Your Health by Dr. Rallie McAllister

Everyone has sweaty palms, feet or underarms from time to time. But for some individuals, heavy perspiration is more than just an occasional occurrence — it's a way of life.

Excessive sweating, officially known as hyperhidrosis, is caused by a constant overstimulation of the sweat glands. The condition most commonly affects the underarms, the palms and the soles of the feet.

Hyperhidrosis is relatively uncommon, affecting slightly less than 3 percent of Americans. For individuals with the disorder, however, it can have a devastating impact on self-esteem, jobs and even relationships.

Sweating is a natural and desirable body function, performed by millions of sweat glands scattered throughout the skin. These glands are designed to help keep the body cool by releasing sweat for evaporation.

Most folks can accurately predict which situations will activate these glands and stir up a good sweat. Strenuous exercise, heat, stress and anxiety top the list, but smoking cigarettes, eating spicy foods and drinking alcohol or hot liquids can also trigger perspiration.

In individuals with hyperhidrosis, heavy sweating occurs for no apparent reason. Their palms, underarms or feet are often drenched even when they're feeling calm, cool and relaxed.

Sweaty palms can be the source of minor annoyances, like smudged newspapers and slippery drinking glasses, but they can also cause major embarrassment, especially when it comes to shaking or holding hands with others. People suffering from hyperhidrosis of the underarms and feet may have to change their shirts or socks and shoes several times a day.

In most cases, individuals with hyperhidrosis are healthy — they've just inherited the tendency to sweat profusely from their parents. Sometimes, excessive perspiration can be a sign of an underlying illness, such as an overactive thyroid gland, an infection or heart disease.

After ruling out these and other potential causes, doctors rely heavily on a patient's history to diagnose hyperhidrosis. Many people with the condition report excessive sweating that began in childhood or adolescence.

The most common treatment for hyperhidrosis involves applying aluminum chloride, a compound with antiperspirant properties, to the affected areas. Prescription antiperspirants are usually applied before bedtime and washed off in the morning to prevent skin irritation.

If this treatment doesn't produce the desired results, physicians may prescribe oral anticholinergic medications.

These drugs work by blocking the actions of acetylcholine, a chemical messenger in the body that stimulates the sweat glands.

Anticholinergic drugs may reduce sweating after a week or two of use. In spite of their effectiveness, their use is often limited by a number of unwelcome side effects, including dry mouth, constipation, visual changes and dizziness.

Some individuals with hyperhidrosis experience success using a treatment called iontophoresis, in which a battery-powered device delivers a mild electrical current to the hands, feet or underarms. Although the mechanism of action isn't fully understood, iontophoresis is believed to temporarily disable the sweat glands.

Iontophoresis treatments typically take about 15 to 30 minutes and are performed daily for up to two weeks, followed by less frequent maintenance therapy. Iontophoresis is generally safe and can be performed at home.

Injections of botulinum toxin, commonly known as Botox, may effectively reduce perspiration by disabling nerves that control the sweat glands. Although the full benefit of this treatment may take up to two weeks to occur, some people begin to experience noticeable sweat reduction within just a few days of treatment.

The effects of botulinum toxin are generally temporary, lasting approximately four to seven months. Because normal sweat gland function gradually returns over time, Botox injections may be required at least twice a year to control symptoms of hyperhidrosis.

In rare cases, surgery may be the best treatment option. If excessive sweating affects only the underarms, removal of the sweat glands in this area can help.

For some individuals with hyperhidrosis, a surgical procedure known as endoscopic thoracic sympathectomy, or ETS, may be appropriate. The operation involves cutting the nerves that control the sweat glands.

Major complications associated with the surgery are rare, and most patients are able to resume their normal activities within a day or two of the procedure. Unfortunately, the surgery may lead to a phenomenon known as compensatory sweating, in which increased perspiration occurs elsewhere on the body.

There's no quick and easy cure for hyperhidrosis, but there is plenty of reason for hope. With proper diagnosis and treatment, most people with the condition can obtain significant relief from excessive sweating and a dramatic boost in their enjoyment of life.

Rallie McAllister, M.D. is a family physician, speaker, and co-founder of www.MommyMDGuides.com, a website featuring child-raising tips from trusted doctors who are also moms. To find out more about Rallie McAllister, M.D., and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com.

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