Why do some people sweat so much?
A friend of ours always has excessive sweating and an unpleasant body odor. Make no mistake - it is not from a lack of cleanliness. He showers as often as the next guy; but he always has a ring of sweat under each arm of his shirt. Fortunately for him, it doesn't seem to bother his wife! So why does our friend sweat so much more than everyone else?
Excessive sweating is also called hyperhidrosis. Our bodies sweat to reduce body temperature when they get too hot. The sympathetic nervous system is responsible for controlling body temperature and sweating. People who have hyperhidrosis sweat even when their body is not hot.
About 4.8% of people have hyperhidrosis. It is most commonly seen in the palms of the hands, soles of the feet, armpits, and head. Often people develop this condition in their teens; however, some children have been known to develop excessive sweating in their hands and feet.
We used to think that excessive sweating was caused by stress and a person's emotional state. New research has shown that people with hyperhidrosis are no more anxious or nervous when exposed to emotional triggers than other people. People with this condition experience increased stress and anxiety because of their excessive sweating. Emotional stress is NOT THE CAUSE of their excessive sweating.
We don't know why some people sweat so much more than others. Researchers think hyperhidrosis may be linked to an overactive sympathetic nervous system. In other cases, excessive sweating is caused by menopause, hyperthyroidism, diabetes, frostbite, gout, obesity, a psychiatric disorder, or medications. Doctors can do a physical exam and run lab tests to determine the cause of hyperhidrosis.
Regardless of the cause, excessive sweating is hard on people.
People with sweaty palms get embarrassed when shaking hands. Excessive moisture on their palms can make things like turning a door knob difficult. People with sweaty feet have smelly shoes, and can get skin breakdown from prolonged exposure to moisture - leading to foot infections. People with extremely sweaty armpits often have embarrassing body odor and noticeable wet areas on the clothing under their arms.
What are the treatment options?
The effectiveness of each of these treatments will vary from person to person. Always try the least invasive methods first. Some people may need a combination of several treatments to get the best result.
Strong Aluminium Chloride Based Antiperspirants are often the first choice in treating excessive sweating. The cream forms work better than the sprays. They can be applied under the arms, to the hands, feet, or hairline.
To get the best results, always apply antiperspirants in the morning and at night. The most important application is at night because most people sweat less at night than they do during the day. Less sweating means less dilution of the active ingredients and a more effective plug in the sweat duct. To avoid irritation, be sure to apply your antiperspirant to dry skin.
Start with over the counter / drug store products first. If those don't work, try clinical strength antiperspirants like Certain Dri or Secret Clinical. They provide the same level of protection, but with less irritation, than prescription products. If none of these products work, talk to a doctor about using a prescription antiperspirant.
How do they work? Antiperspirants work by blocking the sweat ducts. Sweat is still made by the sweat gland, but it can't reach the surface of the skin.
2. Sweat Proof T-Shirts
Thompson Tees makes sweat proof undershirts and t-shirts guaranteed to block 100% of underarm sweat.
Iontophoresis has been used to treat excessive sweating since the 1940s. A medical device runs a mild electrical current through shallow pans of tap water. The current passes through the water and into the skin of the hands, feet, or armpits. (It sounds awful, I know!) The upside is that it has been shown to be effective in 98.5% of people. And provided you maintain the schedule your doctor recommends (usually once each week), the benefits are long-term.
How does iontophoresis work? It is not understood exactly how tap water iontophoresis works for excessive sweating. Research suggests that a sort of skin (parakeratotic) plug is formed that blocks the duct without damaging the sweat gland. A patient must show dedication to make iotophoresis work:
Dr. David Pariser, a founder of the International Hyperhidrosis Society, says: "The ideal candidate for this treatment is a motivated patient. Treatments can continue indefinitely; however, one of the major limitations of iontophoresis is the time commitment, especially early in the course of treatment. Some people find it to be too much of a hassle. But others enjoy the independence of managing their therapy and getting great results. It's like physical therapy."
Does it work equally well on all body parts? People with sweaty hands and feet get really good results with iontophoresis. Underarm sweating gets mixed results. Some people have great success, but others get skin irritation. Because of general body structure, armpits are more difficult to treat with iontophoresis. For these reasons, underarm sweating is not commonly treated this way.
Does it hurt? Are there any bad side effects? The Hyperhidrosis Network writes "For most people, the iontophoresis process is mildly uncomfortable. If done correctly, it's rarely painful." However, it's not a “pleasant" feeling. There are no significant side effects.
Where can you get an iontophoresis machine? Two devices have been cleared by the U.S. FDA and are available by prescription only. They are manufactured by R.A. Fischer and Hidrex. The devices are considered a medical necessity by some insurance plans; however, some do not, so contact your provider for pre-authorization.
This treatment for excessive underarm sweating was cleared by the FDA in 2011. It reduces the number of sweat glands under the arms using microwave energy. After treatment, the sweat glands no longer work and are permanently disabled. Only 2% of the 2 million sweat glands in the body are destroyed by the MiraDry treatment, so your body will continue to sweat everywhere else; however, there will be significantly less sweat under your arms.
What is the treatment like? Treatment time is about an hour. Your underarms are numbed prior to treatment. Some people get swelling, soreness, tingling, or numbness in the treated area. These typically go away within a few weeks. Downtime is minimal. Most people return to normal activity the same day. Exercise can restart within a few days.
How are the results? MiraDry has been used for over 55,000 treatments, so there is good reason to believe the procedure is safe. Studies have shown MiraDry is successful in reducing underarm sweat in over 90% of patients 12 months after treatment. The average sweat reduction was 82% and patient satisfaction was 90%. MiraDry also has a 92% "Worth It" rating on RealSelf.com. There are risks associated with any treatment. Be sure to discuss any concerns you might have with your doctor.
Botox can be injected under your arms to reduce sweating. In a clinical study of 322 patients with severe underarm sweating, 81% of the patients that had Botox injections got a 50% or more reduction in their sweating. 50% of the patients got relief for at least 201 days. Some patients got relief for as long as a year.
There are several ways to surgically treat excessive sweating. Sweat glands may be excised, or cut out. Curettage scrapes out the glands. Liposuction uses suction to remove them, while lasers liquefy the sweat glands. Doctors may use combinations of these types of surgery with good results. Each type may be done under a local anesthetic in a medical office.
There is one more type of surgery called endoscopic thoracic sypathectomy or ETS. In this procedure, the surgeon interrupts the transmission of nerve signals from the spine to the sweat glands. The surgery is effective at reducing sweating in the palms, face, and sometimes the combination of the palms and underarms. There are some serious drawbacks to consider though. ETS frequently causes irreversible compensatory sweating in different parts of the body that is equal to or worse than the original sweating. It can occur on the back, chest, abdomen, legs, face, and buttocks. In a study of 121 patients, compensatory sweating occurred in over 80% of the patients who had ETS. A Danish study got similar results. 90% of the patients who had ETS for underarm sweating, experienced compensatory sweating. Half of them needed to change their clothes during the day because of it. Other side effects include extremely low blood pressure, an irregular heartbeat, and heat intolerance. Because of these side effects, most doctors do not recommend ETS surgery.
In most cases, a combination of non-surgical treatments will handle even the worst case of excessive sweating.
Learn more about excessive sweating in our blog post, What's the best antiperspirant for excessive sweating? Also, the websites SweatHelp.org and HyperhidrosisNetwork.com have tons of helpful information.
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