We all sweat for a good reason, to help control the core temperature of our bodies. At least 1% of the population sweat in excess of what is required, and they have hyperhidrosis. There are also as many as 5% of people who sweat more than average and also benefit from the solutions discussed below. Most people have primary hyperhidrosis which begins in childhood and is a lifelong condition. It typically affects the hands, feet and underarms but the face/head, torso and groin can also be affected. Some people have a secondary form as a result of an underlying condition such as diabetes, hyperthyroidism, chronic infection or the menopause. Given the prevalence of the condition, it is very likely you know or have encountered someone affected.
If you imagine what life would be like if your hands and feet were always wet as if you have just washed them. Everyday tasks using the hands we take for granted are difficult, for example, using a touch screen, handling paper, driving. Many patients avoid skin to skin contact with others so interpersonal and intimate relationships are affected. The feet of affected patients are always wet that can lead to long-standing viral, fungal or bacterial infections and ingrown toenails. Constant underarm sweating is visible to all through the clothing which is why many people wear only black or white garments.
There is, unfortunately, no cure for hyperhidrosis. There are, though, numerous solutions and measures to help those affected. The first level of treatment involves strong antiperspirants and barriers or absorption of sweat.
Antiperspirants are not the same as deodorants; the former actively stops sweat reaching the skin surface, the latter removes odour. Most antiperspirants are aluminium based because this compound has proven to be the most effective for over 60 years. Antiperspirants work by reacting with the sweat and plugging the tube leading from the sweat glands to the skin preventing the sweat reaching the skin surface.
What many people do not know is that they work best when applied to the skin at night time when sweating is at a minimum. They can then exert their effects overnight and be effective the following day. Initially the antiperspirant should be applied every night then after one to two weeks the effect will build up and they then only need to be applied every few days.
Another thing that many do not realise is that antiperspirants can be used on any area of the body that sweats. However, applying some of the strongest antiperspirants to the more delicate skin of the face, underarms and torso is highly likely to irritate the skin. There are antiperspirants developed for these areas such as SweatStop which has a range of strengths to suit the level of sweating and the area of the body affected.
Absorbent materials and barriers
These do not treat the sweating but prevent it showing to the outside world and/or absorbing the sweat from the skin surface. There are absorbent pads that can be worn under clothing and clothing with integrated panels for sweat protection. Also, there are absorbent bamboo and charcoal insoles which absorb sweat from the skin of the foot as well as providing some antifungal and antibacterial properties.
For those patients for whom antiperspirants do not completely control their sweating, the next level of treatment is tap water iontophoresis. A big and difficult word to say but iontophoresis essentially means using a low voltage electric current to drive the ions from the tap water (those elements that cause white deposit in kettles and around taps) towards the skin. It is not completely understood how this works to reduce sweating, the effect is very similar to antiperspirants but lasts longer. It is effective for the hands and feet which can readily be immersed in water as well as the underarms with special electrodes. In some parts of the UK this is available through NHS dermatology units in hospitals for an initial course then patients are recommended to purchase their own device to continue maintenance treatments at home usually once every week to keep sweating under control.
Colloquially known as “Botox” which is widely used for facial aesthetics, it is also licensed for treating sweating of the underarms and is very effective. It is not available on the NHS and tends to be expensive. The effects can last up to six months.
Other underarm treatments
There are a variety of surgical and non-surgical procedures for treating the underarm sweat glands. Perhaps the most successful is miraDry which uses microwaves to destroy the sweat glands. Although an expensive treatment it does seem to offer lasting relief.
There are medications that can be prescribed to act against the sweat glands to stop sweating. Whilst this sounds ideal, these drugs are not specific to the sweat glands and also work to stop other body functions which can result in a dry mouth, constipation and urinary retention.
The very last resort for hyperhidrosis is to cut or damage the nerves that stimulate the sweat glands by a procedure called sympathectomy. Once again, this sounds an ideal solution. However, whilst it generally results in dryness of the affected areas the risk of side effects is high. One particularly troublesome side effect is compensatory sweating in which the sweating is effectively transferred to another part of the body, typically the torso or groin which is more difficult to manage than the original site of sweating.
If you, or someone you know, experiences hyperhidrosis or excessive sweating you will know how severely it affects life. There are solutions to help to begin with absorbent barriers and antiperspirants. Where possible, it is advisable to be referred to a dermatologist. For more details on hyperhidrosis and the treatment options please visit hyperhidrosisuk.org and to purchase products to help your sweating symptoms visit sweathelp.co.uk.
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Last revised: 20 July 2020
Next review: 20 July 2021