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Excessive sweating (hyperhidrosis)

What is hyperhidrosis?

Hyperhidrosis, or excessive sweating, is a common disorder which can cause a great deal of stress and unhappiness. An estimated 3% of the British population suffers from excessive sweating of the underarms (axillary hyperhidrosis) or of the palms and soles of the feet (palmoplantar hyperhidrosis). Underarm problems tend to start in late adolescence, while palm and sole sweating often begins earlier, around the age of 13 (on average). Untreated, these problems may continue throughout life.

Sweating is embarrassing. It stains clothes, can ruin relationships, and complicates business and social interactions. Severe cases can have serious practical consequences, making it hard for people who suffer from it to hold a pen, grip a car steering wheel, or shake hands.

What is the cause of hyperhidrosis?

Although neurological, metabolic, and other systemic diseases can sometimes cause hyperhidrosis, most cases occur in people who are otherwise healthy. Heat and emotions may trigger hyperhidrosis in some, but many who suffer from hyperhidrosis sweat nearly all their waking hours, regardless of their mood or the weather.

What is the treatment for hyperhidrosis?

Through a systematic evaluation of causes and triggers of hyperhidrosis, followed by a judicious, stepwise approach to treatment, many people with this annoying disorder can achieve good results and improved quality of life.

The approach to treating excessive sweating is generally as follows:

  • Over-the-counter antiperspirants -- usually tried first because they are readily available. Antiperspirants containing aluminum chloride may be more effective when other antiperspirants have failed
  • Prescription strength antiperspirants -- those containing aluminium chloride
  • Iontophoresis -- a process of passing electrical current to the skin through water
  • Oral medications -- ones called anticholinergics, which reduce sweating
  • Botox (botulinum toxin) --  for treating axillary (underarm), hands, feet, or facial sweating
  • Surgery -- for example, endoscopic thoracic sympathectomy 

Aluminium chloride and excessive sweating

When regular antiperspirants fail to treat excessive sweating, most doctors start by recommending aluminium chloride, in a prescription-strength version. It is applied just before bedtime seven to 10 nights in a row, then roughly once a week thereafter to maintain improvement. This treatment works reasonably well for many patients whose problem is excessive underarm sweating, but is not satisfactory for most of those with palm and sole sweating.

The main side effect with aluminium chloride is irritation which can sometimes, but not always, be overcome by reducing the frequency of use or applying anti-inflammatory drugs, such as lotions containing a corticosteroid.

Iontophoresis for excessive sweating

Iontophoresis was introduced over 50 years ago as a treatment for excessive sweating. Its exact mechanism of action is still unclear, although it probably works by plugging up the sweat duct. The procedure uses water to conduct an electric current to the skin, which combats production of sweat. The current is applied typically for 10-20 minutes per session, initially with two to three sessions per week followed by a maintenance programme of treatments at one- to three-week intervals, depending on the patient's response. Iontophoresis treatments sound as though they might be painful but in fact they are not.

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