Some People Sweat More
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. The excessive sweating is made worse by stress, heat, and exertion, but is absent during sleep.
What causes hyperhidrosis?
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.
Are there ways to treat excessive sweating?
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.
1. Antiperspirants
Strong Aluminium Chloride Based Antiperspirants are often the first choice in treating excessive sweating. They control most cases of mild - moderate hyperhidrosis, even in areas that aren't your armpits! Creams 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 to dry skin 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. The International Hyperhidrosis Society has some great tips for using antiperspirants effectively.
2. Sweat Proof T-Shirts
Thompson Tees makes sweat proof undershirts and t-shirts guaranteed to block 100% of underarm sweat.
3. Iontophoresis
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. (Special pads are used to treat the 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? We don't understand exactly how tap water iontophoresis stops 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, not all insurance companies cover them, so contact your provider for pre-authorization.
4. MiraDry
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 an 85% “Worth It” rating on RealSelf.com based on 135 ratings. There are risks associated with any treatment. Be sure to discuss any concerns you might have with your doctor.
5. Botox
Botox reduces sweating. It can be injected under your arms, into the palms of your hands, and the soles of your feet. 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.
Learn more about Botox in our post, Considering Botox?
6. Qbrexza
A new underarm wipe was just approved by the FDA (2018). It's called Qbrexza and it's available by prescription. It's great because it doesn't require shots or a machine like MiraDry. Instead, you apply the wipe under your arms once each day. That's it!
Does it work? Dermira, the company that makes Qbrexza, ran 2 clinical trials (pi.dermira.com/QbrexzaPI.pdf) to evaluate its safety and effectiveness. Both trials checked baseline sweat production and the change from the baseline after treatment with Qbrexza using a proprietary patient reported outcome (developed by Dermira and approved by the FDA). The company says in a news release that patients experienced a "noticeable and sustained reduction in their overall sweat production."
How does it work? Qbrexza is the manufacturer's name for a drug called glycopyrronium. It's an anticholinergic that works by blocking the nerve signal to the sweat glands. The result is you sweat less.
Are there any side effects of Qbrexza? Dry mouth, pupil dilation if it comes into contact with your eyes, mouth or throat pain, headache, trouble starting to urinate or maintaining flow, blurred vision, a dry nose, dry throat, dry eye, dry skin, or constipation. You may also get redness, burning, stinging, or itchiness under your arms.
Is there anyone who shouldn't use Qbrexza? Anyone with a medical condition that can be made worse by using an anticholinergic (like glaucoma, paralytic ileus, unstable cardiovascular status in acute hemorrhage, severe ulcerative colitis, toxic megacolon complicating ulcerative colitis, myasthenia gravis, or Sjogren’s syndrome) should not use Qbrexza. It also hasn't been proven safe to use while pregnant, trying to get pregnant, or breastfeeding. It also isn't known if Qbrexza is safe or effective in children age 8 and younger.
The following conditions require caution while using Qbrexza:
- urinary retention
- A high ambient temperature can cause high body temperature or heat stroke. These are made worse if you take Qbrexza because your body may have trouble sweating and cooling itself.
- Transient blurred vision can occur while operating heavy machinery or a car.
7. Surgery
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.
8. Anticholinergic drugs, (like oxybutynin & glycopyrrolate) prescribed off-label
Anticholinergic drugs affect your entire body. Many of their side effects are drying: dry mouth, dry eyes, low blood pressure and dizziness when standing, urinary hesitance, and constipation. These side effects are usually mild and are dependent on the dose given.
Oxybutinin is the best studied drug for excessive sweating. It works well for sweaty palms, underarms, and faces. About 1/2 of patients treated with oral oxybutinin (5 mg taken by mouth twice daily) get improvement.
Glycopyrrolate has fewer eye and nervous system side effects when compared with other anticholinergics.
- Topical glycopyrrolate is applied to the affected area each day. Studies of patients with craniofacial (scalp and face) and gustatory hyperhidrosis (excessive sweating after eating) have shown this works for most patients. The drug was well tolerated by most people, but the 2% strength had more side effects (headache and dizziness).
- Oral glycopyrrolate works for the palms, soles of feet, underarms, face, and scalp. In a retrospective study, glycopyrrolate was effective in 2/3 of patients, but 1/4 of the patients had to discontinue the medication because of adverse effects.
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.
Amy Takken, RN
Amy Takken is a registered nurse with 20+ years of experience helping people improve their health. Her in-depth skincare articles have been featured on Nazarian Plastic Surgery and The Palm Beach Center for Facial Plastic & Laser Surgery. She's also been quoted on Dermascope.com.
Amy loves research and constantly watches for new products and treatments to help you improve your skin’s health – because healthy skin is beautiful! To reach Amy, visit our contact page.
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References:
Iontophoresis And 5 Other Surprising Tips To Stop Sweat by Cybele Fishman, MD for Charlotte’s Book
www.totallyaesthetic.com/sweat-patches-are-you-feeling-the-heat/
https://iontophoresis.info/about-hyperhidrosis/
https://link.springer.com/article/10.1007/s00403-016-1697-9 Hyperhidrosis: an update on prevalence and severity in the United States
https://www.sweathelp.org/hyperhidrosis-treatments/treatment-overview.html
https://www.sweathelp.org/pdf/drugs_2009.pdf Drugs/Medications Known to Cause Hyperhidrosis
https://www.medicalnewstoday.com/articles/182130.php What is hyperhidrosis?
https://www.aad.org/diseases/a-z/hyperhidrosis-treatment
https://www.npr.org/2010/12/06/131734718/just-breathe-body-has-a-built-in-stress-reliever
https://hyperhidrosisnetwork.com/iontophoresis-frequently-asked-questions/
https://www.realself.com/miradry
https://www.dermatologytimes.com/dermatology/what-type-antiperspirant-best-hyperhidrosis
https://www.medscape.com/viewarticle/898719 FDA OKs New Topical Treatment for Excessive Underarm Sweating
https://www.medscape.com/viewarticle/899817 Hyperhidrosis: Five Things to Know
pi.dermira.com/QbrexzaPI.pdf Highlights of Prescribing Information: Qbrexza
https://www.sweathelp.org/hyperhidrosis-treatments/antiperspirants/antiperspirant-basics.html
https://www.dermnetnz.org/topics/anticholinergic-medications/
Disclaimer:
The Information provided on our website is not medical advice and should not be viewed as such. By law, only a medical doctor can diagnose or give medical advice. As a registered nurse, my goal is to educate, so I provide information on skin care, skin care products, and skin care treatments. If you have any condition that concerns you, please see a medical doctor. While most skin conditions are benign, some – like melanoma – can be deadly. If there is any doubt, please, please consult your physician. Thank you!