As a teenager Corrine G was frequently teased by her classmates
for her excessive, uncontrollable sweating. She mentioned
it to her doctor, who chalked it up to hormones. Her symptoms
did get a little better as she got older, but she still
always wears black to hide the stains and avoids physical
contact whenever possible. Patients like Corrine who suffer
from hyperhidrosis (HH) — up to 2.8% of the population,
according to recent surveys — sweat more than the
body actually needs to maintain optimal body temperature.
Left untreated, the condition can have debilitating effects
on patients' social, personal and professional lives.
"It's an embarrassing thing because it conveys the message
that they're not confident," says Dr Antranik Benohanian,
a dermatologist at St Luc Hospital in Montreal. "They
need to know that something can be done."
NO
SWEAT DOC
There are two types of HH. Focal, or primary HH, is
localized to the armpits, feet, hands or face, in that
order of frequency. The cause is poorly understood,
but Dr Benohanian says there are indications that genetics
may be involved. Generalized HH, on the other hand,
occurs over the whole body and is actually caused by
an underlying condition. "In that case you need to ask
patients if they have any other discomforts or symptoms,"
suggests Dr Youwen Zhou, a dermatologist at the Hyperhidrosis
Clinic at Vancouver General Hospital.
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Ten take-home tips
To reduce sweat and
body odour, tell your patients to:
- Wear light-coloured, loose
fitting clothing
- Avoid polyester, silk and
artificial fibers
- Wear natural cotton perspiration
shields under clothing
- Use antiperspirant with aluminum
chloride
- Take a bath or shower daily
- Alternate shoes daily
- Go barefoot when possible
- Eliminate foods or drinks
that exacerbate sweating (like spicy foods and
hot beverages), as well as foods with strong
odours like onions and garlic
- Drink lots of water
- Visit a dermatologist or
sweat specialist. To find one in your area,
go to
www.sweatmanagement.ca
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Dr Benohanian adds generalized
sweating is usually idiopathic, but can also be a sign
of thyroid disease or diabetes. "Night sweats usually
point to Hodgkin's disease, infections or tuberculosis,"
he says.
Both experts agree the diagnosis
of focal HH is pretty straightforward. "It's a functional
definition, meaning that the amount of sweat may vary,"
explains Dr Zhou. "It's the amount of discomfort and
inconvenience that's used as the criteria." He suggests
asking patients how much their sweating bothers them:
never, sometimes, usually or always, to determine the
severity of the condition.
Unfortunately, there are very few
things that patients can do on their own to control
excessive sweating, but certain triggers can exacerbate
it. "Any strong emotion or stressful situation can make
it worse," says Dr Benohanian. "Hot beverages, spicy
foods should also be avoided."
REAL
PROBLEM, REAL SOLUTIONS
There are lots of ways to minimize excessive sweating,
ranging from topical treatments to surgery. A well-informed
GP should be able to discuss these options with patients
and deliver the crucial message that solutions are available.
"The worst thing to tell patients is that nothing can
be done and they should just 'tough it out'," says Dr
Benohanian.
Topicals Treatment varies
according to the location and severity of the condition.
GPs should always start with topical therapies. Prescription
antiperspirants and topicals containing aluminum chloride
(AlCl) are the most effective, but they can be quite
irritating to the skin. Dr Benohanian says a 1% hydrocortisone
cream is usually helpful in these cases. Over-the-counter
antiperspirants, on the other hand, contain the less
potent aluminum chlorhydrate, which is less of an irritant.
For HH affecting the hands or feet, AlCl solutions are
usually ineffective because the thick, horny layer of
skin impedes absorption. In these cases, AlCl can be
mixed in a salicylic acid gel base.
Botox Studies have shown
that injection of Botulinum toxin type A is 83-95% effective
in reducing sweating. Most private drug plans cover
Botox, as do the provinces of Quebec, Manitoba, Alberta,
Saskatchewan and Nova Scotia. "Botox injections can
be cost-effective," says Dr Zhou, "Patients usually
don't need to come in more than once or twice a year."
While Botox injections are relatively painless in the
armpits and face, the densely innervated skin of the
hands and feet make it much more painful. "Having a
nerve block [basically the injection of a local anesthetic
near a peripheral nerve] on the wrist or ankle is a
practical way of freezing the nerves," says Dr Benohanian.
Alternatively, a needle-free device can be used to deliver
minute amounts of lidocaine prior to the injections.
Iontophoresis Though less
effective than Botox, iontophoresis can still benefit
a significant number of patients with localized HH in
the hands and feet. The affected area is immersed in
a tray that contains tap water, and a mild electrical
current is passed through the liquid, disrupting the
function of sweat glands. The cost of a home machine
ranges from $200-$1,200. Unfortunately, the inexpensive
units tend to be much less effective. "The treatment
must be done several times a week initially, then patients
can gradually decrease to a maintenance regimen," explains
Dr Zhou.
Surgery Dr Zhou says that
because of recurrence, complications and rebound HH,
surgery is left as a last resort. Endoscopic thoracic
sympathectomy, or ETS, is an invasive procedure where
the nerves causing abnormal sweating are clipped. The
other option is surgical excision of the axillary glands.
"I have seen over 5,000 patients, and I've only sent
three for ETS," says Dr Benohanian. "It should be avoided
whenever possible."
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