Sweating is the body’s mechanism for disposing of toxins and of cooling itself. The hypothalamus in the brain is the body’s thermoregulator, maintaining constant internal temperature. When the skin temperature rises, the hypothalamus signals the eccrine and apocrine glands to start cooling the body. Of the 2-4 million sweat glands located all over the body, the majority are eccrine. The apocrine glands, on the other hand, are located primarily in the groin and armpits, which do not become active until puberty. Eccrine glands are present from birth.
Sweat glands are located all over the body, under the arms, feet, back, chest, forehead, and palms. Women tend to have more sweat glands than men, but men’s are generally more active. Perspiration is initially odorless. However, when sweat comes in contact with the bacterial flora on the skin surface, a strong odor is usually the result. Humans tend to sweat the most with physical exertion or when in excessive heat. Extreme emotional responses such as being embarrassed, anxious, angry, afraid, or nervous can also trigger perspiration.
Sweating is usually not a problem unless it becomes extreme. Overactive sweating, known as hyperhidrosis, affects between 2-3% of the population. There are two types: primary and secondary. Primary hyperhidrosis occurs when there is excessive sweating to the hands, feet, and armpits. To be considered the secondary form, hyperhidrosis has to be caused by another disease state, such as Parkinson’s, menopause, acromegaly, cancer, heart disease, or other afflictions.
As stated, only 2-3% of the population is afflicted. Fewer than half of those people seek treatment, which can actually lead to serious health consequences. Excessive sweating can lead to severe dehydration and electrolyte depletion as well as skin infections due to constant moisture.
Treatments for hyperhidrosis are based on the severity. A step-by-step approach is generally used for this disorder. Initial management of hyperhidrosis starts with prescription-strength antiperspirants. Excessive sweating to hands and feet is sometimes treated with iontophoresis, a procedure in which electrical current is conducted through water onto the skin. It utilizes very minimal current to achieve results.
If the problem is the axillae (armpits), then Botox (Clostridium botulinum, type A) injections might be the therapy of choice. Botox works by paralyzing the nerve endings that signal the sweat glands. It should be noted that Botox is a temporary solution, lasting anywhere from 6-9 months.
Anti-anxiety medications are often utilized as an adjunct with the above therapies. If the perspiration is refractory to everything else, then surgical options might be considered depending on the severity of the condition. Endoscopic thoracic sympathectomy is a minimally invasive surgery that cuts or clamps the nerves that signal the sweat glands to overproduce sweat.