Excessive Sweating

Expert Advice

Expert Advice

August 09, 2007|By Holly Selby | Holly Selby,Special to the Sun

Everyone knows what it's like to perspire -- particularly during the sultry dog days of summer. But some people sweat so profusely -- from their hands, feet, armpits or genital areas -- that it can radically affect their lives, says Dr. Mark J. Krasna, a thoracic surgeon and medical director of the Cancer Institute at St. Joseph Medical Center.

They may be suffering from a condition known as hyperhidrosis, or excessive sweating. What if, Krasna asks, you weren't able to shake hands at a job interview? Or hold hands on a date because your hands literally are dripping with sweat?

What is the difference between simply sweating profusely and having this condition?

Hyperhidrosis is defined as excessive sweating. People think, `Oh, what's the big deal?' But imagine it can be so severe that you can't type because your hands are dripping on the keys. Or you are a teenager trying to play the guitar and you keep getting shocked each time you touch a guitar string. Young people with the condition often have a very traumatic time of it. What causes this condition?

Sweating, which is regulated by what's called the sympathetic nervous system, is the body's way of regulating its temperature. In hyperhidrosis, the sweat glands are constantly being bombarded with triggers by an overactive sympathetic nervous system. We don't actually know what causes it. There are no known reasons for people to develop what is called primary hyperhidrosis, or excessive sweating not associated with another health problem.

A fever can cause excessive sweating. Two other not-uncommon conditions that can cause excessive sweating are abnormal blood sugar levels (diabetes) or abnormal thyroid levels. And, of course, menopause in middle-aged women.

Does hyperhidrosis occur more frequently in men or women?

It is pretty much equal between men and women. Interestingly, it turns out that close to 1 percent of the world's population suffers from hyperhidrosis. And from reports we get from across the world, people get it more frequently in areas like Asia. But even here in the Mid-Atlantic, it is a significant problem.

How is hyperhidrosis diagnosed?

Typically, the patient comes to the doctor complaining of the symptoms. You rule out other diagnoses -- diabetes, thyroid complications. If it isn't something like that, the patient may really be suffering from hyperhidrosis. It affects your whole life. I have asked patients in my office to sit with their palms up, and the sweat is literally pooling in their hands. They turn their hands over and they will drip.

How is the condition treated?

Often patients will begin by going to a dermatologist, who will give them a prescription [antiperspirant]. A second treatment is called iontophoresis -- during which the hands or feet are immersed in an electrolyte solution and shocked. The treatment works for some patients but needs to be repeated regularly.

Severe hyperhidrosis also can be treated surgically. The sympathetic nerve begins in the base of the brain and comes out into the body, forming a chain at the beginning of the neck and continuing into the chest through the levels of the ribs. In this procedure, the overactive sympathetic nerves, which are in the chest cavity, are cut.

What do you tell patients about the surgery?

We cut the nerves usually at the level of the third or fourth ribs with one small, half-inch incision on each side. We have done hundreds of these procedures and reported our results in medical literature. We are currently working with a group of international experts to set up a registry to study the predictors of good long-term outcomes with sympathectomy.

There are very low risks with the procedure. Mostly we warn them that they may get compensatory sweating, a condition where they may get excessive sweating elsewhere in the body even though their hands are dry. If they are warned about this in advance, usually they can deal with it. The most rewarding feeling is seeing these young patients come back for follow-up years later [and] their lives have been transformed.

Holly Selby

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