To your good health
Excessive sweating can bring significant social problems
BY KEITH ROACH, M.D.
DEAR DR. ROACH: I have hyperhidrosis and want to know what, if anything, I can do to alleviate this condition. I am 71 and physically active. I exercise almost every day for an hour. I sweat profusely, mainly from my torso, but it’s not only when I work out; it’s also if I exert even a modest amount of energy or am anxious about an upcoming event. I wear an undershirt to soak up the sweat. It is embarrassing when I’m out in public and I find that my shirt is soaked and sticking to my skin.
This has been going on for years. My doctor tried changing my prescription drugs, but we did not see a change in my condition. I would appreciate any insight you might offer. If this is just the way I am, I’ll accept it, but if there is a change needed in my lifestyle, I’ll consider doing it. — H.S.
ANSWER: Primary hyperhidrosis is the term for excess sweating for no clear reason. It needs to be considered separately from sweating that occur as part of hot flashes or as night sweats. It sounds like it’s pretty clearly the case in you.
Many people with primary hyperhidrosis sweat in one particular location: The head and hands are common, but underarms are the most common. It sometimes runs in families, doesn’t usually happen during sleep and usually is the same on one side as the other. It often starts around adolescence.
It may not seem to readers like too horrible a condition, but people with it often report significant social problems, both personally and professionally. It can lead to skin problems that stem from having constantly wet skin. It is common but varies widely in severity.
The first treatment for this is a prescription-strength antiperspirant, such as 20 percent aluminum chloride hexahydrate, which physically blocks sweat pores. It is applied at night (when sweating is least) to all the areas of excess sweating, every night until you see improvement, which usually takes a week or so. Then, the applications may be decreased to perhaps weekly. The medication is washed off in the morning.
For people in whom this doesn’t work and those with a relatively small, discrete area of sweating, botulinum toxin can be injected, which lasts for months. I don’t know if you have too large an area of excess sweating for this to work. For people with underarm sweating, there is a device that uses microwaves to destroy sweat glands. Two treatments are about 95 percent effective, but they are expensive and not generally covered by insurance.
Many people find that regular exercise increases overall sweating. However, regular exercise has so many benefits that I wouldn’t recommend you reduce your exercise. I hope one of these treatments is helpful.
DR. ROACH WRITES: A recent column from a person annoyed by medical professionals asking about smoking history led to some letters telling me (some nicely, others not so) that I was naive and that the real purpose of doing so was to bill insurance companies. A nurse who worked in Medicare fraud evaluation suggested that routine asking about smoking could lead to billions of dollars in excess billing, which would be fraudulent if, for example, the person who had smoked one cigarette decades ago was being billed for tobacco cessation counseling.
Of course, it is appropriate to look for tobacco use and to advise smokers to quit. Unfortunately, well-meaning incentives to get health care providers to improve this can be misused.