Hyperhidrosis - Excessive Sweating

Hyperhidrosis or excessive sweating is caused by an over production of sweat from eccrine glands within the skin. These glands are found in high concentrations on the palms, soles and arm pits reflecting the parts of the body commonly effected by hyperhidrosis. Hyperhidrosis can be divided into primary and secondary.

Primary hyperhidrosis is common affecting 1-2% of the population. The cause of primary hyperhidrosis is thought to arise through increased cortical stimulation within the hypothalamic thermoregulatory centre in the brain leading to increased stimulation of the sympathetic nervous system supplying the sweat glands. This process is only occurs during waking hours. Excessive sweating at night can be normal (physiological) but should prompt a medical review to ensure an underlying medical ailment is not the cause.

Hands and feet sweating (palmer hyperhidrosis) 

Excessive, uncontrollable sweating of the hands or palms, is called palmar hyperhidrosis. This  condition is extremely embarrassing and can wreck lives. Topical treatments can be tried but are often irritating and rarely fully work. Dr Nelson can injected botulinum toxin A (botox) into your hands and or feet every six months to stop this life distroying condition. This can be very painful therefore Dr Nelson works with a consultant anesthetist to inject anaesthetic into the nerves in the wrist to complete numb the effected area temporarily.

Triggers of primary hyperhidrosis can be:

– Hot weather
– Anxiety
– Spicy food
– Exercise
– Fever

Secondary hyperhidrosis is brought on by an underlying medical condition. This type of hyperhidrosis is rare. The cause is usually diagnosed based on other symptoms and signs rather than the presentation of excessive sweating but conditions to consider include: lymphoma, chronic infection, pheochromocytoma, lupus, brain injury, carcinoid, endocrine diseases. Nerve injuries can lead to localised areas of excessive sweating. Examples of this include Frey’s syndrome following parotid surgery.

How do you treat hyperhidrosis?

There are several treatment options available for primary hyperhidrosis both localised and generalised.

First line therapy is antiperspirants containing aluminium. These can often be irritant to the skin so should not be applied every day. These are best applied onto the affected area once the skin has be washed and dried thoroughly. Only a single roll should be made before thoroughly drying the area again. Dr Nelson suggests applying the type of treatment last thing at night when the excessive sweating has reduced using a hair drier before and after application.  Repeated applications over 10 days can be very helpful even on tricky sites like the soles and palms.

If the sweating to too great for the above botulinum injections can be considered. These injections will completely block sweating at the site of injection. This type of treatment will need to be repeated every 4 to 6 months.

Generalised sweating can be more challenging to treat. Medication that manipulates that part of the nervous system thought to play a key role in the pathway of sweating can be tried but often side effects are too severe to continue treatment.