Don’t Sweat It

Do you sweat so much and so frequently that it makes you uncomfortable or embarrassed? Excessive sweating is actually a medical condition; it’s called hyperhidrosis. The good news is that there are effective methods to alleviate this condition.

Words Hannah May-Lee Wong

When we’re stressed or worried, people may tell us, “Don’t sweat it.” But for some people, this is not an option. Excessive sweating that is not normal is called hyperhidrosis. Affected individuals can sweat so much that it soaks through their clothes or even drips off their body. Excessive sweating can happen throughout the day and can cause quite a bit of discomfort and embarrassment. Dr Ch’ng Chin Chwen, a dermatologist, answers our questions about this sweaty problem.

Is this a common problem among Malaysians?

It is quite common. But a lot of people don’t know there is such a disorder and that they can do something about it. Hence, they do not take any measures or see a doctor. I get patients who come in for other conditions, then they talk about their excessive sweating and they are surprised when I tell them there are treatment options available for it.

Is hyperhidrosis prevalent in certain groups of people?

Normally, the people seeking treatment are teenagers or young working adults. I don’t usually see elderly patients complaining about hyperhidrosis. It’s probably because teenagers are more self-conscious and concerned about self-image. As for young adults, they would want to get treatment because it might affect their work.

What causes hyperhidrosis?

It’s mainly caused by genetics. In some people, their sympathetic activities are a little more active causing the eccrine sweat glands to produce more sweat. There are also certain hormone-related issues, for example, thyroid disease or overactivity that may cause one to sweat more. Women going through menopause may get hot flushes and sweat a lot.

Which areas of the body produce excessive sweat in a person with hyperhidrosis?

Some people sweat excessively in a localized area, for example the palms, armpit, feet, chest, thighs or back. Others may sweat excessively throughout the body.

Are there triggers for excessive sweating?

Yes, people tend to sweat excessively when they are anxious or nervous. Heat and exercise also cause sweating, but it is normal to sweat when you are exercising.

How can a person tell when their sweating is ‘normal’ and when they should see a doctor?

One of the methods for testing is the iodine-starch test. We can paint iodine onto areas that are excessively sweaty, such as the palms and armpits. You will be able to observe a change in colour in the sweaty areas. That said, I rarely use the test in practice because it all depends on the individual and how much his or her life is affected by hyperhidrosis.

If you sweat a lot but it doesn’t bother you and you don’t think it needs to be treated, it’s fine.

Whether or not a person seeks treatment depends on his or her job, self-image, lifestyle and the degree of sweating. If your hands get too sweaty, they become slippery and holding onto objects can be difficult. Some people sweat excessively on their thighs and it can be very embarrassing when there are wet patches on their clothing.

Most times, those who do seek help have a localized area of excessive sweating rather than generalized whole body sweating.

How does excessive sweating affect a person’s daily life or functioning?

In professions that require use of the hands, excessive sweating can make it difficult or even dangerous when carrying out certain tasks – for example, wielding a hammer or even driving a vehicle.

When there’s an important occasion like an interview or a big meeting, there may be lots of hand-shaking involved and it can be embarrassing if your palms are too sweaty. Furthermore, sweat in the armpit is associated with bad odour, which affects both men and women.

On top of that, as people tend to sweat more in stressful situations or when they feel anxious, it can become a vicious cycle because a person is anxious or worried about their sweating which results in even more sweating.

How is hyperhidrosis treated?

Treatment options depend on which part of the body is affected and whether it’s localized or generalized excessive sweating. In terms of new developments, there has been a newly approved treatment for hyperhidrosis that isn’t in Malaysia yet, but perhaps it will be available in the near future. The medication comes in the form of wipes and they can reduce sweating.

More traditionally, we use products that contain aluminium chloride to reduce sweating. They come in a solution and patients apply them topically every day. There are also anti-perspiratory roll-on products that contain aluminium chloride, available in pharmacies. Take note that you will have to apply these products on a daily basis.

Be aware that some deodorants only help to control odour, not sweating. Remember to check the label for active ingredients.

Botulinum toxin injections are a more long-lasting treatment option. The effect of each injection lasts six to nine months. It can be injected into the palms, feet or armpits by a doctor. These injections can reduce sweating in those areas by about 80 percent.

Iontophoresis is a treatment which passes low level electric currents through the skin. The patient’s palms or feet would be submerged in a shallow tray of water while the electric currents pass through. (This method is not feasible for the armpits, for obvious reasons.) It is effective in reducing sweating; however, the drawback is that it can be inconvenient. A patient has to have the treatment four times a week, ideally. And since it requires a medical device, the patient will have to go to a hospital or clinic for every session, which is time consuming. Each session only takes around 30 minutes, but treatment usually goes on for a few months. Once sweating is reduced to a satisfactory level, the patient can reduce the frequency.

Another option is surgery. The outcome is permanent and will completely stop sweating in certain areas. But I would not recommend this method. Surgery for treatment of hyperhidrosis involves removing the sympathetic nerve at the armpit so that you don’t sweat there anymore. But there are a few downsides to this. Firstly, as with any other surgery, there are risks involved – infection, bleeding, hospital admission and there is a very small risk of puncturing the lung. But more pertinently, quite a number of patients regret their decision of undergoing this procedure. This is because they may end up with ‘compensatory sweat’ in other areas although there is no more sweating in the area that had undergone surgery. Compensatory sweat can get quite severe, especially when you’re nervous.

Other non-permanent treatments like botulinum toxin injections allow doctors to adjust the dosing and make changes if needed. Usually, the doctor will give a dose that’s enough to reduce sweating without much compensatory sweating at other sites. Even if compensatory sweat occurs, the doctor can adjust and lower the dose accordingly at the next session. A surgical result is irreversible – there is no turning back.

For people with whole body, generalized excessive sweating, there are some oral medications available. But we have to use them with caution. Malaysia is a very hot and humid country, and people do need to sweat to regulate their body temperature. (Sweating helps to keep the body cool.) If the body needs to sweat but the process is suppressed with medications, the person might overheat, especially when he or she is active and exercising. If the body heats up too much, the person might get a heat stroke. As such, this option is probably more suitable for people who spend most of their time indoors and do not have active lifestyles.

Lastly, it may be worth mentioning that there is another localized treatment option using microwaves to reduce sweating by destroying sweat glands. Unfortunately, it is not available in Malaysia yet. This treatment is quite expensive but it reduces sweating more dramatically than botulinum toxin, and the results are permanent after three or four sessions.

As you can see, there are many treatment options to choose from. A doctor will work together with the affected individual to assess how severely hyperhidrosis affects his or her life, and whether it is worthwhile treating it, because these treatments have different costs.

Practical tips on dealing with heavy sweating

< >Try to control your anxiety or worry. If you have an anxiety disorder, get it treated.Use air conditioning on dry mode.Change clothing frequently.Use hand wipes.Apply anti-perspiratory products frequently.

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