Why does it happen, how is it treated and when should you see a doctor?
We all sweat. It’s a completely normal process for the body to regulate its temperature. Whereas dogs pant to cool down their furry bodies, we release sweat from over 4 million sweat glands located all over the body. This liquid rises to the skin and then evaporates, leaving us feeling cooler.
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In fact, being able to sweat is critical to our overall well-being. “Sweating helps maintain a balance and regulate the body’s temperature,” says Dr. Fran Cook-Bolden, clinical assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai and a medical and cosmetic dermatologist in private practice in New York. “It’s very necessary,” she says. A rare medical condition called anhidrosis leaves people with the inability to sweat at all, which opens them up to the possibility of potentially fatal heatstroke.
Dr. Tanya Nino, a dermatologist with St. Joseph Hospital in Orange, California, says that sweating “starts with the thermoregulatory center in the brain,” also called the hypothalamus. This region controls the autonomic nervous system, the complex system that regulates everything from whether you feel hungry to whether your heart continues beating. When the hypothalamus senses that you’re getting too warm, it transmits signals to sweat glands to release sweat to cool you down.
What Causes Sweating?
How we sweat and why is a surprisingly complex system that can be triggered by a number of causes:
High temperatures. If your environment is too warm, that can trigger sweating. It’s your body’s best mechanism for reducing internal temperatures to prevent injury from the heat.
Anxiety and other emotions. If you’re feeling stressed, angry, embarrassed or afraid, you may start to sweat a lot. The sweaty palms and armpits that go along with stage fright are an example of this kind of sweating, which can be excessive.
Medical conditions. Menopause, obesity, an overactive thyroid, heart failure and other medical problems can all cause excessive sweating.
Foods. Spicy foods are famous for causing a sweat response in sensitive individuals. Alcohol and caffeine can also trigger sweating in some people.
Medications. Some medications, particularly certain painkillers, illicit drugs or hormonal treatments, can trigger a sweat response.
Hyperhidrosis
While sweat is a normal part of everyday life, for some people, excessive sweating, particularly in the armpits, can become problematic. In these instances, you may be dealing with a condition called hyperhidrosis.
Hyperhidrosis is classified a few different ways based on where it occurs and what’s causing it:
Focal hyperhidrosis. This type of excessive sweating is limited to a particular area of focus, such as the underarms.
Generalized hyperhidrosis. If hyperhidrosis impacts several body regions, it may be classified as generalized hyperhidrosis.
Primary hyperhidrosis. Primary hyperhidrosis occurs in the absence of another triggering problem, such as obesity or medications. It may be caused by genetics, and people with a family history of hyperhidrosis are at higher risk of developing the condition. Excessive armpit sweat that's not attributable to another illness or medication is sometimes called primary axillary hyperhidrosis. (The term axillary refers to the underarm region.)
Secondary hyperhidrosis. This type of excessive sweating it caused by a known triggering factor, such as a medication or a medical condition like a hyperthyroidism.
If you’re sweating a lot and it’s not related to a specific reason you can pinpoint, you might be dealing with hyperhidrosis. “About 3% of the U.S. population will have excessive sweating without an obvious cause,” says Dr. John McConaghy, a family medicine physician at the Ohio State University Wexner Medical Center.
In these instances of hyperhidrosis, the cause is believed to be "genetic. This is thought to be due to an over-stimulation of the sweat glands in the armpits, hands, feet and face by the body’s nervous system. This is different from excessive sweating due to anxiety or stressful situations,” he adds.
Treatments
McConaghy says that while hyperhidrosis isn’t dangerous to your overall physical health on its own, it can negatively affect daily life, emotional well-being, interpersonal relationships and self-esteem. It can even “affect relationships and productivity at work.” If you’re experiencing such problems, know that there are treatments available that may be able to curb the excessive sweating you’re experiencing and help you dry out a bit.
Treatments for hyperhidrosis include:
Clinical strength antiperspirants. The International Hyperhidrosis Society reports that antiperspirants are typically the first line of defense when treating the condition. Some of these products are available by prescription, but others are available over-the-counter. Check the label for aluminum chloride, which Nino says “reduces sweating by blocking secretions from the sweat glands.” Aluminum zirconium is another ingredient that can block the secretion of sweat.
Topical lotions. Lotions that contain aluminum chloride have also been found effective in reducing excessive sweating in the armpits. “It’s a roll-on that you apply sparingly at night,” Cook-Bolden explains. She cautions that you should keep your arms up until the lotion dries. “Because if you put your arms down, that doubles the strength of it and it can irritate the side of the arms.”
Oral medications. Oral medications are usually reserved for people with facial sweating or generalized hyperhidrosis that affects several regions of the body, rather than just the armpits. However, they can be an option for some people if other therapies haven’t worked. Cook-Bolden says these perscription medications contain an anticholinergic agent, which blocks the effects of a neurotransmitter called acetylcholine that’s involved in excessive sweating. Side effects of these medications can be problematic in some people and may include: dry mouth, constipation, impaired taste, blurred vision, difficulty urinating and heart palpitations, all of which are associated with a drying out of the body, Cook-Bolden notes. There's a potential link between use of anticholinergic medications in older adults and increased risk of dementia and/or brain atrophy, so be sure to discuss the pros and cons with your doctor, especially if you're over the age of 65.
Underarm wipes. A new prescription medication on the market called Qbrexza (glycopyrronium) takes the upsides of the oral medications and removes some of their side effects by embedding the medication into a cloth that can be wiped over the armpits to quell excessive sweating. Used daily, these cloths reduce sweating “by acting on the nerves in the sweat glands to slow the secretion of sweat,” Nino explains. A few swipes with the medicated cloth can reduce the amount of underarm sweat you generate without causing some of the other drying side effects, such as dry mouth or constipation, of a systemic oral medication. Qbrexza has been shown to improve symptoms within one week. After four weeks, patients experienced a 25% to 30% reduction in sweating severity. The volume of underarm sweat was also reduced by 50% or more in most patients.
miraDRY. Another newer technology called miraDRY can be used to treat axillary hypderhidrosis. This nonsurgical, inpatient treatment uses microwave technology to destroy sweat glands in the underarm area. It was found to reduce underarm sweat in over 90% of patients by an average of 82%.
Botox injections. Yes, that’s right. The same botulinum toxin injections that give middle-aged Hollywood stars those impossibly smooth foreheads can also be used to quell excessive sweating. With this treatment, your dermatologist will inject a small amount of Botox into the armpits. Once there, the toxin paralyzes the sweat glands and stops the excessive sweating. “It reduces the amount of sweating by about 30% on average,” Cook-Bolden says, so you’re not paralyzing all of the sweat glands, just some of them. “It doesn’t sound like that much, but it’s enough to make a huge difference in what you’re experiencing,” she says. Botox injections usually last about four months to a year, so you'll need to keep up with routine injections to maintain results. The IHhS reports that Botox has been shown to reduce sweating by 82% to 87%.
Lasers. Some patients may be offered a precision laser treatment that heats up and destroys sweat glands without damaging surrounding tissue. It can be very effective and provide permanent results, sometimes with just a single treatment. One study showed that this type of treatment had reduced underarm sweating by about 78% six months after a single treatment.
Surgery. In some cases, patients with hyperhidrosis that doesn't respond to other therapies may undergo a type of surgery called endoscopic thoracic sympathectomy, which cuts nerves in the armpits to block excessive sweating. It can be risky because most patients experience compensatory sweating in a different part of the body that may end up being as bad or worse than the original sweating problem. Because it's irreversible, it's considered the last resort for underarm and hand sweating.
HIFRF. A newer procedure called high-intensity focused fractional radiofrequency microneedling is also gaining traction in the treatment of primary axillary hyperhidrosis (excessive underarm sweating), McConaghy says. In this approach, “very small needles are placed under the skin and radiofrequency energy is applied to destroy sweat glands.” The approach is still new – it's currently FDA-approved for the treatment of facial wrinkles – but one study found that patients had a 75% to 80% reduction in hyperhidrosis symptoms within one week of treatment. Results lasted six to eight months.
Generally speaking, starting with the least invasive option and working your way down the list to more invasive or irreversible treatments as others prove ineffective is usually a smart approach. Depending on the severity of your case of hyperhidrosis, you may find that a topical lotion works just fine while other people need more permanent intervention. Talk with your doctor about which options are best for your specific situation.
Who Can Help?
If you’re having difficulty with excessive sweating, you may want to start with your primary care provider. Depending on how severe the issue is, you may be referred to a dermatologist.
Sometimes, hyperhidrosis can cause additional complications besides just embarrassment and stained T-shirts. “The over-moist skin can become chaffed and irritated, causing rash or infection,” Nino says.
This is because everyone has yeast and bacteria on the skin, no matter how frequently you bathe. Both yeast and bacteria thrive in warm, dark, moist areas, like the folds of skin at the groin and underarm. If the area is too moist, “that bacteria can get out of balance and become an infection,” Cook-Bolden explains. This can cause itching, discomfort and scarring of the skin. “These are examples of when medical interventions can make a difference,” Nino notes.
But you shouldn’t wait until it gets to that point. Nino says that if excessive sweating is interfering with your life, it’s time to talk to your doctor. “Patients have told me that they have to change their shirt at work due to the sweat stains on their clothing, or say that they restrict their clothing to only dark colors, or that they have to wash excessively to stay clean.” All of these situations can be remedied, but you have to tell your health care provider that this is happening.
McConaghy agrees that you shouldn’t suffer in silence. Hyperhidrosis and excessive armpit sweating are “easily treated, yet less than half of people with hyperhidrosis that is ‘intolerable’ or ‘barley tolerable’ mention it to their doctor.” Though it cannot be cured, hyperhidrosis can be effectively managed. These “easy and effective treatments can improve quality of life,” he says.
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