Center who conducts sympathectomies, says that many of his patients are so "euphoric" to have reduced sweating in their feet or underarms they are not disturbed by compensatory sweating in less visible areas. To increase your odds of successful surgery, Burrows suggests seeking out a surgeon with considerable experience in the procedure.

Show Sources

SOURCES: Crystal Barry, St. Louis. Brian Olds, Imperial, Mo. Dee Anna Glaser, MD, vice chairman, department of dermatology, St. Louis University School of Medicine, St. Louis. Harold Brody, MD, clinical professor of dermatology, Emory University, Atlanta. Joseph Coselli, MD, chief of heart surgery, Baylor College of Medicine, Houston. Whitney Burrows, MD, assistant professor of surgery, University of Maryland School of Medicine, Baltimore. Strutton, D. Journal of the American Academy of Dermatology, August 2004; vol 51: pp 241-248.

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