Sweating is a normal physiologic process that is important in regulating body temperature, particularly keeping the body cool.
Hyperhidrosis is a condition where sweating occurs abundantly despite the body not needing to be cooled down. Hyperhidrosis is thought to be inherited. It can also occur secondarily due to a medical condition, such as stroke, overactive thyroid, and diabetic nerve disease to name a few. Medications, such as some blood pressure pills or antidepressants can be the culprit. Heat and exercise can cause hyperhidrosis, however, for many, this makes sense, thus medical treatment is not often sought if this is the only source. When a cause of hyperhidrosis is not found it is referred to as idiopathic hyperhidrosis.
Hyperhidrosis affects quality of life, and therefore may have a link to depression and anxiety. It is obvious how generalized hyperhidrosis can be problematic, but even primary focal hyperhidrosis can cause embarrassment and social isolation. Primary focal hyperhidrosis commonly affects the hands, feet, and underarms. Thus, as an example, sweaty palms can make a work and social environment difficult. Furthermore, excess sweating in skin folds can lead to bacterial or fungal infections.
There are several treatment options for hyperhidrosis. The modality of therapy depends on location and severity. There are topical antiperspirants, both over the counter and prescription, that contain aluminum chloride. This ingredient is usually effective, but it can be irritating to thin skin, and be tedious to apply on the hands and feet, as they often have to be wrapped for better penetration.
Botulinum toxin (Botox) is an effective injectable medication for hyperhidrosis. The medication blocks a chemical in the body that activates the sweat glands. It lasts six months, on average. It is most commonly done for the underarms, however, palms and soles respond well but pain is a limiting factor for the hands and feet.
Iontophoresis used to be one of the main treatments for hyperhidrosis until botulinum injections became popular. It is still available by prescription. Iontophoresis is a medical device where hands or feet are immersed in water. A low voltage current travels through the water, which temporarily turns off sweat glands. It takes about eight sessions, on average, to notice decreased sweating. This process has to be repeated to maintain results.
For more generalized hyperhidrosis, namely that which is idiopathic, more aggressive treatment is usually necessary. Oral medications and surgery are often considered. Due to the side effect potential of systemic therapy or procedures, benefits must outweigh the possible risks.