Q. I want to know what the cure for excessive sweating is. I’m 25 years old and have been experiencing this on my palms for a very long time now. I have already used home remedies but none of them works.  I can’t hold anything for even just 5 minutes without soaking it wet and it’s really embarrassing. In addition, I also have sweaty underarms. I can’t wear fitted clothes, even if I’m using antiperspirants and deodorants.

—“aileen g,” avria@yahoo.com

A. The medical term for excessive sweating is hyperhidrosis. Hyperhidrosis can be secondary to a medical condition such as hyperthyroidism, but usually it occurs without any underlying medical condition, in which case it is called primary hyperhidrosis.

Primary hyperhidrosis affects about 2% of the population. Often, as in your case, it is limited to certain body areas like the palms, soles, armpits and groins. Primary hyperhidrosis is a condition that is probably genetic in nature although the responsible gene or genes have not been identified yet. 

Hyperhidrosis can indeed be a source of embarrassment especially if it involves the armpits because it can produce or aggravate disagreeable underarm odor.

Unlike most areas of the body where there is only one type of sweat gland, called eccrine sweat gland, that produces clear, watery sweat, the armpit has a second type of sweat gland called apocrine sweat gland that produces a stickier form of sweat. Sweat from eccrine glands remains odorless but apocrine sweat, although initially odorless, is promptly broken down by bacteria, a process which releases chemicals with disagreeable odor.

There are a variety of proprietary preparations and medical/surgical procedures for hyperhidrosis that are available in the Philippines. The proprietary preparations are either applied topically (i.e., externally) or taken systemically in the form of tablets or capsules while the medical/surgical procedures include iontophoresis, botox injection and endoscopic thoracic sympathectomy.

Most topical preparations used to control sweaty armpits contain antiperspirants and deodorants. Antiperspirants like aluminum chloride, aluminum hydroxide and “tawas” (aluminum potassium sulfate) control sweating by plugging the sweat glands. They are generally well tolerated, but in many instances, control of sweating is not complete. Deodorants, on the other hand, do not prevent sweating.  They simply masks the unpleasant odor released by the bacteria that attack sweat and they only work if the armpits are washed often.

Systemic preparations that have been used to combat excessive sweating include anticholinergics such as glycopyrrolate (Robinul, Robinul-Forte) that prevent the stimulation of sweat glands, sedatives, tranquilizers and calcium channel blockers. The use of any of these preparations however, has not gained popular support because of their numerous adverse effects.

Iontophoresis is a procedure used for excessive sweating of the hands and feet. In this procedure, the hands or feet are soaked in water, and then a gentle current of electricity is applied to the water. The therapy, which requires several sessions that lasts 10-20 minutes, is relatively safe although side effects such as skin cracking and blisters occur occasionally. But the procedure offers only temporary relief.

Botulinum toxin (Botox) injection is a nonsurgical procedure for the treatment of severe underarm sweating. It involves injecting small doses of the botulinum toxin in the armpits to block the nerves that stimulate sweating. Botox injection, however, does not cure hyperhidrosis. Its effect is temporary and the procedure has to be repeated at intervals of seven to sixteen months to maintain dryness. Side effects of botox include injection-site pain and flu-like symptoms.

A surgical procedure that is being performed for severe hyperhydrosis is endoscopic thoracic sympathectomy (ETS). This procedure, which offers a cure, is very effective (90 -100%) for sweaty palms, but is not as effective for sweaty armpits. It essentially involves cutting the nerve fibers that order the sweat glands to produce sweat.

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