Hyperhidrosis Q&A

We all sweat – and it’s perfectly normal and healthy. But imagine sweating so much that you can’t hold a pen or type on a keyboard.

This type of excessive sweating can be quite distressing and can have disastrous effects on your self-confidence. 

To help shed light on the issue, Consultant Dermatologist Dr Seau Tak Cheung shares his expert advice on hyperhidrosis.

Seau Tak Cheung
Hyperhidrosis means too much or excessive sweating. It can affect just one part of the body (localised) or the whole body (generalised). The common localised areas of the body that are affected include the hands, feet and the underarms (axilla).

Sweating normally occurs to cool the body down when the body temperature rises, for example through exercise. It can also occur as a response to an emotion or even to spicy foods. Made of 99% water, the release of sweat is caused by the activation of nerve fibres connected to sweat glands. The remaining 1% is a combination of minerals, protein and urea.

The characteristic “body odour” smell from sweat is generated when it comes in contact with the bacteria on the surface of the skin. Although there is currently no cure for hyperhidrosis, there are many treatments that can help to improve the condition.

Seau Tak Cheung
It is estimated that 3 to 5% of the population sweat excessively. Sweating too much can have a significant impact on a person’s quality of life. It can affect how they go about their work, such as holding a pen and writing, and it can make them feel self-conscious and decrease their self-confidence.

As the mount that people sweat varies considerably, it is difficult to specify an exact amount or volume of sweat that is too much. However, here are some questions to bear in mind:

  • Do you tend to sweat even when you are not hot or exercising?
  • Do you need to change your clothes or bathe because of your sweating? How many times do you  need to do this a day?
  • How does your sweating alter your daily routine and activities, such as going out, meeting people or at work?
  • Does sweating in public cause you distress?
  • How many types of treatments have you tried to control your sweating (antiperspirants, powders, or deodorants)?
  • How long  do you spend thinking about and managing your sweating a day?

Seau Tak Cheung
Your doctor may enquire and investigate for diabetes, an overactive thyroid or other conditions that can cause excessive sweating. Certain drugs, such as some anti-depressants, e.g. fluoxetine (Prozac), can also cause this. If there is an underlying medical condition or a medication causing the sweating, then this type of excess sweating is known as Secondary Hyperhidrosis because it is caused by something else. This type affects the whole body, also known as generalised sweating.

Primary Hyperhidrosis is the most common type of Hyperhidrosis where it affects certain parts of the body (localised). The underarms, hands and feet are often more affected than other parts of the body as there are more sweat glands in these areas than anywhere else. In this type of sweating, sometimes other members of the family are also affected.

Sweating from the underarms tends to be the area that I manage in our clinics.

Seau Tak Cheung
Simple measures include wearing clothes made of natural fibres and avoiding tight-fitting clothes. To reduce the signs of the wet patches, black or white clothing can be worn. Placing sweat protection pads may also help.

Most people have tried shop-bought antiperspirants which usually contain aluminium chloride as the active ingredient. Higher concentrations of aluminium chloride can be prescribed, although they are more prone to causing irritation, especially if the skin is not completely dry prior to applying it.

Lontophoresis can be recommended for people who have tried prescription strength antiperspirants. This involves passing an electric current through the skin and water. It can also be very effective for hands and feet Hyperhidrosis. If this machine is effective it can be purchased to use at home. Another option is the injection of Botulinum toxin which can be injected into the skin. The combination of these two treatments can also be helpful for your sweat management.

Surgical treatments are less used, such as curettage, laser ablation. Endoscopic Thoracic Sympathectomy (ETS) is not recommended for axillary hyperhidrosis.

Seau Tak Cheung
Clinical studies have shown Botulinum toxin is very effective and usually lasts between 2-6 months, although some patients may some have effect even after 12 months. The full effect usually occurs within two weeks. Although skin can be numbed with an anaesthetic cream or injection, this is often not needed as injections into underarm skin tend to be well tolerated. Botulinum toxin is used less often on the hands and feet as it is more painful and can cause temporary weakness of the hand and feet muscles.