Heavy Sweating

Physiological background

Sweat is produced by millions of eccrine sweat glands that are distributed throughout the body and are particularly numerous on the palms and soles of the hands, face, and armpits. The eccrine sweat glands are spiral and clustered glands that open directly onto the skin surface. They are innervated by cholinergic nerve fibers of the sympathetic nervous system and are stimulated both directly by cholinergic substances and indirectly by adrenaline and sympathomimetics. Sweat formation is subject to central control by the hypothalamus. Sweat cools by evaporation and counteracts overheating.

Symptoms

Profuse sweating, especially on the palms and soles of the feet and in the armpits.

Causes

Primary (essential) hyperhidrosis is without an identifiable cause (idiopathic) and without accompanying symptoms. It usually begins in childhood or adolescence. Secondarily, heavy sweating can be triggered by a number of diseases or substances; see differential diagnosis. According to estimates, between 1-3% of the population is affected.

Complications

Feeling of shame, frustration, social withdrawal, low self-esteem, depression, difficulty at work. Skin disorders: Dermatitis, maceration, fungal infections, bacterial skin diseases, intertrigo (skin wolf).

Differential diagnosis

Physiologic sweating:

• Emotions
• Warm environment or clothing
• Sports

Medication:

• For example, cholinesterase inhibitors, antidepressants such as the SSRIs, SSNRIs and tricyclic antidepressants, opioids, tramadol.

Secondary, heavy sweating can be triggered by, among other things:

• Fever
• Menopause
• Hyperthyroidism, thyrotoxicosis
• Diabetes, in case of hypoglycemia
• Gigantism, acromegaly
• Overweight, obesity
• Cardiovascular disorders (heart failure, myocardial ischemia).
• Respiratory failure
• Hodgkin’s disease, neoplasms, phaechromocytoma.
• Gustatory and olfactory hyperhidrosis.
• Cold-induced hyperhidrosis
• Dermatological diseases
• Infectious diseases (tuberculosis, brucellosis).
• Spinal cord injuries
• Neurologic disorders: Focal brain lesions (e.g., hypothalamus).

Non-drug treatment.

• Iontophoresis with tap water is effective. It involves moistening the skin with a water bath or sponge and applying a current. The therapy can be performed in medical treatment or at home.
• Surgical methods: removal of sweat glands, cutting the sympathetic nerve fibers.
• Methods to relieve stress, if emotions trigger sweating.

Prevention: Wear light clothing, cool ambient temperature.

Drug treatment

Antiperspirants (antihidrotics): tannins close the sweat glands:

• Aluminum chloride (solution 20-25%) is one of the most commonly used agents. The main effect is the closure of the sweat glands. It is applied daily or at intervals of a few days in the evening and washed off with soap and water in the morning. Aluminum chloride is also contained in lower concentrations in most deodorants and is used for normal sweating. Local irritation may occur as adverse effects.

• Other aluminum salts such as alum (alum deodorant stick).

• Methenamine releases formaldehyde in an acidic environment, which precipitates proteins and thus leads to the closure of the sweat glands.

• Synthetic tanning agents

• Less commonly used: Boric acid, resorcinol, tannic acid, potassium permanganate and other tannins.

Anticholinergics:

• Such as atropine or oxybutynin inhibit cholinergic signaling to the sweat gland and thus inhibit sweat production. However, adverse effects such as visual disturbances, dry mouth, constipation, and urinary retention are possible. Restrictions on use and drug-drug interactions must be taken into account. They are also used locally, for example, iontophoresis.

Botulinum toxin:

• Is effective and approved for hyperhidrosis of the armpits. Botulinum toxin inhibits the release of acetylcholine from the sympathetic nerve endings and thus the activation of the sweat glands.The toxin is injected locally into the skin under specialist treatment. The effect occurs after about a week and lasts between 4-7 months. Disadvantages include the method of application, possible adverse effects such as muscle weakness and the cost of treatment.

Sage:

• Is used in phytotherapy as a tea or in the form of extracts. Sage is well tolerated, but should not be used during pregnancy and lactation. The tea should be drunk cold, because the heat supplied can cause sweating.

Sedative medicines:

• If stress and emotions are triggers