Hyperhidrosis cause and treatment
November 25 2015 by
Ray Sahelian, M.D.

Primary hyperhidrosis affects up to 1% of the population and has a significant negative impact on quality of life. It affects the axillae in approximately 80% of cases. Hyperhidrosis results from excessive sympathetic stimulation of the eccrine sweat glands: the various treatment modalities available target points along the pathway between the central nervous system and the peripheral gland. Hyperhidrosis is one of the oldest known dermatologic conditions. The description and definition of excessive sweating date back to Hippocrates in the 4th century B.C.
   A recent survey suggests that the prevalence of primary hyperhidrosis is 3 percent in the U.S. population, 1.4 percent have excessive sweating in the underarms (axillary hyperhidrosis), and one-sixth are projected to have sweating that is intolerable or interferes with daily activities. There also is a hereditary component, as approximately half of these patients have a relative with hyperhidrosis. One part of the brain controls the sweating response to body temperature, while another area controls the sympathetic, or emotional sweating response. For reasons unclear to researchers, the emotional component is in overdrive. The result is typically a healthy individual who perspires excessively, even in mildly stressful situations, such as a handshake or job interview. This can have socially debilitating consequences, particularly in young adults. Not all sweating is benign, however. Primary hyperhidrosis affects people while they are awake, but nighttime sweating is never normal. A careful history and physical examination must be performed to rule out other causes of excessive sweating, which physicians call secondary hyperhidrosis. In contrast to the primary form, secondary hyperhidrosis is associated with other potentially serious medical problems that need further workup from physicians.

Hyperhidrosis treatment
Treatment is based on the severity of the condition and the risks and benefits of therapy. Hyperhidrosis treatment can range from antiperspirants to surgery, which involves disconnection of the sympathetic nerves that direct sweating in the arms and hands. The first line is topical aluminium chloride, which is effective in the majority of cases. Alternative hyperhidrosis treatments such as systemic anti-cholinergics and iontophoresis have significant disadvantages, while surgical sympathectomy has been regarded as the gold-standard in treatment of this condition.
   Botox and Hyperhydrosis - Recently, attention has focused on the use of intradermal botulinum toxin for axillary hyperhidrosis treatment. This is a highly effective, minimally-invasive option with few side effects, and is now recommended as the treatment of choice in isolated axillary hyperhidrosis.

Ann Vasc Surg. 2014. Long-term results of the use of oxybutynin for the treatment of axillary hyperhidrosis. In patients with good initial response to oxybutynin, more than 80% presented moderate or great improvement in axillar and in other sites of excessive sweating. Results were particularly better in females

Avoid these herbs and supplements
Some herbs and supplements can increase body heat and lead to more sweating. The herbs include ginseng in all its forms, tongkat ali stimulant, ephedra stimulant, the tongkat ali extract LJ100, and yohimbe. Nutrients and amino acids that can increase body temperature include tyrosine, choline, trimethylglycine, or CDP-choline. Choline converts into acetylcholine. You may also wish to avoid all stimulants, including caffeine and tea. For some people alcohol can make the condition worse.

Practical suggestions
Stay in air conditioned rooms, drink cold water, avoid hot drinks such as coffee or tea, reduce hot soup intake, reduce emotion triggering situations, take a Zen approach to life with calmness and placidity.

There is an association between tinea pedis (athlete's foot) or interdigital mycosis and focal plantar hyperhidrosis.

Focal hyperhidrosis treatment
Focal hyperhidrosis reduces physical and emotional quality of life, which can result in varied restrictions of a patient's personal and professional lifestyle and activities. Treatment for focal hyperhidrosis oincludes topical and oral agents, tap water iontophoresis, botulinum toxin type A, and surgery. Studies evaluating botulinum toxin type A (Botox) treatment for palmar, plantar, and facial ocal hyperhidrosis reveal that botulinum toxin type A helps improve the quality of life of some patients.

Hyperhidrosis. Hypnotherapy of 2 patients. Ugeskr Laeger. 1990 Sep.
Two cases of hypnotherapeutic treatment of psychogenic hyperhidrosis are presented. In both cases, organic aetiology could be excluded and conventional medical treatment modalities had no effect. In both cases, it was possible to modulate sweating in the trance state within less than a minute, thus supporting other reported cases of the effect of hypnotically induced modulation of autonomic responses. In the first case the psychological dynamics behind the physiological symptoms seemed unrelated to fundamental emotional and personal problems and relaxation and conditioning techniques in hypnosis had a positive effect in reducing the sweating to both objectively and subjectively socially acceptable standards. In the second case the hyperhidrosis was related to more fundamental personality problems and short term hypnotherapy proved ineffective in treating the condition.

There is some benefit in some patients. J Tradit Chin Med. 2008 De.Acupuncture treatment for spontaneous polyhidrosis. Acupuncture Department, The First Hospital Affiliated to Tianjin TCM College, Tianjin 300193, China.

Axillary hyperhidrosis -- sweating in the armpits
Palmar -- sweating of the palms

Hyperhydrosis treatment with botulinum
The Food and Drug Administration approval of botulinum toxin type A (Botox) has provided an effective treatment of excessive sweating, particularly for the underarms. Other treatments may be utilized for excessive sweating on the face, the palms, or soles of the feet.

Topically applied botulinum toxin type a for the treatment of primary axillary hyperhidrosis: results of a randomized, blinded, vehicle-controlled study.
Dermatol Surg. 2007. Glogau RG. University of California at San Francisco, San Francisco, California.
The objective was to demonstrate that botulinum toxin type A can be delivered to targeted skin sites with topical application for the treatment of primary axillary hyperhidrosis. This randomized, blinded, vehicle-controlled study enrolled 12 patients with primary axillary hyperhidrosis with greater than 50 mg of sweat produced per 5 minutes. botulinum toxin type A (200 U), combined with a proprietary transport peptide molecule to bind the toxin in a noncovalent manner, was topically applied to one axilla; vehicle without botulinum toxin type A was applied to the other axilla. Rates of sweat production were measured and imaged at baseline and 4 weeks after application. At 4 weeks, 10 axillae treated topically with botulinum toxin type A demonstrated a 65% mean reduction in sweating relative to the same-patient, vehicle-control axillae, which had a 25 mean reduction. The 40% difference in mean sweat reduction between groups was statistically significant. Quantitative image analysis of the results of the Minor's iodine starch test confirmed the reduction of sweat production in the botulinum toxin type A treated versus the vehicle-treated axillae. Topically applied botulinum toxin type A appears to be safe and may prove to be effective for the treatment of axillary hyperhidrosis. Dr. Glogau is a consultant to Revance, Inc., and funds for this clinical study were provided by Revance.

Is there an herb that could help with extremely sweaty palms and feet?
   We are not aware yet of such an herb for sweaty palms and feet.

I found your website while researching the effects of DHEA supplementation. I wanted to ask you a question related to the condition known as hyperhydrosis (constant sweating in the hands, feet, as well as the hands feeling very hot and very cold, at different times, etc). I have read on one or two websites that one of the possible causes of hyperydrosis condition is the slowing down of the body's production of Human Growth Hormone, DHEA and testosterone, which are necessary to recharge the parasympathetic nervous system. Furthermore, I have read that another side effect of such a condition is irregular heartbeats. Here is a brief excerpt of the info I have found: "...A higher volume of sweat and bouts of fatigue occur due to the insufficient bio-energy in the adrenal cortexes, which produce DHEA to pacify the sympathetic nervous function..." My question is the following: Is there any truth to the above mentioned suggestion regards to hyperhydrosis? And more importantly, how can a person be reliably tested to find out whether there is indeed a need for DHEA and/or testosterone supplementation (in order to reverse this condition)?
   The above explanation makes little sense to us. If anything, DHEA use may increase metabolism and lead to more hyperhidrosis. At this time we have not seen enough research in regards to hyperhidrosis and human growth hormone use.

My husband has excessive heat to the body even when he feels cool and sweating profusely at night or sitting in his chair anyway i went to a health store and bought schizandra herb I hope it helps. My husbands hands and feet dont sweat but he sweats enough at night he has to get up wipe off and lay down a towel to go back to sleep he sweats on his belly.
   Sorry, but I am not familiar with the use of schisandra for excess sweating.

I hope you are doing well. I was going through your website and i am immensely impressed by your knowledge. I am a male of age 25. I am suffering from extreme sweating (as referred to Hyperhydrosis in medicine) especially on face, head and arm pits. It is making my life extremely miserable as i am unable to present my self creating extremely awkward condition for me to face my social and personal life. Over sweating is not only caused by Anxiety or stage / presentation phobia but also if i talking to individual where i am not at all anxious but i start sweating. I also sweat heavily when i am playing sports. Also to let you i have a family history of heart disease from my father side. I saw few doctors. First doctor asked for goiter test which was normal. He prescribed Xanax which i didnt take as unrecommended by few friends. Then i saw another doctor who said that i have high heart rate and prescribed Inderal (10MG) twice a day i-e once in morning and once in evening. I took the medicine for 15-20 days and no significant impact is visible. I would say that it seems to work occasionally but not very effective. I have read numerous side effects of Inderal and hence stopped using the medicine however i am still concerned about my initial problem of hyperhydrosis. If i dont take the medicine, it will affect my job and social life and if i take it, it would affect other thing.
    One has to balance the benefits of the beta blocker, and it could help in higher dosages, with the side effects. One option is to use a higher dosage such as 40 mg but only when necessary on the days of a presentation or important social gathering.