Hyperhidrosis

Everyone knows the situation of sweaty armpits, be it after sports, or during a stressful situation. It is perfectly normal to sweat under the underarms. Yet, for some people the underarm can constantly sweat, causing moist underarms and embarrassing social situations.

Hyperhidrosis is known as excessive sweating, beyond what is necessary to regulate body temperature. Next to the underarms, it can also affect the palms, soles of the feet and face. It can significantly impact an one’s quality of life, leading to embarrassment, social anxiety and emotional distress. About 5 to 10% of the population suffers from hyperhidrosis. Only 0.5 to 1% of the population suffers from bromhidrosis, where the underarms smell bad. Hyperhidrosis is a very common condition, and many people seek solutions for it.

There are two types of hyperhidrosis. Primary hyperhidrosis is when the condition occurs without any underlying medical cause. It usually starts in the morning, and it stops on its own in the evening. It is due to overactivity of the sweat glands, which are controlled by the sympathetic nervous system.

Secondary hyperhidrosis is when it is caused by an underlying medical condition or medication. The underarm glands react to an underlying (and sometimes unknown) condition. We have important immune regulatory glands in the underarms, which are in direct contact with our sympathetic nervous system and brain. Adrenaline and stress stimulate the underarm glands and can lead to a direct sweat secretion.

Hyperhidrosis is a metabolic problem, meaning, it comes from within the body. Much is linked with the internal metabolism and body’s immune system. It can be strongly linked to the blood sugar levels. The western diet does not really promote healthy blood glucose levels. A sugar-rich meal can hike up the blood glucose levels, and as a result the body produces adrenaline and hormones, which results in immediate sweating. If the blood glucose levels are low, for instance in the middle of the night, the body also produces adrenaline, which results in sweat production and feeling of nervousness. Similarly, sweating will be more pronounced with the onset of a flu or other disease. When the immune system is more active, this can be expresses through the sweat glands, which are immediately linked to the nervous system. Primary hyperhidrosis does not have a known medical condition linked to it. But it can also be an early warning signal that something is off in the body.

Below I will list some known and perhaps also novel solutions to cope with hyperhidrosis.

Meditation can be helpful to cope with stress and associated sweating. Simple breathing exercises can help to lower stress and reduce sweating.

Practicing sports and frequent physical activity is also a good way to train our body and teach the body that sweating is needed during sports, and not on other moments. It also lower background stress and will ultimately help to cope with excessive sweating. Practicing sports down regulates the body’s immunity. Physical activity has multiple health benefits including decreased illness incidence and a lower systemic inflammation.

Adjust the diet to cope with sweating. There are many ingredients that can provoke sweating.

  • Sugar and carbohydrates. After a high-sugar meal the body makes too much insulin, the hormone that helps process sugar into energy. This leads to a peak and dive of insulin, which can lead to sweating. Particularly in the morning, when the body naturally has a rise in blood glucose (dawn phenomenon), it is important not to consume too much carbs. Breakfast cereals are the worst breakfast.
  • Caffeine. Avoid coffee or tea, or drink decaf coffee and tea that does not contain theine (rooibos, chamomile and others). Caffeine (chemically the same as theine) is a stimulant and stimulates the central nervous system, heart, muscles and can stimulate blood pressure. As a result, caffeine will provoke sweat (over)production.
  • Gluten. This is the chewy part of wheat and other grains. Difficult to break down in the gut for some people, and can provoke an immune reaction. If gluten intolerant or gluten sensitive, then best to avoid or reduce its consumption.
  • Dairy milk products. As babies our body makes lactase, the enzyme that breaks down the lactose present in milk. As we grow older, our body doesn’t produce it anymore. Our gut microbiome however takes over that role. But we don’t have the strong gut microbiome of a hunter-gatherer anymore, so for many people, this is not an option. Limiting or avoiding dairy products can help in coping with excessive sweating.
  • Fodmaps. Some people experience digestive distress when consuming fructans, galactans, or other saccharides and polyols. Such digestive distress, even low, can be enough to cause an inflammatory reaction that leads to excessive underarm sweating.
  • Red meat or particular fish can cause digestive problems with associated sweating. Joey from friends once consumed a lot of meat, and he mentioned that the meat sweat was coming up. Meat can be hard to digest, and as such, sweating can be the result.
  • Spicy food leads to gustatory sweating. Spicy food contains capsaicin, which binds to receptors in the mouth detecting warmth. This starts a thermoregulatory response in the body. The body feels warm, so sweat is produced to cool it back down.

Next to adjusting the diet, one can also go onto a real diet: refraining from eating at all for a period of time. Throughout history, humans naturally went on a diet, because there was no food to be found for a period of time. Our body recalibrates and readjusts to the situation and it can be helpful against hyperhidrosis.

The most known treatment is antiperspirants, as well as prescription-based antiperspirants. Antiperspirants contain aluminium salts that block the sweat pores. The prescription-based ones contain a higher amount of aluminium salts (15% or higher), in order to have a better effect. For now, there is no alternative for aluminium salts to block the sweat pores. We know that aluminium can have a very big impact on the underarm microbiome, so best not to overuse them. It is not easy to find a good alternative for it.

There are underarm pads for sale that can be put in the underarm areas of the T-shirt. This is an effective way to soak up the sweat, so that it is no longer visible on the shirt or sweater. These can be easily replaced when needed.

There are particular creams and wipes that contain glycopyrrolate or glycopyrronium tosylate, which can alleviate the problem. The creams and wipes are used to treat hyperhidrosis in underarms, hands and feet.

Oral medication, such as propantheline bromide, is another possibility to reduce sweating. These pills are taken orally and block the nerves that trigger the sweat glands. It is a temporary solution, and it could also lead to a dry mouth, dry eyes and other side effects.

Overproduction of sweat is heavily linked with stress, so in some cases antidepressants are prescribed and regarded helpful. The medication reduces stress and anxiety, and as such it also reduces sweat production.

Iontophoresis is often applied for hyperhidrosis on hands and feet. The hands/feet are soaked in water while a device sends mild electric current through the water to shut down the sweat glands temporarily. The current blocks the nerves that trigger sweating. This is a temporary solution and will need to be repeated over time to maintain results.

Botulinum toxin (botox) injections are used to block the release of acetylcholine neurotransmitter, paralyzing the muscles who steer the sweat secretion and consequently reducing the sweating. The botulinum injection results in a temporary sweat reduction of two to six months. After maximum six months, the body broke down the botox, and the effect will run out.

A recent technique that the dermatologist can also perform is the application of a sodium sheet in the underarm (Brella patch). The sodium reacts with water and gives off a lot of thermal energy that can destroy or melt sweat ducts. The sodium will not go very keep in the skin, so the effect remains superficial, and the effect lasts for three to four months.

Other treatments include microwave-based ablation of sweat glands. A handheld device (miraDry) delivers microwave energy to destroy sweat glands in the armpits underneath the skin surface. This will permanently destroy the sweat glands. It is usually done once, or can be done a second time to remove the sweat glands that were missed the first time. It takes immediate effect.

Sympathectomy, on the other hand, is a permanent way to stop the heavy sweating. A surgeon cuts or clamps the nerves and thus prevents nerve signals from passing through. The surgeon removes a small section of the spinal nerves that controls the sweating. This is likely more done for hyperhidrosis in the hands. It is not an option for isolated head and neck sweating. This is a permanent way to stop hyperhidrosis.

Axillary liposuction is often performed to permanently remove or disrupt the sweat glands in the underarms. A surgeon will scrape or suck out the fatty tissue of the underarm skin where the sweat glands are located. This is a permanent way to stop hyperhidrosis.

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