How to help my daughter with excessive sweating?
QMy daughter sweats a lot from her armpits and she is very sensitive about it. She is 16 and very conscious of her looks and whenever she wears anything other than a woolly jumper, she has large wet patches under her armpits. She has bought a deodorant (Driclor) that claims to eventually stop sweating altogether and I am worried that it might damage her health, but I commiserate with her. What do you think? Are there other solutions? I don’t think she will be happy to just wait and see if she grows out of it.
AExcessive sweating from areas on the body where sweats glands occur is known as hyperhidrosis. It is thought that about 1% of the population suffer moderate to severe forms. It can cause significant psychosocial distress, but rarely has an underlying medical condition to explain the sweating episodes.
It is called focal hyperhidrosis when it affects the armpits, palms of the hand, soles of the feet or less commonly the face, scalp, groin region or under the breasts. It commonly begins in childhood or adolescence and tends to run a chronic lifelong course, but in a few people symptoms can resolve spontaneously over time. Classic features include age of onset, typically under 25 years old, often with a family history, affecting both sides of the body equally (e.g. both armpits) and symptoms do not occur at night. Generalised hyperhidrosis affects the whole body and can occur both during the day and at night. This form of the condition is rarer and can have underlying medical explanations such as chronic infection, thyroid/endocrine and other disorders need to be ruled out. Most people presenting to a doctor will have hormone blood tests checked prior to management. There are only a few proven treatment options for hyperhidrosis and your daughter has already tried the first one, namely aluminium chloride-containing antiperspirant deodorants. These are safe to use regularly for life and effective for milder forms of hyperhidrosis, but obviously cannot be applied to the face or scalp. Iontophoresis can be used on the hands or feet and involves immersing them in warm water (or a wet contact pad) through which a weak electric current is passed.
There are other options available, though. Botox injections, delivered by multiple intradermal injections to the sites involved, are used to treat focal hyperhidrosis and can take three to seven days for full effects that can last three to nine months. Botox works by binding to the nerve endings and preventing the action of acetylcholine, a chemical that stimulates the sweat glands thereby inhibiting sweat production.
Microwave thermolysis or ‘miraDry’ is a non-invasive United States Federal Drug Administration approved laser therapy that uses electromagnetic energy to destroy the sweat glands. Typically two treatments are required about three months apart, with usually permanent results. However some people find one treatment provides an adequate reduction in sweat. It is worth noting that miraDry can only be used to treat underarm sweating and is not suitable for the hands, feet or groin area.
Lastly, endoscopic thoracic sympathectomy (ETS) is another permanent but surgical procedure to cut the sympathetic nerve supply (that promotes sweating) to the sweat glands in the upper limb. There are a few rare but potentially serious complications and for this reason sympathectomy is generally reserved for patients who have a BMI <28, absence of symptoms at night and no significant underlying medical conditions. Up to 50% of patients can suffer subsequent and persistent ‘compensatory hyperhidrosis’ elsewhere after undergoing ETS.
A few lifestyle modifications to consider: weight loss (if overweight), and wearing loose-fitting (ideally cotton) clothes can help.