For many of us, sweating is a natural part of life. Between workouts, hot summers, and the occasional moment of nerves, a little perspiration is no cause for alarm. However, for a segment of the population, there is no such thing as a “little bit” of sweat. According to Science Daily, approximately 2.8% of the population suffers from excessive sweating, or hyperhidrosis. The condition can cause incredible social anxiety, to the point where it greatly impacts their every day lives.
We reached out to Dr. Dendy Engelman, M.D., board-certified dermatologic surgeon and associate at Manhattan Dermatology and Cosmetic Surgery, to talk about what constitutes excessive sweating and what the options are for dealing with the condition.
Beauty High: Exactly what causes hyperhidrosis? Are there known factors like genetics, age? Is there a demographic predisposition to it?
Dr. Dendy Engelman: “Hyperhidrosis is the medical term for excessive sweating,” says Dr. Engleman. “Although many diseases (neurologic, metabolic, and other systemic diseases) can sometimes cause excessive sweating, 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 the time, regardless of the temperature or their emotional state. There may be a genetic predisposition to developing the condition. However, a clear link has not be established as of yet. In those with primary hyperhidrosis, family history has been positive in 30-65% of patients.” What about age? According to the Epidemiology of Primary Hyperhidrosis, in the U.S. consumer survey, the average age at onset was 25 years, but varied with location of hyperhidrosis. The average age of onset for those with palmar (sweaty hands) or axillary (underarms) symptoms was 22 years, for those with axillary alone age of onset was 19 years, and for those with palmar alone age of onset was 13 years.”
Strangely enough, it’s more prevalent in women. “Axillary hyperhidrosis occurs more frequently in females and in individuals of Asian or Jewish ancestry,” says Dr. Engelman. “In a national survey conducted in 2004, it was discovered that up to 2.8 percent of Americans (approximately 7.8 million individuals) may have hyperhidrosis.”
Is it a constant state or is it exacerbated by certain things? If it escalates, what causes it to increase in intensity?
Anything that causes your body temperature to rise can make it worse. “Triggers can be stress, heat, emotion, spicy foods in some suffers.” she counsels. Yet, sometimes nothing seems to cause it. ” In others, though, it has no obvious exacerbating factor and they sweat almost constantly.”
What are some common ways to treat it while it’s happening? Once it’s started, how do you manage the symptoms?
“The approach to treating hyperhidrosis ranges from OTC and prescription antiperspirants, to other aids, such as Botulinum toxin A (Botox), oral anticholinergic medications, iontophoresis (electrical current therapy), microwave destruction of sweat glands, and surgery. In mild cases, over-the-counter antiperspirants that contain aluminum chloride or other aluminum salts may be more effective when other antiperspirants have failed. So-called “natural” antiperspirants are rarely very helpful.” She recommends Dermadoctor Med E Tate Wipes for hyperhidrosis, especially if you have an event coming up. “They’re individually wrapped, so you can stash them in your purse before a big event, meeting, etc.” She also says prescription antiperspirants containing aluminum chloride hexahydrate can be effective, like Drysol. Surgery, she advises, is a last resort. “Surgery is only recommended for people with severe hyperhidrosis that hasn’t responded to other treatments. During surgery, the doctor may cut, scrape, or suction out the sweat glands.”
How can you prevent an episode from happening?
“Strong antiperspirants can do a great job preventing hyperhidrosis,” she advises. “If the clinical-strength ones don’t work, consult your doctor about prescription options. Also, don’t just apply the product in the morning: applying at night will keep you drier.”
What about Botox? We’ve heard that can be effective. How does it work?
“Botulinum toxin A (Botox) is FDA approved for axillary (underarm) hyperhidrosis, but the off-label usage is also effective on the hands and feet,” she advises. “Botox works by preventing the release of acetylcholine, a chemical that signals for the sweat glands to activate. Now that this treatment has received FDA approval, many health insurers are providing coverage for injections and the Botox itself. The treatment can decrease or completly stop sweating in the treated area for 6-12 months.”
“For axillary hyperhidrosis, 50 units of Botox (half a standard vial) is used per side. Typically 15-20 injections per underarm are required to inactivate the nerves supplying the sweat glands. There is no downtime required for this treatment and typically topical anesthetic (numbing cream) is applied prior to treatment, so that the procedure is virtually painless. Onset of action is typically within 5-14 days and results are long lasting (average 6.7 months or 201 days according to the Botox studies). I find my patients have results for at the very least 6 months and many report diminished or no sweating for up to a year.”
Are there other treatments on the market that work as well as Botox?
“As far as procedures go, I haven’t found any treatments as effective nor as safe as Botox. I always try prescription antiperspirants first and then offer Botox treatment. Iontophoresis machines are pricey and difficult to obtain. Oral anti-cholinergics come with too many side-effects and surgery is very risky with a huge potential for compensatory sweating (excessive sweating in other areas).”