Hyperhidrosis (excessive perspiration)

Perspiration is a natural phenomenon which is necessary for survival, however it becomes embarrassing when it is excessive. Here is some essential information to help you understand and control excessive perspiration (or oversweating).

Hyperhidrosis, when perspiration is excessive

Perspiration is a natural phenomenon which allows our body to regulate its temperature. When the mechanism becomes overactive, an excessive quantity of sweat is produced which is referred to as hyperhidrosis (from the Greek for "too much sweat"), excessive perspiration or even oversweating. 

This condition is very noticeable and can have a significant impact on the quality of life of people who suffer from it. 

Hyperhidrosis affects a significantly large number of people. In Canada, it affects approximately 3% of the population – some 950,000 Canadians – of whom 300,000 have a severe form of the disorder.

* dermatology.ca

Excessive perspiration: definition

​Hyperhidrosis is defined as follows. Sometimes for no clear reason, sweat secretion greatly exceeds the volume required to regulate body temperature. This is a very real condition that can have a profound impact on the daily lives of people who suffer from it.

There are several types of hyperhidrosis:
  • Localized hyperhidrosis, as the name suggests, only affects one part of the body, most commonly the underarms, hands or feet. It is often called "primary" (since the cause is unknown) and can be genetic. It sometimes manifests in adolescence and then gradually disappears in later life.  It can be exacerbated by stress, intense heat or pain. It can be defined as excessive perspiration, lasting longer than 6 months, with no apparent cause, affecting a specific area on symmetrical sides of the body on both sides at the same time (both underarms, both hands or both feet at the same time) with flare-ups occurring at least once a week, or oversweating that ceases during sleep.
  • Generalized hyperhidrosis affects the entire body and is most often a secondary symptom of other conditions or is caused by taking certain medications. It is therefore very important that your doctor try to find an "organic" reason for this excessive perspiration.
To determine the severity of hyperhidrosis, the impact of the perspiration on daily life should be evaluated, using short questionnaires: from perspiration that passes unnoticed to intolerable perspiration, which prevents the patient from living a normal life.

Glands which produce too much sweat

We have millions of tiny glands spread over the skin's surface which are responsible for producing sweat. They are called the sudoriferous glands. An adult therefore secretes at least a half-liter of sweat (composed of 99% water) per day from these glands, without even noticing!

The quantity of sweat produced by these glands increases (and is more noticeable!) during physical activity or when it is hot, thus enabling the body to cool down. In the case of hyperhidrosis, a large quantity of sweat is produced even if the patient does not take part in physical activity or is not exposed to high temperatures.

Embarrassing symptoms

Excessive perspiration is embarrassing because it is often visible. Sweat patches on clothes, clammy hands, etc., can have psychological and social consequences.

Excessive perspiration on the hands 
For example, excessive perspiration on the hands can be embarrassing when handling objects or documents, or simply when shaking someone's hand.

Excessive perspiration on the feet
On the feet, heat and humidity create the ideal conditions for bacteria and fungi to develop, particularly on the soles of feet and between the toes, which can lead to skin infections.

In addition to producing too much sweat, the bad odor caused by sweat can also be a problem for people suffering from hyperhidrosis… and their friends and family. This bad odor is produced by bacteria on the skin's surface. These bacteria breakdown the constituents in sweat and produce the molecules which cause the embarrassing odors. 

Hyperhidrosis can therefore have a significant impact on the personal and professional life of people who suffer from it, and can sometimes make the patient very unhappy or even depressed.

Solutions for living better day to day with hyperhidrosis

In addition to improving hygiene, there are several solutions for living better day to day with hyperhidrosis.
First and foremost, antiperspirant active ingredients
In the case of localized hyperhidrosis, using antiperspirants is often the first step in treatment. In contrast to deodorants, antiperspirants do not simply mask odors. Those which contain aluminum salts help to effectively control the quantity of sweat produced. Aluminum salts react upon contact with sweat and quickly form a plug in the orifice of the sudoriferous glands. This mechanism puts the sudoriferous glands in rest mode, with each application, and therefore helps regulate perspiration. Aluminum salts also acidify the skin upon contact with sweat, which explains why these products can be irritants, however this action also counteracts bacteria and therefore bad odors. There are different types of aluminum salts (chloride, chloride hydroxide, acetate, gluconate, benzoate, salicylate, etc.), with aluminum chloride being the most commonly used. 

In order to limit skin irritations, it is advisable to use an antiperspirant that is alcohol and fragrance free, and to apply it to clean, dry and non-irritated skin (avoid application immediately after shaving the underarms, for example).

The formulas of antiperspirant products may also contain odor-capturing or moisture-absorbing ingredients, to complement the action of the aluminum salts. 
Alternative solutions
If using antiperspirants does not obtain satisfactory results or is not appropriate due to the extent of the hyperhidrosis, other solutions can be offered:
  • Iontophoresis. 
This method can be offered to patients who suffer from excessive perspiration on the hands and feet. It involves soaking the hands and feet in a tub of water through which a weak electrical current is passed (20 milliamperes), thus allowing small plugs to form in the orifice of the sudoriferous glands.
This treatment protocol, which can be carried out at home, lasts 10 to 30 minutes and must be repeated regularly to be effective.
  • Botulinic toxin injections
Botulinic toxin injections (or Botox®) may be offered as a second option for excessive underarm perspiration, if antiperspirants are ineffective. The doctor identifies the areas affected by excessive perspiration (using the "Minor test") and then injects the product in order to block the sudoriferous glands in localized areas.
This technique produces very good results but its efficacy is only temporary, the injections must be repeated every four to six months, and it is non-reimbursable.
It may sometimes be offered for the hands and feet, if antiperspirants and iontophoresis are unsuccessful.
  • Medicinal treatments
For hyperhidrosis over widespread areas, oral "anticholinergic" drugs may be prescribed. These drugs can help reduce sweat production, however there are several contraindications and they can cause many side effects (dry mouth, vision problems, constipation, tachycardia, etc.).
  • Surgery
Lastly, as a final option, and in the most severe cases where the previously mentioned treatments are ineffective, surgery may be offered. 
The operation is called "sympathectomy" and involves cutting the nerve which regulates the activity of the sudoriferous glands. This severing of the nerve completely prevents perspiration on the upper half of the body. The main side effect is the frequent occurrence of "compensatory" hyperhidrosis on another area of the body, which is sometimes more significant and embarrassing than before the operation.
Don't hesitate to ask your pharmacist for advice or to see a doctor in case of embarrassment due to perspiration. There are solutions!