I’m fit but I pour with sweat when I go out for a walk

Q

I’m a relatively fit 70 year old but I have a problem with excess sweating – any slight exertion and I sweat profusely.

I often go for a five-mile walk but before I’ve even gone a mile my head begins to sweat and it gets worse until my hair is soaking.

By the time I end the walk my shirt is wet through and I’m very embarrassed if we meet neighbours.

I’ve had the condition for some years but it is getting worse. It’s very difficult to see a doctor at my practice and when I mentioned it to the nurse she appeared unconcerned. Is there anything I can do to prevent it?

A

Sweating is a normal body function that regulates our temperature and tends to occur when you are hot, exercising or eating very spicy food.

Occasionally excess sweating can be due to a medical condition, such as an overactive thyroid or diabetes, but in such cases the sweating tends to occur all over the body, not just in one place.

It sounds as if you are more likely to have the condition hyperhidrosis, where excess sweating occurs in specific areas of the body.

The hands are commonly affected, but it can also occur on the feet and for some it affects the head and face.

For some people it can just cause mild dampness, but it can be severe enough to cause dripping from the hairline and face so that just mild exercise can lead to soaked hair and sodden shirts.

Overactivity of the nerves that control the sweat glands are blamed, but why this happens isn’t known, though your genes may be involved as it can run in families.

For hand and feet hyperhidrosis, applying a strong antiperspirant containing aluminium hydrochloride at night can help, while botox jabs to paralyse the sweat glands can be very effective for underarm sweating.

However, unfortunately, neither of these are suitable for use on the face.

The best option is a solution of the anticholinergic drug glycopyrrolate, available on prescription, but this isn’t always available on the NHS.

Another option is a similar drug taken by mouth, such as oxybutynin, but side effects such as a dry mouth and constipation can be a problem, so it is best to start with a very small dose to see how you get on.

See Hyperhidrosis UK for more information (hyperhidrosisuk.org).

Q

For the last year I’ve had dry flaking skin around the side of my nose. I’ve tried several moisturisers but if anything they seem to make it worse. I’ve never had problems with my skin and I’m wondering if wearing a mask for several hours every day could have anything to do with it?

AThis could be a condition known as seborrheic dermatitis, where dry, red scaly skin occurs in the skin creases around the nose and also sometimes along the edges of the eyebrows as well.

It can start at any age after puberty and is slightly more common in men.

It is triggered by an overgrowth of a harmless yeast called malassezia, which normally lives on the skin, or an overreaction by the body’s immune system to this yeast.

It’s not the same as the yeast that causes thrush or is present in foods such as bread. It tends to be more common in cold than warm weather and outbreaks may be triggered by tiredness or stress.

Constantly wearing a close-fitting mask can allow sweat and oil to accumulate on the face, and this may encourage growth of the yeast, so yes it could well be a contributing factor.

The rash can be treated with a cream containing an anti-fungicide, such as clotrimazole, miconazole or ketoconazole, which are available from chemists.

You do need to use these regularly, twice a day, and it may take a few weeks for the rash to clear. It may help to wear a mask made of cotton and wash it out every day.

Q

My GP has just discovered that I have atrial fibrillation. I’m waiting for an appointment at the cardiology clinic, but in the meantime she has started me on the blood thinner rivaroxaban. Will this help my heart by improving the blood flow?

A

The heart is made up of four chambers, two at the top – the atria – and the bigger ventricles below. Normally these contract in a regular way, with the atria first, then the ventricles, and this is controlled by a sophisticated electrical system within the heart muscle.

In atrial fibrillation (AF) this system breaks down and instead the atria contract more randomly.

Only some of these impulses from the atria then pass through to the ventricles, so they too contract in a random way, and also with varying amounts of force.

The pulse rate may be fast or slow, but is very irregular. This may not cause any symptoms, but some with AF experience palpitations, dizziness, or breathlessness.

The irregular contractions in the heart can lead to blood forming inside the chambers and if this travels up to the brain it can block an artery and cause a stroke.

AF has been estimated to increase the risk of having a stroke five times above normal and for this reason anyone with AF is now routinely given anticoagulant medication.

In the past warfarin was used, but newer drugs that do not require regular blood tests, such as rivaroxaban or apixaban are given.

The role of these is purely to prevent a stroke and they do not help address the underlying heart condition in any way.

In some, it may be possible to shock the heart back into normal rhythm (a DC cardioversion), especially if the AF is recent, but in others drugs are used to help control the heart rate and these work more efficiently, helping the heart to beat at a more normal rate, although it may still beat irregularly.

Lifestyle measures can also be beneficial for your heart, which means taking regular exercise, losing excess weight, eating a healthy, low-fat diet, cutting down on alcohol, caffeine and also, very importantly, not smoking.

If you have a health question for Dr Leonard, email her in confidence at yourhealth@express.co.uk. Dr Leonard regrets she cannot enter into personal correspondence or reply to everyone.