Excessive sweating

Symptoms Of Excessive Sweating

Excessive sweating is usually seen in the palms, soles, face, head, or armpits. Other visible symptoms include:

• Excessive body odor

• Sweat-soaked clothing

• Sweating even while sitting

• Difficulty in holding objects

• Extremely soft and white skin

• Skin peels off easily

• Skin infections

Psychological symptoms

• Increased heart rate 

• Palpitations

• Gastric disturbances.

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Types of Excessive Sweating

There are two major types of excessive sweating:

• Primary hyperhidrosis: It is usually seen if one of the family members may have had it. Studies suggest that primary hyperhidrosis begins in childhood and worsens with puberty, especially in women.

• Secondary hyperhidrosis: It is caused by some other condition or behavior like neurologic syndromes, thyrotoxicosis, diabetes mellitus, gout, menopause, chronic alcoholism, etc.

Apart from these, there are other types of excessive sweating that include:

• Night sweats: These are generally associated with menopause, infection, malignancy, or endocrine disease. Also, fluctuating sleep depth due to sleep apnoea, pains, restless legs, etc., can cause excessive sweating.

• Food-triggered (Gustatory) sweating: Everyone knows that your face sweats when you consume highly spiced food. This gustatory hyperhidrosis is seen following salivary gland surgery and is then called Frey’s syndrome. It is also seen in uncontrolled diabetes.

Causes Of Excessive Sweating

Our body has a mechanism to regulate sweating. However, in excessive sweating (hyperhidrosis), this mechanism may not work properly. The negative feedback to the hypothalamus, a structure deep within your brain, which tells it to stop signaling the sweat glands, may be impaired. As a result, the body ends up sweating more than necessary to cool down.

Risk Factors For Excessive Sweating

Excessive sweating is a general feature seen during hot and humid conditions. However, if it is chronic then it can lead to discomfort. There are certain triggers that can lead to excessive sweating. They include:

1. Genetics

Several studies suggest that primary hyperhidrosis has a genetic component as demonstrated by the high frequency of positive family histories.

2. Fever

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3. Certain Conditions

Secondary hyperhidrosis can occur in the following conditions:

• Diabetes mellitus

• Hyperthyroidism

• Parkinson's disease

• Neurologic disorders

4. Medications 

Drugs that can induce hyperhidrosis, or sweating in excess include:

• Antidepressants

• Dopamine agonists

• Selective serotonin reuptake inhibitors (SSRIs)

• Antipsychotics

• Insulin

5. Menopause

The excessive sweating associated with menopause is considered to be a form of secondary hyperhidrosis and is generally known as hot flashes.

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6. Anxiety

Studies have shown that excessive sweating is a potentially disabling symptom, which is often triggered in social anxiety disorder (SAD). It is an intense, persistent fear of being watched and judged by others. 

7. Chronic excessive alcohol consumption

Excessive sweating in palms and soles is frequently observed in patients with a clinical history of chronic abnormal alcoholic intake.

8. Tumors

Excessive sweating can occur in cancer or cancer treatment. Tumors such as pheochromocytoma (a rare tumor that usually forms in the adrenal glands, which are located on top of the kidneys) and lymphoma (cancer of the lymphatic system) known to cause hyperhidrosis.

Diagnosis Of Excessive Sweating

To diagnose excessive sweating, it is important to first determine whether the source is primary or secondary and this can be done through a thorough history. The diagnosis consists of the following:

1. History and physical examination

Diagnosis of excessive sweating is usually made by a visual inspection. A family history and medical history can determine primary or secondary hyperhidrosis.

Primary hyperhidrosis is more commonly seen in the younger population. Symptoms that present later in life are mostly linked to a secondary cause.

2. Starch-iodine test

In this test iodine solution is applied to the skin and starch powder is applied on top of that. As soon as those substances are in contact with sweat, they turn violet in color. 

The distribution pattern of the color (or absence of it) helps in the identification of excessive sweating.

3. Quantitative sudometry 

The quantitative sudomotor axon reflex test (QSART) is a quantitative test assessing sweat glands innervated by small nerve fibers.

4. Filter paper test

This test is suitable to detect excessive sweating in the armpits. A pre-weighed filter paper is inserted into the armpit for a defined time period (60 sec or 5 min) and then weighed again. The difference corresponds to the amount of sweat released in mg/time can help diagnose hyperhidrosis. 

5. Other tests

If a secondary cause is suspected, a complete work-up is done to rule out infection, kidney dysfunction, malignancy, diabetes mellitus, thyroid disease, an inflammatory disorder, or connective tissue disease. Some of these tests include:

• Complete blood count (CBC)

• Basic metabolic panel

• Thyroid-stimulating hormone (TSH)

• Erythrocyte sedimentation rate(ESR)

• Antinuclear antibody

• Hemoglobin A1C (HbA1C)

• Chest x-ray

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Prevention Of Excessive Sweating

Here are a few things that you can adopt and a few you can avoid to prevent generalized excessive sweating. They include:

Do’s

• Wear loose-fitting, breathable clothes to minimize signs of sweating

• Wear socks that absorb moisture 

• Change your socks at least twice a day if possible

• Eat smaller frequent meals

• Keep your moisturizers in the fridge to get the cooling effect during summers

• Get a small handy fan to avoid sweating during hot weather.

Don’ts

• Do not wear tight clothes or synthetic fabrics like nylon

• Refrain from wearing enclosed boots or sports shoes that may cause your feet to sweat more

• Avoid spicy food

• Limit alcohol and caffeine consumption

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Specialist To Visit

To address excessive sweating, it is crucial to identify its underlying cause. Consulting with a dermatologist(skin specialist) is essential as they can provide appropriate treatment for individuals experiencing this condition.

When to see a doctor?

• Excessive sweating for 6 or more months

• Sweating involves the armpits, palms, soles, and/or face

• Sweating is on both sides of the body in symmetry

• Decreased or no sweating at night

• Sweating episodes last at least 7 days

• Sweating impairs daily activities.

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Treatment Of Excessive Sweating

There are several treatment options available to manage or treat excessive sweating. These include:

1. Topical applications

Generally, topical applications are suitable only for cases of focal hyperhidrosis. The most commonly used ones include:

• Antiperspirants: These are products designed to reduce sweat or perspiration on the skin. They are available in creams, powders, and sprays. Aluminum salts are added to many topical antiperspirants.

• Astringents: These act by contraction or tightening of body tissues. In case of excessive sweating, they work by constricting the skin's pores, reducing sweat production, and providing a drying effect.

2. Oral Medications

Oral medication is reserved for treatment-resistant cases or generalized hyperhidrosis. Medications used include:

• Anticholinergics: These are the most commonly used oral medications. Examples include:

• Glycopyrrolate

• Bornaprine

• Methantheline bromide

• Alpha-adrenergic agonists: These are used to treat localized types of excessive sweating. Clonidine is the most commonly used drug.

• Calcium channel blockers: Calcium channel blockers like diltiazem inhibit the calcium-dependent release of acetylcholine and help to reduce sweating.

• Other drugs: Beta-blockers (like propranolol) and benzodiazepines (like diazepam) are used to reduce anxiety-related excessive sweating.

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3. Iontophoresis

It is the process of passing a weak electrical current through the skin to block the sweat glands. 

The current is applied usually for 10-20 minutes per session, initially with 2 to 3 sessions per week. It is followed by maintenance sessions at 1 to 3 week intervals, depending upon the patient's response.

Iontophoresis may sound painful but is not.

4. Botox injections

Injection of botox (botulinum toxin) is an effective therapy for excessive sweating of the armpits, hands, feet, armpit, and face.

It works by inhibiting the release of acetylcholine, the chemical that activates sweat glands. 

The injections can be uncomfortable, but the use of a very small needle helps to minimize discomfort. 

They usually give around six months of relief from sweating. 

5. Surgery

It is the last resort when all other treatment modalities show no positive results. These include:

• Endoscopic thoracic sympathectomy: This surgery is used to treat sweating of the palms or face. The sympathetic nerves control sweating. A sympathectomy is an irreversible procedure during which at least one sympathetic ganglion (relay station between the nerves) is removed.

• Removal of axillary(armpit) sweat glands: Sweat glands in the armpit (axilla) is removed by means of axillary curettage (removal of tissue) or liposuction (removal of fat).

Home Care For Excessive Sweating

The following home remedies are traditionally known to manage excessive sweating and gain some control over perspiration. However, make sure to take consent from your healthcare provider before trying these.

1. Apple cider vinegar: This is a natural astringent that tightens skin pores and helps control sweat production. It can also help rid your body of odor caused by bacteria by balancing the pH level.

How to use it: Soak a cotton ball in apple cider vinegar and apply it to your problem areas at night just before you go to bed. Wash it off of your skin in the morning.

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2. Sage tea: It contains a natural astringent called tannic acid that has the ability to constrict and shrink your skin and pores to reduce sweat. Sage also helps to tackle the body odor of the armpits and feet.

How to use it: Add two sage tea bags to two cups of boiling water and then let it cool. Dab a clean towel in it and wipe your underarms, arms, and feet. Repeat two or more times daily for best results. You can also soak your feet in warm water with sage tea bags in it.

3. Black tea: It is a great natural antiperspirant due to its high levels of tannic acid. 

How to use it: Add two bags of black tea to four cups of boiling water. When the water is cool enough, soak your palms or feet for 20 minutes. 

4. Potatoes: These can absorb excess sweat on the body and act as a natural antiperspirant.

How to use it: Take a small piece of potato, and rub it on your sweat-prone areas. Let the potato residue dry completely before getting dressed.

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5. Baking Soda: Baking soda can be used to get rid of body odor.

How to use it: Mix equal parts baking soda and cornstarch. Add lavender essential oil for its sweet fragrance and apply the mixture with a damp cloth to clean the underarms. Rinse it off after 20-30 minutes.

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6. Chamomile tea: Chamomile is one of the best herbs for eliminating stress and promoting relaxation which can help reduce sweating.

How to use it: Drink two to three cups of chamomile tea each day to stay calm and refreshed.

Complications Of Excessive Sweating

Excessive sweating may not be a life-threatening condition, but it sure has an effect on the quality of life. Some of the general complications include:

• Skin problems: Excessive sweating can lead to several skin complications due to prolonged moisture and the breakdown of the skin's natural protective barrier. These include:

• Body odor

• Skin infections

• Dermatitis (redness, itching, and irritation of the skin)

• Friction between moist skin surfaces 

• Eczema

• Acne breakouts

• Unusually soft or moist skin

• Skin discoloration

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• Social embarrassment: It can be due to visible sweat stains and an unpleasant odor, making individuals self-conscious and affecting their confidence in social interactions.

• Emotional distress: This is caused by negative body image, and increased anxiety due to concerns about appearance and social interactions.

• Psychological distress: It can trigger feelings of embarrassment, shame, and self-consciousness, leading to anxiety, low self-esteem, and a negative impact on overall mental well-being.

• Work or school-related disability: Excessive sweating can interfere with productivity, concentration, and performance due to constant discomfort, distraction, and the need for frequent clothing changes at school or work. 

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Alternative Therapies For Excessive Sweating

There are few alternative therapies that have shown good results in recent times to manage excessive sweating. They include:

1. Microwave thermolysis

This is a non-invasive method that causes local destruction of sweat glands through microwaves. It is used to treat excessive sweating in the armpits.

2. Cryotherapy

Topical cryotherapy uses a surface nitrous oxide cryoprobe applicator to freeze-damage the sweat glands. 

3. Microneedle radiofrequency (MNRF) 

The mechanism of action is the destruction of the sweat glands by heating. The radiofrequency generated by microneedles targets both the odor-producing and the water-producing glands. The results of this treatment last a long time.

4. Photodynamic therapy

This therapy involves using a photosensitizing agent. When the photosensitizer is exposed to specific light wavelengths, it generates reactive oxygen that targets and destroys sweat glands.

It is a safe and effective treatment for excessive sweating, particularly in areas like the armpits and palms.

6. Laser therapy

It is used for the treatment of underarm sweating, where lasers can precisely target, heat, and destroy the sweat glands. It is a safe, effective, and minimally invasive solution for excessive sweating.

7. Ultrasound

Micro-focused ultrasound is also an effective and well-tolerated treatment for excessive sweating in the armpits. It works by delivering focused ultrasound energy to the deeper layers of the skin, targeting and reducing sweat gland activity.

Living With Excessive Sweating

Living with excessive sweating can be challenging, as it can affect one's confidence and social interactions, but with proper management, support, and understanding, individuals can lead fulfilling lives and minimize the impact of excessive sweating on their daily activities. Tips that can help include:

1. Pay attention to personal hygiene

Individuals affected by hyperhidrosis should bathe daily and pay special attention to drying affected areas of skin (particularly the feet) to reduce any infections. Affected feet should be aired regularly. Also, changing the clothing once it is swat-soaked is a good option.

2. Use absorbent pads

Individuals with excessive sweating, especially in the armpits may benefit from using absorbent pads to prevent sweat from soaking through clothing.

3. Select proper footwear

For individuals with excessive sweating of feet, it is recommended to wear thick socks crafted from cotton or wool, regularly changing both socks and shoes. Optimal footwear options include leather, mesh, or canvas materials, while it is advisable to steer clear of synthetic materials.

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4. Maintain a sweat journal

Individuals who sweat a lot react to specific conditions. Heat, anxiety, and particular foods are a few common triggers that can cause excessive sweating. Finding out if you have triggers is crucial and they can be avoided to prevent sweating.

5. Focus on hydration

Excessive sweating can result in dehydration if fluids are not replenished. Therefore, maintaining adequate hydration is an important aspect of managing the condition and preventing its negative effects.

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6. Stay calm and relaxed

Practicing relaxation techniques may assist individuals to cope with emotional stimuli that trigger sweating. Apart from this other psychological therapies that one can try include:

• Psychotherapy: Hypnosis, psychotherapy, and biofeedback are only effective only in limited individuals. The treatment typically can lead to improvements in quality of life.

• Behavioral therapy: These can help overcome anxiety benefitting individuals with anxiety-related sweating.

Tips for parents

Each child's experience with excessive sweating may vary, so it's essential to be patient, empathetic, and proactive in finding strategies that work best for your child's individual needs. Keep in mind the following things:

• Talk openly with your child about excessive sweating to help them feel less self-conscious. 

• Explain that it's a common condition and reassure them that they are not alone

• Opt for lightweight, breathable fabrics such as cotton to help keep your child cool

• Encourage your child to maintain good hygiene by showering regularly and using an antiperspirant or deodorant suitable for their age. 

• Teach them proper skincare routines to prevent skin irritation

• Ensure your child drinks enough water throughout the day

• Pack an extra set of clothes, including socks, for your child to change into if needed in school. 

• Provide them with sweat-absorbing pads or talcum powder to help manage excessive sweating.