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.
Hyperhidrosis: Problem area: armpits
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.
Hyperhidrosis Munich: Effective methods against excessive sweat production – without surgery!
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.
What is sweat made of and why does it often smell so bad?
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.
How many sweat glands do people have?
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).
Does sweat contain pathogens?
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).
Still normal sweating or already hyperhidrosis?
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).
Which parts of the body can be affected by hyperhidrosis?
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.
What are the causes of hyperhidrosis?
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.
Are there different types of hyperhidrosis?
The cause for the overactivity of the sweat glands is not known. There is no clearly identifiable medical reason. Sweating mainly occurs in certain situations (fear, stress, pain).
There is a specific trigger for sweating, e.g. a physical or mental disorder or disease. It is possible that the sweating symptoms will disappear completely if the corresponding triggers are treated.
Heavy sweating is limited to certain areas of the body. Local hyperhidrosis includes the following three forms: 1. Hyperhidrosis axillary
The patient sweats particularly heavily under the armpits. 2. Hyperhidrosis manuum
In this form, the patient’s sweat glands on the hands are excessively active. 3. Hyperhidrosis peduum
The patient suffers from particularly pronounced sweaty feet.
The excessive sweat flow occurs all over the body.
Why can hyperhidrosis be so unpleasant?
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.
How do I find out if I really suffer from hyperhidrosis?
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.
How is hyperhidrosis diagnosed by a doctor?
As a rule, the medical history and hyperhidrosis examination with your doctor will be carried out in four different steps:
Questions about the occurrence of sweating problems
Your attending doctor will ask you about your current symptoms. He would like to find out when the increased sweating first occurred and whether you see any connection with everyday situations, for example.
Questions about family history and personal previous illnesses
The next step is for your doctor to ask you about your relatives’ illnesses to find out whether certain illnesses are more common in the family. In this way he finds out whether the hereditary component can play a role in your complaints. In addition, it is important to consider any previous illnesses that you may have had that can also indicate hyperhidrosis.
Questions about profession and environment
The doctor then goes on to the social anamnesis. In doing so, he gets an idea of your environment (job, family, partnership, circle of friends, possible involvement in associations etc.). It is also a question of whether the sweating problem restricts your private life and social contacts – because this is a clear indication of a reduced quality of life.
Your doctor has a variety of tests available to determine the presence or nature of hyperhidrosis. On the basis of this he derives the treatment. Here, for example, there is the iodine strength test (minor test). It focuses on an optically visible colour change of the skin in case of excessive sweat production. Gravimetric measurement can also be used, which allows the exact amount of sweat secreted to be measured. This test is used when the hyperhidrosis area is precisely defined.
How can hyperhidrosis be treated?
Depending on how pronounced the hyperhidrosis is, the cause of the excessive sweating and how much the patient suffers, there are different treatment options.
For secondary hyperhidrosis: Treatment of the underlying disease
If the excessive sweating is due to an underlying disease of the body (which raises the question: What are the causes of hyperhidrosis?), then the disease must be treated. In many cases hyperhidrosis will then disappear on its own. If the heavy sweating persists, various other treatments (listed below) can help.
An antiperspirant is usually offered in the form of deodorant rollers, creams or powders. When applied, it leads to a death of the sweat glands. In this way the welding flow is significantly reduced. In most cases, these antiperspirants also have an antibacterial effect. The effect is based on the metal salts contained, most commonly aluminium salts. As effective as antiperspirants are, there are also opponents of this sweat-fighting variant. Aluminium salts are suspected to be harmful to health and to promote the development of breast cancer, nerve damage and Alzheimer’s disease, for example. Their use is therefore controversial. However, there are currently no studies that clearly prove this.
The natural remedy sage helps some patients to reduce sweating to a normal level. Sage is a medicinal plant from the labiate family. It contains essential oils, tanning agents and secondary plant substances, so-called flavonoids. The ingredients can have a calming effect on the central nervous system, which also controls the sweat glands. Preparations containing sage can reduce mild forms of hyperhidrosis. But they are also a good and natural complement to other therapy options. Traditionally, sage can be used internally or externally: Three cups of tea made from fresh or dried sage leaves, steeped for a quarter of an hour, can help against sweating from the inside. Sage drops are also considered a good way to combat mild hyperhidrosis. Sage baths can help with perspiring feet. It is recommended to put two litres of hot water with four to six tablespoons of dried sage leaves in a tub and bathe the feet in it.
Drugs can also be used to treat hyperhidrosis. For example, if the patient sweats too much all over the body and the cause is unclear, so-called antihidrotics have proven effective in many cases. If excessive sweating occurs mainly in psychologically stressful situations or is to be regarded as the result of a mental illness, psychotropic drugs, tranquilizers or, in certain cases, sedatives can also help.
Tap water iontophoresis
Patients who suffer from heavily sweating hands and feet can benefit from treatment with weak current. This can be directed to the affected skin areas by water baths or moist electrodes.
In the case of excessive underarm perspiration, curettage treatment can also be considered. This is a shallow suction of the sweat glands. In the second step, a curette, a kind of “sharp spoon”, is used to complete the treatment. In this way the armpit area is thoroughly freed from sweat glands.
In our practice we can combat overactive sweat glands with the innovative Ultherapy®. With micro-focused ultrasound, we permanently destroy overactive sweat glands in the armpit by heating them up to 65°C for a short time, whereby the ultrasound energy is emitted at different depths of the skin. The skin surface remains undamaged during the treatment and there is no downtime.
Botulinum is mainly known as an “anti-aging injection”. The active ingredient reliably smoothes expression lines, such as transverse forehead wrinkles, crow’s feet, frown lines or even nasal wrinkles. But it can do even more! Botulinum toxin is also used against excessive underarm perspiration, and thus to combat hyperhidrosis.
How does Botox work against hyperhidrosis?
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.
How does hyperhidrosis treatment with botulinum toxin work?
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.