Understanding hyperhidrosis: Why some sweat more than others

We have all experienced moments of unexpected, excessive sweating –  whether from stress and nerves, heat, physical activity, or even a change in environment. For some, this is a once-off experience, but for many others, this is a daily struggle, clinically referred to as hyperhidrosis.

“Sweating is completely normal and is a natural and a key function of the body,” says Dr. Alek Nikolic, aesthetic medicine specialist and owner of Aesthetic Facial Enhancement. “It is important to note that sweating is actually the body’s way of regulating the body temperature, but for some the apocrine glands which are responsible for sweating become overactive and produce more sweat that is actually needed.”

Dr. Nikolic shares insights into hyperhidrosis below and clarifies that it isn’t limited to specific areas of the body, occurring across the body including the underarms, palms, feet, lower back and face.

What is hyperhidrosis?

Hyperhidrosis is a medical condition that leads to excessive sweating beyond the body’s natural cooling needs. The condition affects approximately 5% of South Africans – severely impacting their daily lives.  

There are two main types of hyperhidrosis; primary and secondary.

Primary hyperhidrosis is the most common form and usually starts during puberty. Secondary hyperhidrosis is less common and is usually caused by an underlying condition.  

Hyperhidrosis typically affects areas such as armpits, palms, soles of the feet, and face. These areas have a high concentration of sweat glands.

“The diagnosis of primary focal hyperhidrosis can be made on the presence of visible and excessive sweating of at least six months duration without any apparent cause,” explains Dr. Nikolic.

Along with excessive sweating, at least two of the following characteristics also need to be present:

  • Bilateral and relatively symmetric areas of sweat
  • Impairs daily activities
  • Frequency of at least one episode per week
  • Younger than 25 years old
  • Positive family history
  • Sweating during sleep

Treatment options for hyperhidrosis

Hyperhidrosis can have a significant impact on one’s life which can lead to social embarrassment and anxiety, a knock to self-confidence, and can interfere with daily activities.   There are a range of treatment options available to treat this medical condition – many of which are guided by budget and the severity of the condition.

Some of the non-invasive treatment options include topical antiperspirants, oral medication and iontophoresis. Dr. Nikolic suggests applying topical antiperspirants that contain aluminium chloride hexahydrate right before bed on dry skin as it is more effective than in the morning on damp skin. This will temporarily block the sweat glands.

General practitioners can also prescribe oral medications such as anticholinergics to help reduce sweating; while iontophoresis involves passing an electrical current through water and then placing the affected area into this ‘charge’ water. Invasive treatments include surgery such as local sweat gland resection and endoscopic thoracic sympathectomy.

The most popular invasive treatment to treat hyperhidrosis, however, is botulinum toxin, which treats sweating the same way it prevents wrinkles.

“When injected, botulinum toxin blocks the nerve signals that stimulate sweat production, which essentially decreases the secretion of sweat,” explains Dr. Nikolic.  There is no evidence that using botulinum toxin to treat hyperhidrosis will cause rebound or excessive sweating in other areas. This is more commonly seen with surgical resection of nerve sympathectomy procedures.

The results are fast-acting and one can see the full effect of the treatment about two weeks after the injections. The results will last a minimum of three months but are also dependent on how fast the body metabolises botulinum toxin and where it is injected.

“If you do suffer from hyperhidrosis it’s important to discuss your treatment plan with a medical professional, as they can advise on the best way to treat specific conditions and discuss concerns and questions about the treatment. Like any treatment, there will be possible side effects, and patients can expect bruising but it will be temporary,” explains Dr. Nikolic.

If you think you are sweating too much, seek medical advice as there are plenty of treatments to consider that can manage your symptoms and improve your quality of life.

To learn more about botulinum toxin visit www.dralek.co.za.

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