Hyperhidrosis, or excessive sweating, is a problem all too common for M.E. sufferers. Here Julie Halford RGN of the Hyperhidrosis Support Group gives help and advice.
Primary Hyperhidrosis is a chronic condition with a general onset in childhood or adolescents. It affects about 1% of the population, causing severe embarrassment to those who suffer from it.
We do not know why Hyperhidrosis starts; however, it has been successfully linked to over activity in the sympathetic nervous system. This chain controls the apocrine and eccrine glands, responsible for perspiration throughout the entire body and, when it is overactive, it causes excessive sweating at most times during the day and night. This in turn may cause considerable social, psychological and occupational problems.
Hyperhidrosis can occur in many different areas of the body, but most commonly affects the hands and feet. Palmar and Plantar Hyperhidrosis are most disabling as they are difficult for the patient to hide. Hyperhidrosis is also common in the axillae (armpits), causing staining of clothes and, together with an embarrassing odour, forces most sufferers to change their clothes several times a day.
Facial, groin and back sweating, although less common, affect a considerable number of people.
Secondary Hyperhidrosis, on the other hand, is often generalized, typically involving the whole body. This type of excess sweating may seem to come on for no apparent reason – although a closer look will typically reveal a root problem. This is why this type of hyperhidrosis is called "secondary." The excess sweat is secondary to the more primary condition.
Whether you have primary or secondary hyperhidrosis can be determined by asking yourself a few simple questions. Ask yourself if you have experienced visible excess sweating for at least six months without apparent cause. If the answer is "yes", then the next step is determining whether you meet at least three of the following criteria:
- Your sweat is bilateral and relatively symmetrical, meaning you sweat the same amount on both sides of your body.
- Your excess sweat impairs your daily activities.
- You experience at least 2 episodes a week.
- The onset of your excess sweating is earlier than age 25.
- You have a positive family history (meaning that other members of your family suffer from similar sweating problems).
- You stop sweating when you're sleeping.
If you meet at least three of the above criteria, the chances are you have primary hyperhidrosis, and you should make an appointment with a dermatologist familiar with treatment options for people with hyperhidrosis. Your GP can refer you to a dermatologist.
It is Primary Hyperhidrosis that we mainly deal with at the Hyperhidrosis Support Group.
If you don't meet the criteria for primary hyperhidrosis, then it gets a little more complicated, as your doctor may end up needing to do a complete check-up to determine why you are sweating excessively. The cause may be as simple as a new medication you've been taking. Or, you might be suffering from one of a range of medical conditions – M.E., infection, thyroid disease, malignant disease or other medical disorders such as diabetes or gout. A hormonal imbalance related to pregnancy or the menopause could be another potential root cause. For a list of medications and diseases that can cause excess sweat, go to Causes of Secondary Hyperhidrosis on our website.
- avoid tight clothing
- avoid all man-made fabrics
- minimise obvious signs of sweating by wearing black or white clothing
- wear leather shoes only
- use emollient washes and moisturizers rather than soap-based cleansers
- identify any trigger factors for sweating such as crowded rooms, alcohol etc.
- introduce to patient support group
Aluminium chloride antiperspirants are applied at night and washed off in the day. Brands include Anhydrol Forte, Driclor and SweatStop. These can be irritant for some, but SweatStop is less so than the others.
Iontophoresis is the most effective treatment for Palmar, Plantar and Axillary Hyperhidrosis available on the NHS and this service is available from many Dermatology Departments in the UK and some Physiotherapy Departments. Patients are now able to purchase their own machines for home use; see www.iontophoresis.info.
Nearly all patients achieve a complete cessation of sweating after about four 20-minute sessions, but should initially have seven treatment sessions and then just have one session for maintenance, as and when necessary.
The treatment is pain free, safe, cheap to run and can be done as often as is necessary. After treatment in a clinic or hospital setting, patients can purchase their own machine for home use at a cost of approximately £335.
Medications such as Glycopyrromium Bromide (Robinul), Ditropan (Oxybutynin) and Propantheline (Pro-banthine) are often prescribed for those who suffer from more generalised hyperhidrosis. The most effective for generalised hyperhidrosis is modified release oxybutynin (Lyrinel XL).
Intradermal injection of Botulinum Toxin is a very effective treatment for hyperhidrosis of the axillae, but few NHS hospitals now provide this as it is an expensive treatment and needs to be performed every 4-8 months. There are many private practices who now offer this service to sufferers. It is too painful for plantar and palmar hyperhidrosis and is only licenced to treat the axillae.
Endoscopic Transthoracic Sympathectomy (ETS)
Division of the overactive sympathetic nerves which lie in the sympathetic postganglionic fibres of the T2 region for palms and the L2 region for feet. This is endoscopic surgery with results being most successful for primary palmar and facial hyperhidrosis and is only performed if all other treatments have failed, as there is a high risk of compensatory sweating following ETS, which can be considerably worse than the original symptoms. Complications include compensatory sweating, pneumothorax, bleeding, infection, Horner’s syndrome and neuralgia.
Clothing protectors/underarm pads: www.esteemclothingprotectors.co.uk
Specialist insoles: www.canonbury.com
Dermasilk clothing: www.dermasilk.co.uk
Foot wipes and spray: www.trycare.co.uk
The Hyperhidrosis Support Group aims to provide specific individual advice to UK sufferers, many of whom are desperate and have nowhere else to turn. The Group also works tirelessly to raise awareness of the condition among medical practitioners.