Summer is the season of swimming, sunbathing, and sweating.
As the heat index climbs, our bodies work hard to keep us cool.
“When we become hot, a part of our brain called the
hypothalamus signals to little nerves in the skin to tell the sweat gland to
produce sweat,” said Dr. Whitney Bowe, a dermatologist in New York City. The
liquid then cools us when it evaporates.
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While sweating is helpful for cooling us down, few people
enjoy having smelly underarms, stinky feet, and clothes stuck to their back and
groin. And some people sweat excessively no matter the time of year, and in the
absence of typical triggers like heat and physical activity.
Here is why some of us get extra swampy, and a few methods
to cut down on chronic sweating.
Why some people are prone to perspire
People can sweat more when they have infections, take medications
(such as certain antidepressants) or go through perimenopause or menopause,
among other causes, Bowe said.
Others may have a condition known as hyperhidrosis. With
this disorder, sweating is often spontaneous and “unrelated to triggers like
stress, emotion, exercise, and environmental triggers like heat,” said Dr. Mark
Ferguson, a thoracic surgeon who treats excessive sweating at UChicago
Medicine.
About 5 percent of Americans are believed to have
hyperhidrosis. It is unclear what causes it, but it can run in families. People
with hyperhidrosis may sweat excessively around their armpits, hands, feet,
scalp or any combination of those body parts, Ferguson said. Typically, the
condition arises either in infancy or during puberty.
For some people with hyperhidrosis, sweating can be so
intense that they must change clothes multiple times a day. If their hands
sweat, they may have trouble using touch screens, computer mice, and steering
wheels unless they wear heavy gloves, Ferguson said.
If their feet sweat, he said, “you can imagine how quickly
they go through a pair of shoes, because they’re constantly wet and start to
get smelly and start to fall apart.”
Some people sweat so much that it significantly affects
their daily lives. “They don’t want to go out anymore,” Ferguson said.
What can help
For people who sweat a lot, Bowe recommends loose,
moisture-wicking clothing. Many athletic brands offer fast-drying layers and
outerwear. Numi, a women’s clothing company based in Canada, sells undershirts
with sweat-absorbent underarm pads. Mizzen+Main makes sweat-wicking dress
shirts for men. It may also help to spend time in well-ventilated,
air-conditioned spaces, Bowe added.
Antiperspirants can also reduce sweating, Bowe said. These
topical treatments are typically made of aluminum compounds that “plug the
pores of the sweat glands and prevent sweat from coming out,” said Dr. Lyall
Gorenstein, a thoracic surgeon and the surgical director of the Center for
Hyperhidrosis at Columbia University Medical Center. (Deodorants are different
from antiperspirants: They do not affect sweat production, but can help reduce
any accompanying odor.)
Antiperspirants made of up to 15 percent aluminum chloride
are sold over the counter, but doctors can also prescribe stronger prescription
formulations, Gorenstein said. These products can be used not just on the
underarms, but also on the hands, face and feet.
“If you choose to wear antiperspirant, I recommend applying
it at night before you go to bed, rather than in the morning after your
shower,” Bowe said. “Antiperspirant is more effective when it is applied to dry
skin rather than damp skin.”
Iontophoresis is an at-home treatment that can also reduce
hand, foot and underarm sweat, Gorenstein said, and it is sometimes covered by
health insurance. After soaking the affected skin in water, patients use a
small device to produce an electrical current that blocks their sweat glands.
The procedure typically has to be done three times in the first few weeks to
see initial results, and then once a week to maintain them. Some medical device
suppliers may require a prescription for the purchase of an iontophoresis
device in the United States.
In-office treatments
If you are up for a series of visits to the doctor’s office,
another treatment that can reduce underarm and hand sweat is Botox, which
prevents the brain chemical that initiates sweating from activating the sweat
glands, Gorenstein said. Botox is sometimes covered by health insurance. Its
effects typically wear off after four to six months around the armpits, and two
to three months in the hands, Gorenstein said. People can also become resistant
to the effects of Botox after a few treatments, Ferguson added.
A treatment called miraDry can also be used to reduce
underarm sweat in particular. After doctors have numbed the skin with
lidocaine, they use a device to apply heat to the area to destroy its sweat
glands. Often, patients see results after one treatment, but two or three
treatments may be required, Bowe said. MiraDry is typically not covered by
health insurance and can cost several thousand dollars.
Minor outpatient surgery, called endoscopic thoracic
sympathectomy, is usually a last resort, but it can effectively reduce sweating
that affects specific body parts, especially the hands, Ferguson said. During
the surgery, doctors make small incisions under the arm and then either cut,
clamp or excise nerves that stimulate sweat glands.
“It is a very effective therapy — I would say 99 percent
effective in eliminating bothersome hands sweating,” Ferguson said. Sometimes,
however, people sweat more on other parts of their body afterward, he added.
Few people — including primary care physicians — know that
so many treatment options for excessive sweating are available, Gorenstein
said. The condition is “underdiagnosed and underreported,” he said, but
thankfully, it can be managed.
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