Hyperhidrosis - excessive sweating

Written by: Sandra Eriksson Mirkovic, MD with special interest in hyperhidrosis.

Hyperhidrosis, excessive sweating, is a condition that affects about 1-3% of the population all around the world. It is equally common among men and women. It can occur almost anywhere on the body. Many people believe that excessive sweating only affects palms, feet and armpits but the condition might as well affect your head, groin, chest, back or even your whole body. In some cases the hyperhidrosis disappears after a few years. In some cases the sweating gets worse. Hyperhidrosis cannot be detected with blood tests and usually all tests are normal. Sometimes there are other, underlying causes to why a person sweat a lot. It is important to know that the treatments that are used against excessive sweating are not a cure but only a sympthomatic treatment. It is important to see a doctor and to receive the diagnosis hyperhidrosis and not to give the diagnosis to one self because that can make you miss signs of other, underlying diseases.

There are problems in the healthcare systems around the world today. We have most experience with the Swedish system but we know that there is usually not any difference in other countries. Patients with hyperhidrosis are not taken seriously and it is also very common that doctors and nurses lack important knowledge about hyperhidrosis and its possible treatments. To make sure you get a good experience with health care personnel familiar with hyperhidrosis, you should seek contact with practices that specialize in excessive sweating. In Sweden there are a few of these specialized clinics and Swedish citizens are allowed to seek care anywhere in the country for example: Akademiska sjukhuset in Uppsala, Huddinge sjukhus in Stockholm, Svettmottagningen Stockholm, Hudmottagningen in Uddevalla and so on. Svettmottagningen in Stockholm is a private practice but one can receive free treatments in Copenhagen through this clinic because of the laws of the European Union. If one is suffering from hyperhidrosis it is recommended to try out Aluminium Chloride that can be bought at pharmacies withput a prescription. If this does not work well enough, which is often the case with hyperhidrosis, one can try going to a clinic and receiving injections with Botulinumtoxin “Botox” over the areas with excessive sweating. Botox injections are usually very effective but need to be repeated 1-4 times per year. One can also receive medication against excessicve sweating, so called anticholinergic tablets but they are in many cases associated with several side effects.

There is a new method up and coming that is called Miradry. So far, it is only tested on treatment of the armpits and it looks like it might lead to permanent decrease of sweating. The method uses microwaves where the sweat glands are ”bolied”. If one suffers from hyperhidrosis in palms and feet one can also try the method called Iontophoresis. If one suffers from excessive sweating of the armpits one can try Aluminium Chloride. One can receive Botox injections at a clinic with and effect that usually lasts 3-12 months. One can try Miradry treatment a clinic. There is also a kind surgery where the surgeon removes the sweat glands but that can lead to scar tissue as well as swelling. These matters should be discussed with a plastic surgeon. Iontophoresis is not a scientifically proven method for treating excessive sweating of the armpits.

If one suffers from excessive sweating from the head, back, chest, groin och several large areas of the body on can Aluminium Chloride. Is this does not work the treatment is usually a combination och medicine and injections with Botox. This is a matter that should be discussed with the doctor at a clinic specialzing in excessive sweating. Excessive sweating of the palms and feet can also be treated with Botox but in cases where this is not possible, iontophoresis can be a good alternative.  

 

10 common questions about hyperhidrosis - excessive sweating

1. Who gets hyperhidrosis?

Answer: One can say that there are two main forms of hyperhidrosis, one that affects children/adolescents and one that comes later in life. Men and women are equally affected by this disease. Children often get hyperhidrosis in their palms and feet, then later on, often during their teens, the armpits and possibly groin/ buttocks are affected. Facial sweating or more general sweating is more common among adults and later in life. But there are also mixed forms of hyperhidrosis that doesn’t follow this exact pattern

2. Can hyperhidrosis disappear with age?

Answer: Yes, hyperhidrosis may disappear over time. Hyperhidrosis can also become worse or simply move to other body parts after e few years.

3.How do you diagnose hyperhidrosis?

Answer: There are no blood tests or objective measurements that can tell who suffers from hyperhidrosis. The patient's story is the foundation on which the diagnosis rest upon. Sometimes you can also see the excessive sweating which is of course good, but not mandatory for diagnosing hyperhidrosis. Different forms such as HDSS (Hyperhidrosis severity scale) and Dermatology life quality index (DLQI) are often used.

4. What can I do to get rid of my hyperhidrosis?

Answer: Hyperhidrosis is a physical disease, such as diabetes or any other disease. Stress can indeed exacerbate the symptoms, but that is not the reason why you get hyperhidrosis. The same applies to obesity. You can certainly sweat more if you have to make a lot of effort while moving, but that's not the reason for your hyperhidrosis. Many obese sweat very little and there are many thin people who suffer from hyperhidrosis. If you are at good health and happy with your life, it is easier to manage the hyperhidrosis. But one cannot control it. You should never blame yourself or someone else, suffering from hyperhidrosis, and tell yourself/them that you/they are the cause of the sweat problems.

5.How do you know if you have this condition, hyperhidrosis?

Answer: It is a diagnosis that must be determined by a doctor. You can of course read a lot on the internet in various forums, but there are other reasons for excessive sweating besides hyperhidrosis and you should seek a doctor to get the necessary examinations and blood samples to rule out other conditions that require other treatment.

6. I have read online about hyperhidrosis and sought help at my health center but they said there is nothing to do. Is that true?

Answer: No, that's not true. It's regrettable, but there is a big gap in knowledge of hyperhidrosis, both among the public and unfortunately also among doctors. Hyperhidrosis is a bit of a forgotten diagnosis and, as a doctor, I often meet physicians who have not heard about the diagnosis or that there are treatments available. The fact that excessive sweating is so stigmatized does not make it easier. But, I do see a bright future. I notice that younger colleagues have increased knowledge about and interest in the diagnosis, although a lot of work remains.

7. Is there any cure for hyperhidrosis?

Answer: Most treatments available today are symptomatic treatments. Thus, they aim to relieve the symptoms and not to cure. Miradry is a relatively new form of treatment that uses microwaves. This method is mostly tested on hyperhidrosis of the armpits and it is thought that it is a method that can give a permanent results. However, to be sure, further follow-ups are required. In the past, so-called sympathectomies, a type of surgery, were used, cutting nerves, to reduce excessive sweating or blushing of the face. It gave a permanent result, but a lot of people got compensatory sweating on large parts of the body. We strongly advise avoiding this kind of procedure in the vast majority of cases. Please discuss the details with your doctor before going through with this kind of surgery

8. I’ve heard that you can use botox to treat hyperhidrosis. Botox is a toxin, isn’t that dangerous?

Answer: Botox, or Botulinum Toxin, is a well-tested method for treating hyperhidrosis, which has been around for many years. It has been found that treatment with Botox produces few short-term side effects but no long-term or serious side effects. There is also no indication that Botox would be carcinogenic, as many are afraid of. Botox is a substance that is produced by a particular type of bacteria. Our body is used to dealing with bacterial attacks and the toxins that they produce. The body therefore has a natural way of breaking down Botox. You should not be afraid to be treated with, or let your children get Botox treatments. (Of course this must be a decision made together with your doctor for the right indication and during safe circumstances). For those who still feel doubtful, I say, read. Read the facts. Do not read on forums on the Internet but stick to good, reliable sources.

9. Iontophoresis, does it really work? To me, it doesn’t sound real. How does it actually work?

Answer: Yes, studies show that iontophoresis is very effective in treating hyperhidrosis, especially of the palms, feet and in the armpits. Up to 90% of patients can get a good effect from the treatment. But it takes some time to find the right settings. No one has yet proved how iontophoresis works, but the most common hypothesis is that the ions in the water form a mechanical "blockade" that prevents the sweat from coming out.

10. What do you do to spread knowledge about hyperhidrosis? What can I do?

Answer: We have our website: www.hidroxa.com where we write about hyperhidrosis and different treatment methods. We also have a blog. We try to become more active on social medias such as Instagram and Facebook. I, Sandra Eriksson Mirkovic, together with Emmili Yoshiguchi, who suffers from hyperhidrosis, have a podcast where we talk about hyperhidrosis. It is called “Svettpodden”. The podcast is in swedish, but maybe we’ll do an english version in the future. If you are a patient suffering from hyperhidrosis or have relatives that do, you can join a patient association for hyperhidrosis. You do not need to be an active member, but the more members, the stronger is the voice of the association. If you dare, please talk about your problems with the people around you, to help normalize the diagnosis. As a relative, it is important not to put the blame on the patient: "It's because you're stressing", "It's because you're fat". This is simply not true in most cases. Together we can make a difference and make sure that all those suffering from hyperhidrosis get a diagnosis and the right information as well as treatment.

Written by: Sandra Eriksson Mirkovic, MD with special interest in hyperhidrosis.

 

Links to scientific texts about hyperhidrosis, some in Swedish, some in English:

Vetenskaplig artikel publicerad i Dermatology and Therapy om olika metoder att behandla hyperhidros

Docent Carl Swartling som är ledande inom hyperhidros pratar om sjukdomen

Ung bloggerska pratar om sin hyperhidros och man får följa med henne på en behandling med Botox (gäller dock armhålor)

Doktor Mikael pratar i TV4 nyhetsmorgon om hyperhidros