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Keep breaking a sweat? This might be why

24/2/2023

Translation: Veronica Bielawski

One in ninety people suffer from hyperhidrosis. Excessive sweating isn’t a dangerous condition, but it’s tough to deal with and can wear you down. I spoke to an expert about the causes and treatments.

You’re in the middle of a job interview. Of course, you feel nervous and hope to put your best foot forward. And then the ball gets rolling: your first handshake is damp, beads of sweat are running down your face and your light-blue shirt is growing ever patchier by the minute. Are you no stranger to excessive sweating? You may be suffering from hyperhidrosis.

Hyperhi–what? Don’t worry if you’ve never heard of it. While experiences like the one above are familiar to many people, very few are aware of the clinical presentation. «Hyperhidrosis has no impact on life expectancy. You won’t live any shorter due to it,» says Dr. Christoph Schick of the German Hyperhidrosis Center. «But those affected experience lower quality of life.» All that to say, hyperhidrosis isn’t a dangerous disease – but it’s a damn annoying one.

Triggers and causes – why do I sweat so much?

Approximately one in ninety people suffer from hyperhidrosis, Dr. Schick says. For many years now, he’s been investigating the mechanisms behind heavy sweating and why it affects some more than others. The cause is known: hyperhidrosis is inherited. «In fact, people with hyperhidrosis have a neurological problem,» explains Dr. Schick. «It’s an error in the control system of sweat – and it’s hereditary.»

On the other hand, the triggers of sweating are a bit more diverse. Warm temperatures, for one, and especially large jumps in temperature, are enough to set off nigh unstoppable sweating. For example, severely affected people will end up drenched in sweat if they go from cold to warm. Another trigger can be physical activity; moving around generates heat.

Alright, but isn’t it normal to sweat when you’re hot or playing sports? True, these are things that affect everyone. Which leads us to the distinction between «normal sweaters» and «hyperhidrosis sweaters». Namely, emotion as a trigger.

As Dr. Schick explains, «Ultimately, people who suffer from hyperhidrosis display sympathetic overactivity.» The sympathetic nervous system is that part of your autonomic nervous system that increases your ability to take action, drives your pulse and increases your heart rate. Your brain houses the autonomic nervous system, including the sympathetic nervous system, directly above the hypothalamus. The latter controls sweat production. You can see the structure in this article published in the Journal of Neurology & Neuromedicine.

«So, in a way, the emotion centre is anatomically linked to sweat control,» Dr. Schick says. If the activity in the emotion centre becomes too high – for example, before a job interview – the following happens: «The trigger level is exceeded, the signal spills into the neighbouring centre and pushes the ‘sweat’ button.» People who sweat excessively have a lower trigger threshold and an exponential, rather than linear, progression curve. In other words, sweating starts suddenly and with full force and can’t be stopped initially.

Sweat can break out all over the body, but the hands, feet, armpits, buttocks and head are most commonly affected.

Primary and secondary hyperhidrosis

Primary hyperhidrosis is the genetically inherited disease marked by overactivity of the sympathetic nerve. Sometimes, however, excessive sweating is a symptom of another disease. In this case, it’s referred to as secondary hyperhidrosis.

According to the expert, neurological diseases such as Parkinson’s or metabolic diseases such as diabetes can be behind it. Many medications can also trigger heavy sweating, including psychotropic drugs such as antidepressants or blood pressure medications. In the worst case, heavy sweating may indicate a developing tumour.

According to Dr. Schick, warning signs include a sudden onset, night sweats and a lack of family history. Whatever the suspected type – primary or secondary – those affected should seek medical attention to rule out any serious diagnoses.

Managing hyperhidrosis – tips for everyday life

Treatments for hyperhidrosis range from simple deodorants to surgery. Which measures need to be taken – if any at all – is solely up to the affected person. But there are a couple of things you can do in your everyday life to counteract sweating.

First up: keeping cool.

«Cooling signals to the brain that there’s no need to sweat right now,» Dr. Schick says. He recommends dressing light whenever possible, keeping the room temperature down, avoiding hot foods and drinking your morning coffee lukewarm. A breeze in particular – for example, a fan at your workplace – can create the desired cooling effect. As Dr. Schick explains, «Moving air causes moisture to evaporate from your skin, and that promotes cooling,» says Dr. Schick.

By the way, the best body part to target with this approach is the head. When your head cools down, it sends a general «stop sweating» reflex.

Treating hyperhidrosis – what sustainable solutions are there?

No one has to resign themselves to simply living with hyperhidrosis. Due to the genetic component, the condition can’t be cured. But it can be successfully managed. According to Dr. Schick, there are two treatment paths you can go down: «You either inhibit the sweat gland itself or the nerve impulses.»

1. Deodorants vs. antiperspirants

You should always start off with a non-invasive, local treatment, that is directly on the affected area. In contrast to deodorants, antiperspirants block your pores, reducing excessive sweating. Antiperspirants contain aluminium salts (the best known one is aluminium chloride) that penetrate the sweat gland and crystallise out, blocking the ducts.

However, aluminium salts have a bad rep, and most deodorant manufacturers have refrained from using them for years. It’s true that antiperspirants shouldn’t be applied to any microtears, which may occur during shaving. This is the advice of the German Federal Institute for Risk Assessment. «The important thing to remember about applying antiperspirants is not to do so on the day you shave or the day after. Microtears from shaving can lead to increased absorption of aluminium salts,» Dr. Schick explains, adding that other than that, using antiperspirants isn’t dangerous.

2. Tablets to combat excessive sweating

Just as there are medications that induce sweating, there are medications that inhibit it. In contrast to antiperspirants, these don’t inhibit the sweat glands, but the glandular nerve. Drugs that were actually developed for other complaints are often used for this purpose, an example being the gastrointestinal drug Metanemylium bromide. According to Dr. Schick, that’s a weaker drug you can try.

The problem? «The drug is registered only for hyperhidrosis that’s localised to the armpits. This makes no sense, given this tablet has an effect all throughout the body.» Side effects mainly include a dry mouth, as the drug blocks all glandular nerves. In this video, dermatologist Dr. Yael Adler only recommends the as a short-term solution for important events, as its effect lasts about six hours.

A new player on the market is the cream Axhidrox. Dr. Schick was involved in its development, but says he has no financial stake in the matter. The cream also works by inhibiting the glandular nerve. However, the active ingredient isn’t taken orally, but applied locally to the affected area. This is effective because the active ingredient is small enough to pass through the skin barrier.

«The medication takes the direct route to the nerve. As a result, having a dry mouth is less common, and other side effects are also more moderate,» explains the expert. You should take care not to get any cream in your eyes. Other than that, it can be used just about anywhere, though it was developed specifically for the armpit.

Axhidrox can be used once a day for the first four weeks, after which you should reduce use to a maximum of twice a week (linked article in German) and discuss further use with your doctor.

3. Botox

It’s true: botox can help combat excessive sweating and last up to several months. The active ingredient, botulinum toxin, is injected under the skin on the affected area. It starts working within a few days and is especially recommended for people looking for a quick, long-term treatment without major surgery and long downtimes.

Botulinum toxin is a waste product of a bacterium found in perishables such as sausage products. It’s one of the most potent poisons in the world. According to Dr. Schick, one pound of it would be enough to wipe out all of humanity.

«That’s why Botox is injected locally in a millionth of the concentration. It blocks the transmission of stimuli at the synapses. The active ingredient travels only a few inches around the injection site and remains effective for about six months.» He continues to say that side effects are unlikely, but there’s still a low risk of infection, and there may be temporary bruising around the injection site.

In the worst case, if the toxin penetrates too deep, paralysis may also occur in other parts of the body. «In my 24 years of experience, I’ve never once had a patient exhibit intolerance to the treatment,» Dr. Schick says reassuringly. However, the procedure is very expensive and isn’t covered by health insurance.

4. Sympathectomy and MiraDry

A surgical procedure for a condition that does not pose a health risk may seem drastic at first glance. But, as Dr. Schick says, «Hyperhidrosis is highly demoralising. It’s always there and flares up in the most inconvenient situations. With that, it makes sense that some people opt for surgery despite the risks.»

First off, this isn’t a high-risk operation. Even so, you should only consider it if nothing else works. In the procedure, the sympathetic nerve itself, which runs next to the spine, is pinched off. Because the nerve responsible for sweating then no longer sends impulses to the affected parts of the body, the excessive sweating disappears forever.

However, the operation isn’t suitable for every part of the body. The parts it is especially suited to are the hands, feet and head. The procedure is typically covered by health insurance. There is, however, a decisive disadvantage to the surgery: so-called compensatory sweating. After the procedure, patients experience increased sweating from other parts of the body. As Dr. Schick explains, «The operation alters the sweating control system as a whole, as you’re intervening in a feedback loop.»

A less invasive option is the novel MiraDry procedure. It relies on microwaves to heat sweat glands to 60 degrees, causing them to atrophy. «The energy waves don’t go all the way into the body, but only into the subcutaneous tissue and fatty tissue, where it kills of sweat glands, odour glands and hair roots,» Dr. Schick explains. The procedure is currently only suitable for underarm hyperhidrosis, but is a long-term, effective and less invasive solution.

Those suffering from hyperhidrosis do indeed suffer – that much is clear. Even so, Dr. Schick advises that treatments are tested in the order described above. Surgical intervention should only be considered when adjusting the room temperature and using deodorants, creams and tablets are no longer effective. And medical clarification is advisable in any case. That way, you can rule out other diagnoses and find the ideal treatment for your hyperhidrosis.

Header image: Shutterstock

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Olivia Leimpeters-Leth

Autorin von customize mediahouse

oliver.fischer@digitecgalaxus.ch

I'm a sucker for flowery turns of phrase and allegorical language. Clever metaphors are my Kryptonite – even if, sometimes, it's better to just get to the point. Everything I write is edited by my cat, which I reckon is more «pet humanisation» than metaphor. When I'm not at my desk, I enjoy going hiking, taking part in fireside jamming sessions, dragging my exhausted body out to do some sport and hitting the occasional party.

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