Q: My underarms sweat a lot, even when it is cold. I am a young and otherwise healthy guy. This is causing a lot of social anxiety. What is causing it, and what can I do about it?
Dr. Chris Prakash
A: You are not alone. Excess sweating (hyperhydrosis) is a common disorder, and affects almost 3% of the population. The excessive sweating cannot only be localized (involving the underarms, or palms and soles), but it can be generalized (all over the body) as well. It is often a severe and emotionally distressing problem for people with the condition.
What causes it?
The most common type of excessive sweating is called primary focal hyperhidrosis. This is localized, such as to underarms, hands, feet, face or groin. Symptoms also tend to be symmetrical, occurring on both sides equally. This usually starts in childhood or adolescence. Although it is a problem, it’s not a sign of disease. People who have it are otherwise healthy. The cause of this is believed to be a minor malfunction in the nervous system. There’s some evidence that it could run in families.
The other less common form is called generalized secondary hyperhidrosis, and causes sweating all over the body – not just on the hands or feet. It’s called secondary because it’s being caused by an underlying health condition. There are a number of different medical conditions and diseases which may cause it, such as: menopause, thyroid problems, diabetes, tuberculosis, rheumatoid arthritis, or some types of cancers. Medications can also cause general excessive sweating (Some psychiatric drugs and blood pressure medications).
When should you see the doctor?
- Night sweats (drenching).
- Generalized sweating, especially if it gets worse.
- If the sweating starts at middle or old age.
- If you have other symptoms – fatigue, weight loss, cough, or increased urination.
How do we treat it?
While there is no cure for focal excess sweating, the following treatment options may be tried:
- Over-the-counter antiperspirants are worth trying first (look for the ones containing aluminum chloride).
- Prescription-strength antiperspirants: those containing aluminum chloride hex hydrate (Dry sol). This works by blocking the sweat glands, but may cause irritation. Also, it only works for underarms, and not other areas.
- Iontophoresis is a cumbersome procedure that uses water to conduct an electric current to the skin, which slows production of sweat. The current is applied typically for 10-20 minutes per session, initially with two to three sessions per week followed by a maintenance program, but this is too cumbersome for most people.
- Microwave destruction – This new device produces microwaves that destroy sweat glands while preserving other tissues. Treatments occur in a physician’s office, and can cause local swelling and irritation.
- Oral medications (anticholinergics)are not commonly used because of side effects.
- Botox injections are FDA approved for treating excess sweating in underarms, but not other areas. These injections are expensive and painful, but can provide up to six months of relief, but have to be repeated periodically.
- Surgery (Endoscopic thoracic sympathectomy) is rarely used, due to risk of serious complications, and then only as a last resort.
This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com.