14 December 2004

Help! I'm drowning in perspiration

If you feel that you're drowning in perspiration and that you're an embarrassment to yourself, this article is for you.

Assuming that you’re not overweight, don’t suffer from a thyroid problem and that you’re in good general health, you might be suffering from hyperhidrosis. This is basically excessive perspiration due to overactivity of the sweat glands.

Localised hyperhidrosis usually occurs in otherwise healthy persons. It usually is confined to the palms, soles, axillae, inframammary regions, or groin. Excessive sweating of the palms and soles may be psychogenic.

In hyperhidrosis, the skin in affected areas is often pink or bluish white. In severe cases, the skin, especially on the feet, may be macerated, fissured, and scaling.

You should first try and determine the cause before you try to treat it. Treating the underlying cause is a lot easier than to try and treat the hyperhidrosis itself. If there is no underlying cause, you can try using an aluminium chloride containing antiperspirant (Drichlor®). Systemic anticholinergic drugs have only a temporary effect, and side effects (eg, dry mouth, blurred vision, difficulty with urination) are problematic.

For localised hyperhidrosis, a 20 to 25% solution of aluminium chloride hexahydrate in absolute ethyl alcohol applied at night to the dried axillae, palms, or soles and covered tightly with a thin polyethylene film is usually effective. In the morning, the polyethylene film is removed and the area is washed free of salt. Two applications usually protect the area for 1 wk. If the aluminum chloride under occlusion is irritating, it should be tried without occlusion. This solution should not be applied to inflamed, broken, wet, or recently shaved skin.

In some patients, tap-water iontophoresis may be effective. A 5% solution of methenamine (available in some countries) in water may also be effective. Topical solutions containing glutaraldehyde or formaldehyde may be effective but can be irritating.

If the anhydrous aluminium chloride treatment fails, extreme axillary hyperhidrosis may be relieved by surgically excising the concentrated group of glands in the axillary vault or injecting the area with Botox® (much more acceptable).

An operation called a sympathectomy can also be done where the nerve supply to the offending glands is cut off and keeps them from secreting any sweat. This operation is not possible for excessive sweating of the head.

- (Dr Bram van Niekerk, CyberDoc)


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