1. Your Mom, Uncle or Third Cousin Sweat a Lot Too
There’s a type of excessive sweating that runs in families called primary hyperhidrosis (PH). Experts don’t know what causes it, but it’s definitely not because you have more sweat glands or that they’re supersized. The size, number and location of these glands appear totally normal in people with PH, says Dee Anna Glaser, MD, professor of dermatology at Saint Louis University School of Medicine and president of the International Hyperhidrosis Society. Their best guess: Something’s off with your body’s autonomic nervous system, which controls your internal temperature. PH is estimated to affect up to 3 percent of Americans.
You might have it if: You’ve always had a sweating issue (PH is often diagnosed during puberty, when sweating starts creating some social problems, but symptoms can start long before that), you sweat heavily in specific areas like your underarms, hands and feet, groin, scalp or upper lip, and you have a relative who sweat(s) a lot too. “Eight times out of 10, they can think of a family member who had it, like an aunt who never went anywhere without a handkerchief to wipe her palms or face,” says Malcolm Brock, MD, medical director of the Center for Sweat Disorders at Johns Hopkins in Baltimore. If you’re wondering what separates sweaty from clinically sweaty, ask yourself if you’re dripping at times when you wouldn’t expect to, like in an air-conditioned movie theater.
How to fix it: There are quite a few treatments for PH. Here are the options your doctor will likely talk you through, in order of least to most invasive.
1. Rx-Strength Antiperspirant
Works for: Underarms, palms of hands and soles of feet
What it does: Ingredients like aluminum chloride create tiny plugs inside your sweat ducts so the sweat can’t get out.
The pros and cons: Prescription antiperspirants are the least expensive option, but they often need to be combined with other treatments to get the problem under control. They can be irritating, especially to underarm skin. (That’s less of a concern on the hands and feet, where the skin is thicker, says Brock.)
Works for: It’s FDA-approved for your underarms, but Glaser notes that it can also be used effectively (and safely) on the face and scalp, palms and groin.
What it does: It blocks the signal that turns on the body’s sweat glands in the area where it’s injected.
The pros and cons: “In the underarms, Botox is a grand slam every time,” says Glaser. It’s temporary though, usually lasting about six months, and the cost can add up. You might also notice some muscle weakness if you overuse it in areas like your palms, says Bruce Robinson, MD, assistant clinical professor of dermatology at Mt. Sinai Medical Center and Lenox Hill Hospital in New York.
Works for: Hands and feet
What it is: In this treatment, you place your hands or feet in water that has a mild electrical current running through it. That stimulates the formation of a plug in your sweat glands, similar to the way prescription antiperspirants work.
The pros and cons: You can buy your own iontophoresis device and do it at home (after you’ve gotten instructions from your doctor). But it’s time intensive. Most patients start by doing it three times per week for 30 to 40 minutes until the excessive sweating stops, says Glaser, followed by a once-a-week maintenance session.
Works for: Any area you sweat in
What they do: They limit sweating over your whole body, not in just one location. These are off-label uses, but the most commonly prescribed types of medications are anticholinergics (treats asthma, muscle spasms and stomach cramps) and beta-blockers (used to treat conditions like high blood pressure and migraines).
The pros and cons: Meds are a relatively low-effort way to handle your sweat. The concern here is that unlike other PH treatments, meds decrease sweat everywhere, so you could get overheated in situations where you need to sweat to cool off, like being outside on a hot day or exercising. Doctors typically prescribe very low doses and use meds in conjunction with other treatments like Botox to lower that risk. Your doctor also needs to know exactly what other medications or supplements you’re taking to avoid potential interactions.
Works for: Underarms (it’s FDA-approved for that area)
What it does: It uses microwave energy to permanently destroy the sweat glands. Don’t worry about overheating—you can still sweat as necessary from other parts of your body.
The pros and cons: The effects are very long lasting (experts can’t say that you’ll never sweat from your armpits again because as a relatively new device, that’s not proven yet) and only requires two treatments, max. On the downside, it’s expensive, and not covered by insurance. Expect to pay between $2,000 and $3,000, says Glaser, who notes that many patients say it’s still cheaper than the amount they’ll spend on dry cleaning their sweat-soaked clothes in the long run.
There’s also a surgical option (called ETS surgery), but many doctors advise against it. The main reason: It can lead to serious compensatory sweating, meaning you start sweating in other areas of your body where you didn’t have problems before, and the procedure isn’t reversible. Compensatory sweating can happen with other treatments like Botox, but it’s not nearly as common.
2. You’ve Got a Bigger Health Issue Going On
Certain conditions are known to have sweating as a symptom, and that kind of sweating is known as secondary hyperhidrosis, or extreme sweating with a known cause. The usual suspects:
POTS — You probably haven’t heard of this syndrome, which affects up to 1 percent of the U.S. population, but Brock says he’s seeing more and more patients at his clinic with excessive sweating caused by POTS (Postural Tachycardia Syndrome). The hallmark of the condition is an accelerated heartbeat (about 30 beats per minute higher than your normal rate) when you’re in an upright position, usually standing. It can also cause lightheadedness, fainting and headaches.
Diabetes — Experts don’t know why diabetes is linked to excessive sweating, but it can happen when your blood sugar is low, says Brock, which could be a sign that your diabetes isn’t well controlled.
Hyperthyroidism — This is another instance where the reason for the sweat link isn’t entirely clear, but if you have an overactive thyroid, you may also notice symptoms like sudden weight loss, a rapid heartbeat, irritability and difficulty sleeping.
Obesity — More skin-to-skin contact means less airflow and evaporation and increased heat on the surface of the skin, explains Robinson.
What you can do about it: In most cases, treating the underlying health issue will solve the sweating, says Robinson. If you’ve got your condition under control but the sweating won’t stop, ask your doctor about trying treatments normally recommended for primary hyperhidrosis.
3. Your Medications Are Causing It
Known offenders include certain antidepressants and anti-anxiety meds, blood pressure and heart medications, antibiotics and hormonal medications. The International Hyperhidrosis Society keeps a list of meds known to lead to sweating here.
What you can do about it: Talk to your doctor about alternative medications that can still address your issue but don’t come with sweating as a side effect, says Robinson. If that’s not an option (like if you’ve finally found an antidepressant that works for you and don’t want to mess with it), the treatments for PH are your best bet.
If None of These Apply to You, But You Still Feel Sweaty
You probably fall into the category of “sweat-bothered,” says Brock. It’s not a clinical diagnosis, per se—it just means that you wish you sweated less (but you’re not changing shirts a few times a day, like someone with hyperhidrosis might need to do). It’s not completely unheard of for a sweat-bothered person to seek out treatments like MiraDry, but your better bet is to start with these at-home tips for more effective antiperspirant application and go from there.
– Swipe it on before bed, then again in the morning. That twice a day schedule works best to keep sweat in check. If you only want to do it once, do it before bed.
– Towel off first. Combining wet or even damp skin with antiperspirant can lead to irritation. If you need to, blast your underarms with a hairdryer (on the cool setting) for a few seconds before you apply.
– If your hands or feet are the problem, try using an aerosol antiperspirant on them. (Make sure they’re dry first too).
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