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How Much Sweat Is Too Much?

miraDry at Lakeview Dermatology

Article published in SELF Magazine | November 1, 2019 | By Angela Ballard, R.N.

What experts want you to know about sweat and when to see a doctor.

This article was created in collaboration with the International Hyperhidrosis Society.

Embarrassingly clammy handshakes, feet that slip-slide off even the tackiest of yoga mats, cute shoes ruined, smeared makeup, damped-down hair, and armpits that soak shirts like a leaky faucet. Sometimes there’s too much of a good thing.

And, yes, sweating is actually a good thing…usually.

Like it or not, sweating is human, necessary, and natural. Sweating helps the body to maintain a healthy internal temperature so we can function and survive. Think of sweating as a personal air conditioning system; it kicks in when you need it most—like on hot, humid days or when you’re in the midst of a butt-kicking workout (and, uh, yeah, butt sweat is a thing). There’s also, of course, the stress sweat that emerges during job interviews, presentations, and other now-I’m-in-the-hot-seat situations.

So, sweat is normal. But yes, it can be annoying at times.

But what if you sweat a lot. Like a lot, a lot? Like, four or five times more than your friends are sweating, regardless of stress, exercise, or the weather? Such extreme, uncontrollable sweating is actually a medical condition called hyperhidrosis, or excessive sweating. Hyperhidrosis can soak, drip on, smear, saturate, and ruin many things in a person’s life—from clothing, shoes, makeup, hair, and technology tools to self-confidence and well-being. Living with excessive sweating can take a hefty toll. In fact, one study published in 2016 in the Journal of the American Academy of Dermatology looked at the rates of anxiety and depression in a sample of dermatology patients and found that both mental health conditions were much more common in patients with hyperhidrosis than in patients without it.

But if you’ve never heard of hyperhidrosis before, you’re not alone. Even though it’s a relatively common health condition (affecting approximately 4.8% of the population and 8.8% of people ages 18 to 39) many people—even doctors—still don’t know much about it, nor its life-damaging impacts, how it’s diagnosed, and the many ways to treat it.

It’s time to change that.

An important thing to understand is that there are actually two different types of hyperhidrosis: primary hyperhidrosis and secondary hyperhidrosis.

  • Primary hyperhidrosis is a medical condition unto itself. It’s sometimes called idiopathic hyperhidrosis because it’s excessive sweating with no discernible cause. It is its own thing.
  • Secondary hyperhidrosis is extreme, unwanted sweating that’s being caused by another medical condition or by a medication that a person is taking. Some common causes of secondary hyperhidrosis include serious medical conditions like type 2 diabetes, heart failure, rheumatoid arthritis, and even pregnancy. So, yeah, you want to get your sweating problem checked out. Medications that can cause secondary hyperhidrosis include: certain antidepressants, some beta blockers (used to treat high blood pressure and heart problems), some treatments for schizophrenia, cancer treatments, and many more (the International Hyperhidrosis Society lists at least 240 meds that can cause excessive sweating along with more than 70 medical conditions.)

Key takeaway? Before you start trying to manage your sweating so that it’s less embarrassing and debilitating, please see a knowledgeable health care provider for a thorough checkup and review of your medical history and any medications you’re taking to rule out other potentially more serious conditions and to figure out whether adjusting any medications you’re on may be able to help. Of course, never stop taking any of your medications or change their dosages without talking to your prescriber first.

Okay, so your doctor has ruled out other medical problems and you’re not taking any medications that can cause extreme sweating as a side effect. What else might be considered before making a primary hyperhidrosis (often just called hyperhidrosis) diagnosis? Here are some things that providers typically look for (which can also be thought of as the ABCDEFG’s of hyperhidrosis):

  • Age of onset: 55% of people with hyperhidrosis say their condition started at or before the age of 10 years.
  • Bilateral. Hyperhidrosis sufferers often experience symmetric symptoms on both sides of their body, centered around hands, feet, and/or underarms (or other specific body areas or body area combinations—think face, scalp, groin, and under the breasts).
  • Cessation during sleeping. Primary hyperhidrosis typically doesn’t bring on episodes during sleep. Oddly enough, night sweats aren’t considered a symptom of primary hyperhidrosis.
  • Duration. Your health care provider will likely look for symptoms that have been going on for more than six months.
  • Episodes. Extreme, uncontrollable sweating isn’t usually constant. Most people with hyperhidrosis will experience episodes of varying length and degree. Your doctor may ask about the number of episodes per week and the effects those episodes have on your daily life and mental well-being.
  • Family history. Nearly two thirds of hyperhidrosis sufferers say they have other family members with the problem too.
  • Gets in the way. Hyperhidrosis gets in the way of sufferers’ ability to function, work, have fun, pursue dreams, develop relationships, and more. Tell your doctor about what excessive sweating means to your life.

You might be thinking, Okay, yeah, sometimes I get really sweaty and it’s super embarrassing and inconvenient. Could I have hyperhidrosis? Great question. Here are some examples of what we mean by hyperhidrosis that gets in the way of your life:

  • You can’t use your smartphone because of your sweaty hands.
  • You’re afraid to be touched because of your sweat.
  • You seem prone to skin infections.
  • You find yourself constantly worrying about your next sweating episode.
  • You’ve had to choose a different career path because your sweating would have made your real dream impossible.
  • You’ve had sweat-related slips, falls, or other accidents.

If any of this sounds like you, it’s a great idea to talk to a health provider about your symptoms.

Hyperhidrosis is treatable. Your doctor can tell you about all the various options, like stronger antiperspirants (and how to apply them for maximum benefit), a medical device that uses electricity to address sweating called iontophoresis, injections, electromagnetic treatment, prescription skin wipes, oral medications, and individualized combinations of these treatments. A drier life is possible, but it can take some patience to get it right.

Just remember that if you’re consistently dealing with excessive sweat, you have options. And if your sweat attacks are mostly relegated to your high-intensity workouts, just know that as annoying as that is, it’s totally normal.