Hyperhidrosis (Excessive Sweating)

This may be caused by a number of things including a fever, sunburn or a reaction to a vaccination.

There is a strong link between obesity and hyperhidrosis. People who are carrying a large amount of excess weight find that it takes more physical exertion to perform day-to-day activities, resulting in more sweating.

When you get stressed or anxious, your body temperature rises and the sweat glands kick in. Hyperhidrosis is sometimes a secondary symptom of social anxiety disorder.

Fluctuating hormone levels in pregnancy often cause excessive sweating during pregnancy, particularly during the first and third trimester. It is common for women to sweat excessively during the postpartum period too, as this is the body’s way of getting rid of the extra water retained during pregnancy.

Menopause is characterised by hot flushes and night sweats, caused by changing hormone levels.

Alcohol consumption, alcohol withdrawal or alcohol intolerance can cause night sweats. This is because alcohol can affect the nervous system and how the body regulates body temperature. For people who have hyperhidrosis, alcohol can make the problem worse.

Certain drugs, such as cocaine, increases blood flow, therefore increasing the amount of heat transferred to the surface of the skin, resulting in excessive sweating.

Caffeine is a stimulant. If you drink too much, it can exacerbate excessive sweating, for example in a woman going through the menopause.

Excessive sweating is also associated with several medical conditions:

• Diabetes: When a person with diabetes experiences high or low blood sugar levels, this can lead to hyperhidrosis.
• Parkinson’s disease: Many people with Parkinson’s disease experience problems with excessive sweating. This can be a side effect of certain medications too.
• Rheumatoid arthritis: Some people suffering from rheumatoid arthritis report experiencing excess sweating.
• Lymphoma: Heavy night sweats are commonly associated with lymphoma. However some people experience excessive sweating during the day too.
• Gout: Gout is recognised as a cause of secondary hyperhidrosis.
• Infection: Many viral or bacterial infections are characterised by a temperature and excessive sweating. 

There are also a number of medications which can cause hyperhidrosis. These may include:

• Medications to treat dementia or Parkinson disease
• Antidepressants
• Antipsychotics
• Opioids (for example, morphine and tramadol)
• Certain antibiotics and antivirals
• Thyroid medications
• Diabetes drugs, including insulin

You will be asked about your medical history, including the list of medications which you currently take, at your initial consultation at the Cadogan Clinic.

Most people who suffer with hyperhidrosis experience problems with excessive armpit sweating. People who experience excessively sweaty underarms may find they need to change their shirt or top during the day. Some people may even shower a number of times during the day. However underarm hyperhidrosis has nothing to do with hygiene.

Armpit sweating is usually symmetrical, meaning both underarms sweat equally. If you notice that you are only sweating from one side of your body, you should seek further advice as this may signal an additional underlying problem. 

When hands sweat profusely, this is known as palmar hyperhidrosis. This can make everyday tasks such as holding a pen or using a computer keyboard difficult.

People who suffer from excessive underarm sweat also tend to experience hyperhidrosis on the soles of the feet too. This is known as plantar hyperhidrosis. People who suffer from this form of hyperhidrosis may find their socks are frequently soaked and as a result change them regularly throughout the day. Sweaty feet can also create odour, meaning a person may feel embarrassed to take their shoes off in public, for example in the changing room at the gym or at a shoe shop. This extra sweat makes the feet slippery, sometimes ruling out certain items of footwear, such as sandals or sliders, as it may be difficult to keep these on the feet.

Excessive sweating of the face and head is known as craniofacial hyperhidrosis. There are a number of sweat glands in the face, which makes this particular area of the body prone to hyperhidrosis. People who experience this particular form of hyperhidrosis may take a flannel or towel around with them to soak up any excess sweat. Alternatively, they may carry a small fan to help cool them down. Common triggers for craniofacial hyperhidrosis include eating spicy food and caffeine. A person who experiences excessive sweating of the head and face will often find they continue to sweat long after they finish exercising, meaning they will avoid exercising before work or socialising.

Men and women can both suffer from a problematic sweaty groin. This form of hyperhidrosis can leave embarrassing stains on clothing and can lead to chafing, itching or a pungent odour. A sweaty groin may also lead to an unpleasant yeast or fungal infection which will require treatment.

Injectables, such as Botox, are an excellent way of tackling excessive sweating. A carefully measured dose is injected into the skin of the armpits. This blocks the signals coming from your nervous system to the eccrine glands (sweat glands). By blocking this signal, this prevents the glands from producing so much sweat. 

During the treatment, an iodine solution and starch powder are applied to your armpits to help the dermatologist identify the areas where you sweat. Then a very fine needle is used to deliver a series of small injections to the skin. There may be some stinging, but the procedure is not painful.  You should expect results within the following two weeks.

Injectables are not a permanent cure for excessive sweating, but can vastly reduce the amount of sweat produced. The effect varies from one patient to another. You will need repeated treatments in order to maintain the results.

Another popular hyperhidrosis treatment is iontophoresis. This treatment involves sending a mild electrical current through water to the hands, feet or armpits, which are all parts of the body which are prone to excessive sweating.

The treatment is spread out over several sessions.

Iontophoresis involves placing the hands and feet into plastic containers filled with tap water, or placing water-soaked pads under your arms. The current is then delivered to the affected areas. The power can be increased or decreased, depending on your tolerance. The treatment may feel uncomfortable, but it should not be painful.

Iontophoresis is usually offered to patients where previous treatments have not worked.

Although iontophoresis is not a cure for hyperhidrosis, this non-invasive excessive sweating treatment can effectively manage the condition.

Iontophoresis machines can be purchased for home use, but we strongly recommend sessions with a trained dermatologist to ensure the best results.

In extreme cases of hyperhidrosis, your consultant may recommend surgery. Also known as ETS (endoscopic thoracic sympathectomy), this procedure involves interrupting the nerve signals being delivered to the sweat glands.

This keyhole surgery is carried out under a general anesthetic and takes around two hours in total. A miniature camera is inserted into the chest under the armpit and the surgeon will carefully move your lung aside before cutting or clamping the nerves.  

Although surgery is a permanent hyperhidrosis treatment, it is an invasive procedure and comes with significant risks. Immediately after the procedure, you may experience pain or discomfort, particularly when breathing. It is also possible that you may experience something called compensatory sweating, where other areas of your body begin to sweat to make up for a lack of sweating in the areas which have been treated.

There are other serious complications which come attached to ETS, including nerve damage, a slowed heart rate, infection in the space around the lung and air collecting in the chest cavity (pneumothorax). There are also the usual risks associated with general anesthesia, including infection, bleeding and deep vein thrombosis (DVT). If you are considering ETS, your consultant will discuss all the potential risks and benefits with you at your initial consultation.

If you are suffering from excessive sweating of the armpits, then sweat gland surgery to remove the sweat glands from your underarms is a quicker and less invasive surgical option. However this will not tackle the problem of excessive sweating of the hands and feet.

At the Cadogan Clinic, our preferred treatment method is to avoid invasive surgery and to treat the affected areas with injectables, as we believe these to be the most effective and safe.