Excessive sweating

Heavy Sweating

Why do I sweat so much?

By Lewis P. Stolman, MD

It seems like every time I get a little nervous, I start sweating intensely. Is there anything I can do about it?

Nov. 6, 2000 -- The problem you describe is called hyperhidrosis, or excessive sweating. And yes, there's lots you can do.

Sweating, of course, is perfectly normal. It's one way the body maintains its temperature. We sweat when it's hot or when we've been exercising vigorously. And when the moisture produced by perspiration evaporates, it cools the skin, and therefore the core temperature of the body.

But sometimes this nifty system goes awry. As many as one in 100 people suffer the kind of problem you're having: When they're under stress, the sweat starts flowing, usually on the palms, soles, face, and armpits.

For whatever reason, some people can undergo extreme stress and not sweat at all. Others find themselves drenched in perspiration from just having to say a few words at a meeting. We don't really understand why one person's threshold for sweating is different from another's. But we do know that the tendency to sweat under stress sometimes runs in families.

If you find yourself sweating all the time, and all over -- not just on your palms, soles, and underarms -- it may be a sign of a serious illness like tuberculosis, some kind of cancer, or thyroid disease. Talk to a doctor immediately.

Fortunately, most people who sweat heavily under stress aren't in any danger. But they may feel quite embarrassed, and the problem can get in the way of their careers. I've treated artists who can't work because their palms get too sweaty and musicians who have trouble playing their instruments.

How do you stop it? The simplest remedy is an antiperspirant, which can be used on hands and feet as well as in the underarm area. Over-the-counter versions work well. If these don't prove strong enough, you can ask your doctor for a prescription-strength version. And if that doesn't help, your doctor may suggest a tranquilizer (such as Valium) for those special occasions when you know you're likely to be extra nervous -- a job interview, some kind of public speaking, or even a first date.

In particularly stubborn cases, we may have to try other approaches. One option is surgery to remove sweat glands in the affected area. Another is to inject small amounts of Botox -- botulinum toxin -- to block the nerves that trigger sweat glands. This treatment must be repeated every 6 to 8 months, however, and the injections can be painful, especially in the palms and feet. Finally, if all else fails for sweaty hands, a surgical procedure may be performed to sever the nerves to the affected sweat glands. However, this is a serious operation that carries with it the risk of complications.

In my experience, the simplest and most cost-effective way to turn off the faucet is a treatment called iontophoresis. This involves applying a low-level electrical current to the affected area, which essentially blocks the sweat duct. For many patients, a one-time treatment may control excessive sweating for good.

The bottom line: Don't worry too much if stress leaves you with sweaty palms and damp circles under your arms. Make the right moves and you can stay dry. You shouldn't have to sweat it forever.

Lewis P. Stolman, MD, is associate professor of pediatrics at the University of Medicine and Dentistry of New Jersey and a member of the Dermatology and Laser Center of Northern New Jersey. He recently published a review of treatments for hyperhidrosis in the journal Dermatologic Clinics, October 1998.




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