Excessive Sweating Treatments
HYPERHIDROSIS IS TREATABLE!
It is common to blame stress, nervousness, or sometimes even fear (for example, the fear of public speaking) for excessive sweating, but this certainly doesn’t cover the full range of causes for this condition. What exactly leads to hyperhidrosis, and what treatments can resolve it?
How many times have our palms gotten sweaty? Or have those ugly dark circles on our clothes under the armpits "embarrassed" us in front of others? Or have we felt sweat beads forming on our foreheads? These uncomfortable situations can be caused by many factors, which implies different approaches to the treatments that medicine and dermatology use to address hyperhidrosis today.
Sweating is a natural physiological process, an important mechanism of the body’s response to elevated body temperature, increased physical activity, or heightened metabolic activity of the entire body, but it can also be a sign of an emotional state. For humans, the loss of body heat is accomplished through the evaporation of sweat from the skin’s surface. This process is influenced by the eccrine glands, and what’s important is that sweating can also be triggered by other mechanisms that do not serve this function.
Excessive sweating is called hyperhidrosis in medicine. The term refers to the secretion of sweat beyond what is considered normal, with typical sweat amounts ranging from 100 ml to 1 liter, depending on body temperature, external temperature, humidity, etc. Increased sweating is most commonly observed on the palms, soles, and underarms, and can also occur on the forehead, face, or hairy part of the head. It is very important to understand that excessive sweating interferes with daily life for those affected, often leading to social anxiety and discomfort.
In our bodies, there are two types of glands: eccrine and apocrine, explains dermatologist Dr. Jasmina Kozarev. “They differ mainly in the quality of the secretions, or sweat. Eccrine glands consist of 99% water molecules, some electrolytes, and a little amino acids. Apocrine glands, typically located in intimate areas and the hairy parts of the head, secrete a much smaller amount of sweat compared to the eccrine glands, but it contains higher amounts of proteins and fats. These glands are very prone to bacterial colonization, which, due to reproduction, causes a specific odor and color in the sweat.”
TYPES OF HYPERHIDROSIS
Medicine divides hyperhidrosis into two types. Focal hyperhidrosis is most commonly localized to the palms, soles, and underarms. Its cause is unknown, but it is often genetically determined and typically appears in young people before the age of 20. This type is also called primary hyperhidrosis.
The second type is generalized hyperhidrosis, which affects larger areas of the body. It appears suddenly and is often associated with medication or other general conditions or metabolic disorders, such as diabetes or thyroid issues. It can even occur during the early months of pregnancy or during menopause, and can also be a sign of some malignant diseases, heart problems, or infections.
However, it is becoming increasingly important to talk about sweating caused by anxiety, also known as emotional sweating. This is a response to stimuli such as fear, prolonged stress, pain, or anxiety. We have all experienced this at least once and know how to recognize it. When we are emotionally excited or fearful, we "sweat," as we commonly say. This type of sweat can be mild or intense enough for the person to feel "drenched" in sweat. It primarily manifests as wet palms, wet areas under the arms, the front of the chest, back, wet hair, or a beaded forehead.
Emotional sweating is part of the physiological response to stress – says dermatologist Dr. Jasmina Kozarev. "Excessive sweating is becoming more common in modern life. More and more patients are referred to us by our medical colleagues and specialists from other fields. These patients, along with increased sweating, also experience rapid breathing, increased heart rate, and this combination represents the manifestation of physical anxiety, which is undoubtedly disruptive to social activities."
Secondary hyperhidrosis conditions are associated with possible bacterial and viral infections, pregnancy, menopause, chronic illnesses (such as diabetes, malaria, hyperthyroidism, malignant diseases, rheumatic conditions, obesity…), or the use of specific medications.
Social phobias, or anxiety disorders, involve intense fear of various social situations, especially those that are unfamiliar or where the patient feels observed or evaluated by others. For those prone to anxiety disorders, these situations can lead to conditions that cause hyperhidrosis as part of an anxiety syndrome.
This fact – emphasizes Dr. Kozarev – "is leading more and more teenagers to our practice. Although they are active on social media, they often find direct real-life contact to be intimidating. Despite what it may seem, teenagers think about this and do practically everything to avoid such situations, especially direct contact. Given their sensitive age, hormonal fluctuations, and emotional states, this can easily lead to hyperhidrosis. Of course, sweating of the palms is dominant, followed by sweating under the arms, changes in the color of the face, and even redness."
It is also important to note that some dermatological conditions may accompany sweating. For instance, people with a fungal infection of the feet, especially between the toes, may experience increased sweating in that area.
The treatment for hyperhidrosis depends on the underlying cause. If the sweating is not very intense, the first line of treatment includes various antiperspirants. However, in many cases, excessive sweating can lead to skin damage due to constant moisture, called maceration. This leads to a higher risk of fungal or bacterial infections. This means that antiperspirants may not be effective for skin already affected by sweating, and may even cause allergic or irritating reactions.
HYPERHIDROSIS TREATMENTS
Modern medicine and dermatology offer various therapeutic techniques for treating hyperhidrosis. The first of these is iontophoresis, which is highly effective (65-70%). It is painless and very convenient because the device can be applied to the hands, feet, and other body areas, including the face. It can be used in medical facilities or at home, depending on the type of device. Essentially, this technique uses modulated currents to introduce electrolytes, or ions, into the skin, targeting the cells that produce sweat.
If hyperhidrosis is localized to the underarm or hand areas where iontophoresis is not effective, neurotoxin therapy, such as Botox, may be used. It is injected very superficially in specific quadrants in the appropriate dose. The effects last from 6 to 8 months.
Anticholinergic drugs are the next option used in treating excessive sweating. They have side effects such as dry mouth, bowel movement issues (constipation), urinary retention, and vision problems. Due to these side effects, they are only used for the most severe cases of hyperhidrosis.
Finally, there is a surgical technique called sympathectomy, which involves laparoscopic surgery in the chest area to sever the nerve that innervates certain regions of the underarms. This leads to a cessation of sweating in that area. Although minimally invasive, this technique carries certain risks, including the possibility of pneumothorax. It can also cause gustatory sweating, where the body sweats in response to the taste or smell of certain foods.
At Dr. Kozarev’s Clinic, all of the treatments mentioned are available except for the surgical one. What makes the clinic unique is its use of laser techniques, developed worldwide as microwave and laser fractional treatments.
Laser treatment for hyperhidrosis involves – explains Dr. Kozarev – “directing a laser beam through the skin to target the area affected by excessive sweating. First, the area of excessive sweating must be marked, typically using an iodine test. An iodine solution is applied to the skin, followed by the sprinkling of starch. After about ten minutes, a dark pigmentation develops, indicating that sweat has reacted with the iodine and starch. This allows us to precisely mark the area to be treated with the laser. The treatment physically destroys the sweat glands that produce excessive sweat. After the treatment, an antiseptic is applied to the skin, and patients are advised not to use any antiperspirants or products that could cause infection or irritation for 3 to 4 days. Two to three sessions are usually required, depending on the intensity of sweating in the area.”
This laser technique is considered the most successful because it targets the exact zone, provides lasting effects, and does not cause excessive sweating in other areas of the body.