Ex­cess sweat­ing of­ten has no clear rea­son and varies in sever­ity

Times Colonist - - Life - DR. KEITH ROACH Your Good Health Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu

Dear Dr. Roach: I have hy­per­hidro­sis and want to know what, if any­thing, I can do to al­le­vi­ate this con­di­tion. I am 71 and phys­i­cally ac­tive. I ex­er­cise al­most ev­ery day for an hour. I sweat pro­fusely, mainly from my torso, but it’s not only when I work out; it’s also if I ex­ert even a modest amount of en­ergy or am anx­ious about an up­com­ing event. I wear an un­der­shirt to soak up the sweat. It is em­bar­rass­ing when I’m out in pub­lic and I find that my shirt is soaked and stick­ing to my skin.

This has been go­ing on for years. My doc­tor tried chang­ing my pre­scrip­tion drugs, but we did not see a change in my con­di­tion. I would ap­pre­ci­ate any in­sight you might of­fer. If this is just the way I am, I’ll ac­cept it, but if there is a change needed in my life­style, I’ll con­sider do­ing it. H.S.

Pri­mary hy­per­hidro­sis is the term for ex­cess sweat­ing for no clear rea­son. It needs to be con­sid­ered sep­a­rately from sweat­ing that oc­curs as part of hot flashes or as night sweats. It sounds as if it’s pretty clearly the case in you.

Many peo­ple with pri­mary hy­per­hidro­sis sweat in one par­tic­u­lar lo­ca­tion: The head and hands are com­mon, but un­der­arms are the most com­mon. It some­times runs in fam­i­lies, doesn’t usu­ally hap­pen dur­ing sleep and usu­ally is the same on one side as the other. It of­ten starts about ado­les­cence.

It might not seem to read­ers that it’s too hor­ri­ble a con­di­tion, but peo­ple with it of­ten re­port sig­nif­i­cant so­cial prob­lems, both per­son­ally and pro­fes­sion­ally. It can lead to skin prob­lems that stem from hav­ing con­stantly wet skin. It is com­mon, but varies widely in sever­ity.

The first treat­ment for this is a pre­scrip­tion-strength an­tiper­spi­rant, such as 20 per cent alu­minum chlo­ride hex­ahy­drate, which phys­i­cally blocks sweat pores. It is ap­plied at night (when sweat­ing is least) to all the ar­eas of ex­cess sweat­ing, ev­ery night un­til you see im­prove­ment, which usu­ally takes a week or so. Then, the ap­pli­ca­tions can be de­creased to per­haps weekly. The med­i­ca­tion is washed off in the morn­ing.

For peo­ple in whom this doesn’t work and those with a rel­a­tively small, dis­crete area of sweat­ing, bo­tulinum toxin can be in­jected, which lasts for months. I don’t know if you have too large an area of ex­cess sweat­ing for this to work. For peo­ple with un­der­arm sweat­ing, there is a de­vice that uses mi­crowaves to de­stroy sweat glands. Two treat­ments are about 95 per cent ef­fec­tive, but they are ex­pen­sive and not gen­er­ally cov­ered by in­surance.

Many peo­ple find that reg­u­lar ex­er­cise in­creases over­all sweat­ing. How­ever, reg­u­lar ex­er­cise has so many ben­e­fits that I wouldn’t rec­om­mend you re­duce your ex­er­cise. I hope one of these treat­ments is help­ful.

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