Question: My husband, 49, sweats an awful lot — his face drips and he would regularly soak a shirt in the summer. His health is good otherwise . He won’t see a doctor about it as he says he tried when he was younger and there was nothing to be done. Is this the case? Can you tell me anything encouraging for him?
Dr Grant replies: Excessive sweating from areas on the body where sweats glands occur is known as hyperhidrosis and it is thought that about 1pc of the population suffer moderate to severe forms. It can cause significant psychosocial distress but rarely has an underlying medical condition to explain the sweating episodes.
It is called focal hyperhidrosis when it affects the armpits, palms of the hand, soles of the feet or less commonly the face, scalp, groin region or under the breasts. It commonly begins in childhood or adolescence and tends to run a chronic lifelong course, but in a few people symptoms can resolve spontaneously over time. Classic features include age of onset, typically under 25 years old, often with a family history, affecting both sides of the body equally (e.g. both armpits) and symptoms do not occur at night.
Generalised hyperhidrosis affects the whole body and can occur both during the day and at night. This form of the condition is rarer and can have underlying medical explanations such as chronic infection, thyroid/endocrine and other disorders need to be ruled out. Most people presenting to a doctor will have hormone blood tests checked prior to management.
There are only a few proven treatment options for hyperhidrosis. The first line is topical aluminium chloride containing antiperspirant deodorants. They are safe to use regularly for life and effective for milder forms of hyperhidrosis but obviously cannot be applied to the face or scalp. Iontophoresis can be used on the hands or feet and involves immersing them in warm water through which a weak electric current is passed.
There are other options available though. Botulinum toxin ‘Botox’ injections, delivered by multiple intra-dermal injections to the sites involved, are used to treat focal hyperhidrosis and can take 3-7 days for full effects that can last 3-9 months. Botox works by binding to the nerve endings and preventing the action of acetylcholine, a chemical that stimulates the sweat glands thereby inhibiting sweat production. This is safe to use on the face and will provide the additional wrinkle-reducing effects.
Microwave thermolysis or ‘miraDry’ is a non-invasive US FDA (United States Federal Drug Administration) approved laser therapy that uses electromagnetic energy to destroy the sweat glands. Two treatments are required about three months apart with usually permanent results. Some people find one treatment provides an adequate reduction in sweat production. It is worth noting that miraDry can only be used to treat underarm sweating and is not suitable for the hands, feet or groin area.
A few lifestyle changes to consider include weight loss (if overweight), showering twice per day and wearing loose-fitting clothes, which can help reduce sweating. Also consider reducing or avoiding caffeine, nicotine and alcohol as this will also help.
Dr Jennifer Grant is a GP with Beacon HealthCheck