Do you have hyperhidrosis?

Source: Best Health magazine, May 2014; Images: Thinkstock

Sharlene Amerl was 12 years old when a family member first commented on the sweat stains under her arms. She cringed in shame. Over the years, Amerl tried every new antiperspirant on the market, fretted about how to manage social or work situations, never raised her arms over her head, and never left the house without wet wipes and a change of top. ‘I spent a lot of time, from puberty on, worrying about it,’ says Amerl, who is now a 36-year-old mother and retail manager in Victoria. ‘It was embarrassing. And it constantly ruined my clothing.’

Excessive sweating, or hyperhidrosis, is a condition in which the sweat glands are overactive. It tends to run in families, and is triggered by being too hot or by emotional situations that increase stress or anxiety. There are two forms: localized hyperhidrosis, which predominantly affects the underarms, hands, feet and/or forehead; and the generalized form, which covers larger areas of the body. Together they affect 2.8 percent of the population’or about one million Canadians. A number of studies have shown that those with the con­dition say it undermines their confidence, and limits them at work and in social relationships.

But here is the good news: Highly effective treatments are now available.

Symptoms of hyperhidrosis

The ability to sweat is essential to human survival’we can’t cool our bodies without it. Each person has two million to four million sweat glands in various concentrations all over the body. But people with hyperhidrosis produce more sweat than is necessary for cooling’up to five times the amount of an average person.

According to experts, however, it is not the volume of sweat that indicates the severity of the condition, but rather how intolerable it is to the individual. Dr. Mark Lupin, a Victoria dermatologist who is a leader in the treatment of the condition, explains that in severe cases, patients describe their sweating as always interfering with daily activities.

Before a diagnosis for generalized hyperhidrosis can be made, other serious conditions for which sweating is a symptom should be ruled out, says Lupin. These include a viral infection, hyperthyroidism, diabetes and cancer.

Hyperhidrosis typically starts young. ‘Excessive sweating of hands and feet often starts in early childhood, whereas armpit sweat typically starts in puberty,’ says Dr. Nowell Solish, an assistant professor of dermatology at the University of Toronto. ‘Many people suffer in silence and don’t know that effective treatments are available.’

Start with simple treatments

As with many medical conditions, hyperhidrosis should first be treated with simple therapies before you consider more invasive options. If you have tried ‘extra-strength’ clinical antiperspirants from the drugstore and they haven’t worked for you, other therapies are available. Here is a list, from the simplest to the most invasive. Ask your doctor or dermatologist if one of these might be right for you.

‘ Topical agents
Extra-strong antiperspirants, available over-the-counter at the drugstore or online, contain various percentages of aluminum chloride hexahydrate. They are usually in a liquid or gel solution that is either rolled on, or dabbed on with cotton balls or a built-in sponge; ask your pharmacist to explain the options. Certain Dri (12%), extra-strength Drysol (20%) and Perspirex (20%) are the most common. They range in price from about $8 to $28 for 35 millilitres. When applied before bed to wherever the sweating regularly occurs, they work by reacting with moisture to create a plug that blocks the sweat ducts.

Is aluminum chloride safe? While some people worry that applying strong concentrations of it or blocking sweat ducts may be harmful to health, both Solish and Lupin note that the products’ safety has been well established for many years, and no link has been found to increased rates of breast cancer or Alzheimer’s disease. However, for some people the products can be irritating, causing a rash. Applying them at night on dry skin can help, says Solish. A milder option is topical glycopyrrolate cream, an anticholinergic chemical that blocks the neurotransmitter acetylcholine from getting to sweat gland receptors. Since it is milder, it can be used on the face. A glycopyrrolate solution can be made up at some compounding pharmacies.

‘ Medications
An anti­cholinergic such as oxybutynin or glycopyrrolate (mentioned as a topical cream above) can be taken as a pill to reduce overall sweating, but this systemic treatment has not been approved for hyperhidrosis by Health Canada or the U.S. Food and Drug Administration. Still, some doctors in Canada do prescribe it for generalized hyperhidrosis. Its ‘off-label’ use for excessive sweating, particularly facial sweating, is supported by years of anecdotal evidence and a growing number of studies. It is not for everyone, and since it interferes with the neurotransmitter acetylcholine, which has receptors all through the body, it can have side effects such as dry mouth, constipation, blurred vision, urinary retention and heart palpitations. Notes Lupin, another medication that is used off-label, particularly for sweating associated with menopausal hot flashes, is the high blood pressure drug clonidine.

‘ Iontophoresis
This technology, which uses a mild electrical current passed through water, has been used since the 1940s to treat hyperhidrosis. Today’s method differs little from back then: It is most effective for hands and feet, which are placed in shallow containers of water, through which a mild current is passed, making them tingle and disrupting the nerve signals for sweating. This needs to be done once a week, says Solish, but safe and effective home machines are available for $800 to $1,000.

‘ Botox
Botox has been widely used in Canada since 2001 to treat sweating, mostly for the underarms and palms. It works by disrupting the nerve signals to the sweat glands. A numbing cream may be applied first, and then the toxin is injected into a series of locations, which in the armpit is primarily around the hair follicles, taking less than five minutes per underarm. This lasts six to nine months, with no side effects except some short-term tenderness at the site, says Solish. ‘It’s amazing,’ says Joana Lourenço, 30, an associate editor at Best Health who has had the treatment in her underarms. ‘I wish I’d had it done for my wedding years earlier!’ The Botox serum costs about $400 to $800 per treatment, with upfront physician costs of about $200 (the cost of using Botox for this purpose is often partially covered by many extended benefit plans if you have a referral from your doctor to a dermatologist).

‘ MiraDry
In the fall of 2011, Health Canada approved this technology for armpit sweating. It’s a hand-held device, administered by a doctor, that pulses microwave energy to the sweat glands, causing them to heat up and die while cooling the skin on top. It has minimal side effects (local swelling and tenderness) and produces very long-term, if not permanent, results, says Lupin. Prior to MiraDry’s approval in Canada and the U.S., Lupin and another University of British Columbia dermatologist led a study on the device; they found that even two years after the procedure, the sweating had not returned and, unlike some types of surgery (see below), the pro­cedure did not result in more sweating in other parts of the body. After trying everything for some 20 years, Amerl was one of the early recipients; three years later, she is still sweat free. ‘I was tender and sore for about a week and a half, and then it was fabulous,’ she says. ‘It is such a freeing feeling.’ The pro­cedure, which costs about $3,000, is just becoming available in major Canad­ian cities at dermatologists’ offices. See miradry.com for Canadian locations.

‘ Surgery
Prior to MiraDry and Botox, the only long-term option was surgery, done either locally in the armpit to damage or remove the sweat glands, or under general anesthesia to cut the spinal cord nerves responsible for sweating. These days, surgery is seen as a last resort, in particular because the local procedure to remove the sweat glands has a risk of restrictive scarring, and because the operation to cut the nerves, called endoscopic thoracic sympathectomy, can lead to ‘compensatory sweating,’ in which the hands or underarms no longer sweat but the patient sweats profusely everywhere else.

Where to get help

The International Hyperhidrosis Society presents a host of unbiased information about the condition (including pros and cons of the treatments), as well as links to accredited professionals in Canada and the U.S. who do the procedures. See sweathelp.org.

This article was originally titled "Sweat Much?" in the May 2014 issue of Best Health. Subscribe today to get the full Best Health experience’and never miss an issue!