Imagine your life on a daily basis, living with a medical condition that only gets worse the more you think about it. This is what millions of people living all over the world suffer with every day. The medical condition is called Hyperhidrosis and, while its name may imply a hyperactive or behavioral problem, the truth is that this disorder affects the body’s ability to sweat.
While sweating is normal and it is true everyone sweats, those suffering with Hyperhidrosis sweat at a much higher rate than the average person. Since the body’s mechanism for cooling itself is overactive, Hyperhidrosis sufferers may sweat four or five times more than is necessary (Definition of Hyperhidrosis 1). Typically the average person sweats in situations such as warm temperatures, exercising, and emotional types of situations such as being nervous, angry, embarrassed, or scared (Medical Encyclopedia: Hyperhidrosis 1). However people with Hyperhidrosis sweat in all types of situations and much more in these specific circumstances. Just thinking about their sweaty hands condition makes those with Hyperhidrosis sweat even more, essentially amplifying the problem and making the situation worse. Primary Hyperhidrosis affects two to three percent of the American population, where the excessive sweating is primarily concentrated on the hands, feet, and armpits. Despite this fact, less than forty percent of those with this condition attempt to seek any medical remedy at all (Medical Encyclopedia: Hyperhidrosis 1). If excessive sweating occurs as an indirect result of a preexisting medical condition, it is called Secondary Hyperhidrosis. Some of the common medical conditions that result in Secondary Hyperhidrosis include: cancer, menopause, anxiety, and spinal cord injuries (Medical Encyclopedia: Hyperhidrosis 1).
The term Hyperhidrosis dates back to ancient medicine, where the Greek physician Hippocrates used the term hidroa, which was translated from Greek to Latin and Latin to English to the word sudamina. Eventually, sudamina gave birth to the word hidrosis, which we use today (Eisenach 657). Hyper, which can be defined as an excess of some sort, is the prefix affixed to the term hidrosis to form the current medical term for excessive sweating, Hyperhidrosis.
Ancient and historic medicine have long tried to define and understand what exactly is Hyperhidrosis and, from a medical standpoint, why this abnormality happens in a generally rare group of individuals. In 1911, Meachen authored three goals for the diagnosis and treatment of Hyperhidrosis: “To seek out the underlying cause for the increased sweating and endeavor to remove it; to check or modify the amount of secretion itself; and to relieve any secondary dermatitis or other complications that may arise” (Eisenach 657). While written in 1911, these goals are still the primary goals of dermatologists treating Hyperhidrosis today. With the advancement in medicines and technology, there are several treatment options in helping deal with or eliminate this condition all together including the following: antiperspirants, medication, iontophoresis, botox injections, and endoscopic thoracic sympathectomy, ETS for short (Medical Encyclopedia: Hyperhidrosis 2-3).
Antiperspirants are usually the first option when the signs and symptoms of excessive sweating are first noticed. These products work by essentially plugging the sweat ducts, eliminating sweating by stopping it at the source, using 10 to 15 percent aluminum chloride hexahydrate as the chemical compound contained in these strong antiperspirant products. Some of the side effects of this treatment include skin irritation and damaged clothing (Medical Encyclopedia: Hyperhidrosis 2). While ideal in the treatment of underarm sweating, antiperspirants are not practical for facial and hand sweating.
If antiperspirants are ineffective or the excessive sweating is bothersome in places other than under the arms, medication is the next popular treatment option used. Specifically, anticholinergics drugs are used to assist in the prevention of frequent and overactive sweat gland stimulation. Glycopyrrolate is a common medication which can be prescribed under names such as Robinul and Robinul-Forte, with side effects including dry mouth, dizziness, and urination problems (Medical Encyclopedia: Hyperhidrosis 2). The effectiveness of these drugs is in question, although some patients report success in the reduction of their excessive sweating, as these drugs have not been studied as scientifically as other treatments.
If prescription medication fails to alleviate excessive sweating, the next treatment option available is an FDA-approved procedure called iontophoresis. Using electricity to temporarily turn off sweat glands wherever the device is applied, it is usually most effective for treating excessive sweating in the hands and feet. The therapy is conducted by inserting the hands or feet into water and by using a gentle current of electricity, the electricity is gradually increased until a light tingly sensation is felt. This process usually takes 10 to 20 minutes and must be done over several sessions for optimal results, with the side effects being skin cracking and blisters, although rare (Medical Encyclopedia: Hyperhidrosis 2). This is generally the last topical treatment available for the treatment of Hyperhidrosis, with several medically intensive treatments available if symptoms continue to persist.
Botulinum toxin type A, or botox for short, is a recently approved FDA drug for the treatment of primary auxiliary Hyperhidrosis. The treatment consists of small amounts of purified Botulinum being injected the areas of severe sweating which temporarily blocks the sweat stimulating nerves, with the side effects being injection-site pain and flu-like symptoms, although if used for the treatment of sweating of the palms, mild, temporary weakness and intense pain may result (Medical Encyclopedia: Hyperhidrosis 2). Due to the fact that botox is also used in cosmetic surgery, many insurance companies consider botox injections cosmetic rather than medically necessary and will not pay for the usually expensive costs of botox injections, which means this treatment option is out of reach for many Hyperhidrosis sufferers.
The last treatment option currently available to Hyperhidrosis sufferers is a medical procedure called endoscopic thoracic sympathectomy, or ETS for short. Usually reserved for patients with severe cases of Hyperhidrosis, this surgical procedure is preformed by a specially trained doctor who makes 2-3 cuts in the patient’s underarm. The patient is asleep under general anesthesia with a lung collapsed by the doctor to allow more room to work. The cuts are used to guide in an endoscope camera to the nerve associated with the overactive gland. Once the nerve is properly identified, it is clamped or cut and removed, with the identical procedure done on the other side of the body. This is a very risky procedure with risks including artery damage, nerve damage, and increased sweating, which occurs in 50% of post-surgery patients (Medical Encyclopedia: Hyperhidrosis 3). For Hyperhidrosis sufferers, some believe the potential benefits outweigh the risks with success reported by many and excessive compensatory sweating reported in others. As reported by forum user fmurphy00, “The CS was really bad that I have to change my lifestyle. Its like a sauna like sweating specially summer time” (CTSNet Forums: Hyperhidrosis Thread#176682). Life-altering excessive compensatory sweating is a risk that must be considered when contemplating this medical procedure. This procedure is reversible however surgery will again be required and depending on the method used to originally remove the nerve associated with the overactive gland, nerve transplant may be necessary with no guarantees the compensatory sweating or other side effects as a result of the ETS procedure will be cured. With this treatment, eliminating sweating in certain parts of the body only to have extreme sweating in other parts of the body that were not an issue before the procedure is a reality that many who have undertaken this procedure must deal with on a daily basis.
While much has been done medically, the social and mental affects of Hyperhidrosis are still somewhat of a mystery, nearly 100 years after Meachen created the three goals for the physical treatment of Hyperhidrosis. Socially, sweating is generally frowned upon unless exercising or participating in athletic activities. The lack of awareness and grave misconceptions of the uncontrollable nature of the excess sweating leads many to pass judgment and initiate negative criticism. Society has yet to recognize excessive sweating as an accepted medical condition. For example, those who would not dare insult or criticize people with Parkinson’s disease for their uncontrollable shaking would easily insult people with Hyperhidrosis for their excessive sweating. Whether just made light of or ill-intended, comments on a person’s excessive sweating cause immeasurable mental damage that may change a person’s daily life. For example, a person’s Hyperhidrosis may lead them to avoid wearing certain light colors which easily show sweat stains or marks. Heavy socks must be worn at all times to absorb the sweating of the feet. Certain types of deodorants and antiperspirants must be used as only the strongest products can effectively counter the effects of Hyperhidrosis. Certain lifestyle choices must be made as well, such as in a person’s career or place of residence as hot or humid environments are not ideal for Hyperhidrosis sufferers.
Excessive perspiration interferes with even life’s most trivial of tasks, such as working with hand tools, operating an automobile, and writing in schoolwork. Imagine frantically trying to take notes as the teacher is lecturing about important class material only to go back later and find out your notes are nothing more than wrinkled pieces of scraps from the sweat that dripped all over the paper. For those diagnosed with Hyperhidrosis, this is not just a bad day; rather this is life on a daily basis.
Psychologically, those with this genetic disorder must endure relentless fear of ridicule and embarrassment their excess sweating potentially may bring. Constantly worrying over sweating means there is little else to think about other than how sweaty their hands might be or already are. In business and in life, our society is based around the “handshake” and psychologically, Hyperhidrosis sufferers fear the “handshake” in places such as job interviews and business meetings. Some people have this belief that a man can be judged by his handshake. Hyperhidrosis sufferers detest this ideology, and feel that their sweaty handshakes can be a huge detriment to their personality and overall likeness.
Hyperhidrosis sufferers especially struggle with romantic and intimate types of situations. Given that the showing of one’s feelings for another involves heavy physical contact, not to mention the fact how nervous and emotional these circumstances can be, it is no secret why Hyperhidrosis sufferers have psychological issues with physical contact. In relationships with Hyperhidrosis sufferers, partners who don’t have Hyperhidrosis may claim to offer acceptance and understanding of this socially embarrassing disorder; however, their subconscious cues such as wiping sweat off their body after physical contact with their partner tells a different story. These subconscious actions have long lasting and deep psychological affect on those with the uncontrollable excessive sweating.
Children are another example where the psychological impacts of Hyperhidrosis have not been fully studied or fully understood. Given how much physical contact children participate in on a daily basis for an early age, excessive sweating, with its socially embarrassing connotation, causes awkwardness in physical contact with other children. Playing intense video games, for example, can lead to excessive sweating which leads into embarrassing situations with other children when taking turns playing with the same controller.
Hyperhidrosis suffers from a lack of general public awareness and education and a misconception that is as detrimental to the general scientific community studying Hyperhidrosis as it is to those who have it. Perhaps the socially trendy botox injections with its ties to the treatment of Hyperhidrosis will elevate this disorder to a higher level? Ultimately, this misunderstood genetic disorder must be continued to be scientifically studied and evaluated in order for society as a whole to fully recognize and understand the detrimental social, physical, and psychological affects Hyperhidrosis can have on those who suffer with the embarrassment of uncontrollable, excessive sweating on a daily basis. More needs to be done to get the message out that there is help and with continued scientific study, one day those who do not suffer with excessive sweating will understand that Hyperhidrosis is more than just a little bit of extra sweat.