Dear Walking Sponge,

Profuse sweating that occurs at times other than in hot conditions or after exercise is usually due to a rare disorder called hyperhidrosis, marked by perspiration produced in abundance by overactive sweat glands. Excessive sweating may be all over the body or be limited to certain areas of the body. It most commonly affects the underarms, palms of the hands, and soles of the feet, although it has also been known to affect the face, neck, backs of the knees, groin, and beneath the breasts. It is a condition that affects both men and women and usually begins during childhood or at puberty, but improves spontaneously for many people in their mid-twenties or early thirties. The hyperhidrosis itself can cause anxiety or distress for people who have it, which leads to additional sweating, as you mentioned, further incapacitating them during social and business interactions. Fortunately, more treatment options and a safer cure have become available to help improve the quality of life for people with hyperhidrosis.

If you are a student at Columbia, you can call Health Services at x4-2284 or log onto Open Communicator to make an appointment with a health care provider to make sure that what you have is primary hyperhidrosis (rather than an underlying condition that causes profuse perspiration, known an secondary hyperhidrosis, which would require treating the underlying condition first, often resolving the abundant sweating as well). Use this opportunity to get more information and to discuss your treatment options, their possible side effects, and their contraindications.

If you have primary hyperhidrosis, your provider may recommend the following treatment possibilities depending on how severe it is:

For mild hyperhidrosis:

• Apply talcum or cornstarch powder to perspiration-prone areas.
• Use an unscented, aluminum salt-containing antiperspirant, preferably one that's specifically made for application on palms and soles.
• Dust medicated powder on affected areas to help soak up sweat and prevent bacterial growth.
• For damp feet, slip on cotton socks and shoes. Alternate footwear to allow them to air and dry out in between wears. Regularly use and replace absorbent insoles in shoes.

For moderate or persistent hyperhidrosis:

• Apply aluminum chloride paint (or other aluminum salt preparations) to perspiration-producing areas to block your sweat pores.

For severe hyperhidrosis:

• Take a prescription anticholinergic drug recommended by your provider.

If none of these treatments are effective or satisfactory to you (because your primary hyperhidrosis is extreme and debilitating), let your provider know because, depending on your medical history, you may be eligible for a cure with an invasive or surgical option or for treatment with a neurotoxin injection.

With surgical procedures, some risk and possible adverse effects are involved which you need to discuss in detail with your provider, who will determine whether or not this is a good option for you. Results are immediate and often complete and permanent after having surgery. Two of these procedures include:

• Endoscopic Transthoracic Sympathectomy -- an outpatient, minimally invasive, and quick procedure with speedy recovery time that involves cutting and removing the sympathetic nerves that control sweating of the palms, underarms, face, and neck. For some, sweating of the soles of the feet is also cured. Most people who choose this surgical option are cured or have a dramatic improvement in symptoms. In general, this procedure is safe when done by a skilled and experienced surgeon.
• Surgical removal of underarm sweat glands to help stop sweating of the hands.

Recently, studies have found a neurotoxin injection, better known by its brand name, Botox, effective for those with hyperhidrosis who have not found success with the previously-mentioned treatments. Injected into the skin of perspiration-prone sites, this botulinum toxin stops sweat production by blocking cholinergic nerve terminals within three to seven days, the effect lasting for at least five months. Injections would need to be repeated when hyperhidrosis symptoms begin to reappear. Side effects are minimal and mostly mild. It's still not recommended for pregnant and nursing women and for women of childbearing age who are not on birth control. Considering how safe, simple, and effective botulinum toxin injections have been in treating hyperhidrosis, it has the potential to become the preferable alternative to surgery.

Other than the above-listed remedies and procedures, there are two techniques you can try that may be helpful for you as well:

• Biofeedback — using this technique, people can learn how to manage their sweating.
• Iontophoresis — this technique involves applying a low electrical current to sweat-prone skin surfaces on a recurrent basis in order to help stop perspiration.

Download and discuss these various options with your health care provider to see which one is appropriate for you. You might also check with your health insurance provider to see which of these options they will and won't cover.

Hope you find some drying relief soon,

Alice

Related Q&As

The meaning of sweat

What can I do about my strong body odor?

Perspiration polka dots: Sweat stain sources and solutions?