Sweating is a vital function of our body that protects us from overheating. For this reason, about 3 million sweat glands, which are responsible for regulating body temperature, are distributed over the whole body.
As a rule, increased sweat production only occurs when the body has to cool itself, for example on hot days or during sports. However, if our body permanently produces too much sweat, which is not needed, this is called hyperhidrosis. About 3 percent of all people are affected by hyperhidrosis.
Very many sweat glands are found particularly under the armpits, which is why excessive sweat production is particularly noticeable and burdensome here. Those affected have to change their clothes several times a day in order to avoid visible patches of sweat.
Furthermore, the armpits provide optimum conditions for certain skin bacteria, which are responsible for the typical unpleasant odour of underarm sweat.
Commercially available deodorants can protect against unpleasant odour in hyperhidrosis, but not against excessive sweat production.
Hyperhidrosis does not need, however, be confined solely to the armpits. Excessive sweat production can occur in other parts of the body, for example on the hands, feet or head.
In our practice in Munich, we basically rely on non-operative procedures to stop excessive sweat production: ultrasound therapy with Ultherapy® and treatment with botulinum toxin. With both methods, a reliable connection of the sweat production can be achieved within a short time.
When our body is challenged – whether by heat, exercise or exertion at work – it starts to sweat.
Sweat in itself is a good thing, because its formation and evaporation removes heat from the skin and the blood vessels that lie within. In this way, the body virtually starts its own climate system. At the same time, harmful germs on the skin are combated by the production of sweat and with the help of certain immunoglobulins. Their toxins are neutralized. This creates a special environment on the skin, which strengthens the acid mantle. And this in turn inhibits the growth of microbes.
Sweat consists of 99 percent odorless water. The remaining one percent is distributed among common salt, calcium or magnesium. The fact that it can develop an unpleasant smell is due to various metabolic products, fatty acids and sex hormones that are excreted at the same time. Harmless microorganisms on the skin then convert the actually odorless substance into “fragrances”.
Nevertheless, there are two types of sweat glands:
Eccrine glands, which produce odorless sweat and spread throughout the body, and apocrine scent glands, which are found mainly in the genital area and armpits.
In hyperhidrosis patients, the eccrine sweat glands are overactive, so sweat is usually odorless.
About two to three million sweat glands are distributed over the entire skin or body. They give off between half a litre and a litre of sweat every day. Nautrally, we sweat most where the sweat glands are particularly dense and numerous (e.g., on the soles of the feet, palms of the hands, underarms or forehead).
Some people are “disgusted” when others sweat a lot and worry about getting sick on contact. But don’t worry: By itself, sweat contains no pathogens that can be passed on.
For the sweating patients themselves, however, sweating can cause problems: Increased perspiration, e.g., on the feet, can actually lead to diseases (e.g. athlete’s foot, warts or the bacterial infection keratoma sulcatum).
No matter how many sweat glands a patient has and how close together they are, they say nothing about that person’s activity. This shows whether the sweating process in the body is normal or disturbed.
If hyperhidrosis is present, the sweat glands work excessively. The purpose of sweating is no longer to fulfil the natural and normal functions of sweating. The sweat glands have a malfunction and produce secretion even when it is not necessary.
For hyperhidrosis patients, this means that they sweat heavily even though no physical exertion is undertaken and there are no elevated outside temperatures. You sweat so much that large, wet stains on clothing become visible (or noticeable in footwear).
In patients with hyperhidrosis the sweat can come out very suddenly, especially in the armpits, and even run down the side of the body. Other areas of the body that are often affected by excessive sweating are the palms of the hands and feet. Some patients even sweat a lot all over their body.
Often no clear medical reason for hyperhidrosis can be found. The sweat glands seem to be particularly active “just like that”.
Then there are patients who, for example, begin to sweat particularly heavily when they are anxious, in pain or under stress.
In some cases hyperhidrosis can also be the result of another disease. Possible conditions include hyperthyroidism, certain infectious diseases, and autoimmune diseases, but also hormonal disorders as well as neurological or psychological diseases. Other causes that may be associated with hyperhidrosis are: high blood pressure, low blood sugar, menopause, overweight/obesity, the side effects of medication or circulatory problems.
If you suspect that you have hyperhidrosis, you should definitely have a medical examination to rule out (more serious) diseases.
Patients who sweat a lot usually deal with this problem on a daily basis. This is why they spend a lot of time avoiding situations that are unpleasant for them. To hide the sweat stains, they lay cloths and pads under their arms, for example, or constantly wipe themselves dry, or freshen up and change their clothes. Others wear dark, wide garments under which sweating and sweat stains are not immediately noticeable.
There are certainly patients who are ashamed and afraid of what other people might say and think about them. They therefore withdraw from active life and mothball themselves in their homes. Many also choose a profession where they don’t have to have much contact with other people, shake hands and give lectures and presentations, for example.
Hyperhidrosis patients often suffer not only from problems with self-confidence and self-esteem, but the frequent heavy sweating can also lead to unpleasant skin problems: Softening of the skin, inflammation or a bacterial and fungal attack are frequent consequences of constant sweating.
For an initial assessment you can take a hyperhidrosis test on the Internet (e.g here).
However, this cannot replace a visit to the doctor. Since hyperhidrosis can also be a symptom of a physical illness, you should definitely have yourself examined – especially if you suddenly sweat a lot, which was not the case in your previous life.
By taking a comprehensive medical history and carrying out various examinations and tests, your doctor will narrow down where the hyperhidrosis comes from.
As a rule, the medical history and hyperhidrosis examination with your doctor will be carried out in four different steps:
Depending on how pronounced the hyperhidrosis is, the cause of the excessive sweating and how much the patient suffers, there are different treatment options.
Botulinum inhibits the transmission of excitation from the nerve to the muscle. The muscle in question relaxes. In the treatment of wrinkles, this means that wrinkles are smoothed out. In the treatment of hyperhidrosis, the active ingredient binds to the peripheral nerve endings that use acetylcholine as a transmitter to activate the sweat glands, where it blocks signal transmission. The activity of the sweat glands is reduced and the patient perspires significantly less.
The active ingredient is mainly used to treat severe underarm perspiration. First, we draw a grid on the skin that marks the entire sweat center. This allows for an even distribution of the active ingredient. The botulinum is then injected under the skin at a certain distance with the finest needles, about 20 to 30 times per armpit. It develops there, and its effectiveness lasts for about half a year.