Conditions We Treat

Hyperhidrosis (Excessive Sweating)

At Livingstone Dermatology, we understand that your skin is a reflection of your health and well-being. We are committed to the latest advancements in dermatological science, and dedicated to providing you with quality care.

Overview

Sweating is a normal bodily function that helps regulate temperature. However, for some individuals, excessive sweating occurs regardless of temperature or physical activity. This condition, known as hyperhidrosis, affects daily life, causing discomfort, and social anxiety. Fortunately, various treatments are available to help manage excessive sweating effectively.

What is Hyperhidrosis?

Hyperhidrosis is a medical condition characterised by excessive sweating that goes beyond what is necessary for temperature regulation. It can affect different parts of the body, including the palms, soles, underarms, and face. This condition is typically caused by overactive sweat glands, leading to persistent sweating – even when at rest.

Types of Hyperhidrosis

Hyperhidrosis is categorised into two main types, which are:

Primary Focal Hyperhidrosis – primary focal hyperhidrosis is usually inherited, affects specific areas such as the hands, feet, underarms, and face. It typically starts in childhood or adolescence, and is not caused by an underlying medical condition.
Secondary Generalised Hyperhidrosis – secondary generalised hyperhidrosis is triggered by an underlying medical condition or medication. It causes excessive sweating over large areas of the body, and can occur during sleep.

What causes Hyperhidrosis?

The overstimulation of the sweat glands, due to the influence of the nervous system, is typically the cause of hyperhidrosis. Be that as it may, the causes can be divided into two categories:

Primary Hyperhidrosis

Primary hyperhidrosis is caused by overactive nervous system that trigger excessive sweating, even without external heat or stress.
Primarily affects specific areas like hands, feet, armpits, and face.
Thought to be genetic, as it often runs in families.

Secondary Hyperhidrosis

Secondary hyperhidrosis can be due to medical conditions such as diabetes, hyperthyroidism, infections or menopause.
Certain medications, including antidepressants, and painkillers, may trigger excessive sweating.
Neurological disorders, and hormonal imbalances can also contribute to excessive sweating.

What are the common symptoms of Hyperhidrosis?

Some of the common symptoms of hyperhidrosis are:

Body odour, caused by bacteria mixing with sweat, leading to potential skin infections.
Clammy hands, and feet, making it difficult to grip objects or wear certain footwear.
Irritated, cracked or peeling skin, particularly on the feet, due to prolonged moisture exposure.
Persistent wetness on the skin, causing damp clothing, and visible sweat droplets.
Sweat pooling or dripping, especially from the palms, forehead, or underarms.

Emotional and Social Impact

Beyond physical discomfort, hyperhidrosis can significantly impact daily life, and mental well-being:

Avoidance of physical contact, such as handshakes, due to clammy or wet palms.
Anxiety, and emotional distress, sometimes resulting in social withdrawal.
Concerns about personal hygiene, and body odour, even with frequent washing.
Constant worry about visible sweat stains on clothing.
Self-consciousness or embarrassment, leading to reluctance to engage in social interactions.

Where will these symptoms show up?

The eccrine glands are responsible for producing sweat. As it exists in the skin throughout the body, symptoms of hyperhidrosis can occur anywhere, with the following areas being the primary areas:

Armpits or the underarms (axillary hyperhidrosis)
Cheeks or forehead (craniofacial hyperhidrosis)
The palms of your hands (palmar hyperhidrosis).
The soles of your feet (plantar hyperhidrosis)
Genitals
Lower back

What triggers Hyperhidrosis?

When it comes to hyperhidrosis, it is important to manage the triggers. There are certain factors that can worsen hyperhidrosis episodes, including:

Emotional stress – anxiety, excitement or nervousness can stimulate sweat glands.
Hormonal fluctuations – changes due to puberty, pregnancy or menopause can exacerbate hyperhidrosis symptoms.
Hot, and humid weather – high temperatures can trigger excessive sweating, even in people without hyperhidrosis.
Physical activity – while sweating is normal during exercise, those with hyperhidrosis may sweat excessively even with minimal effort.
Spicy foods, and caffeine – consumption of spicy foods, and caffeinated beverages can increase sweating.

How is Hyperhidrosis diagnosed?

Diagnosing hyperhidrosis involves a thorough evaluation to determine the type, severity, and potential underlying causes of excessive sweating. At Livingstone Dermatology, our dermatologists begin with a detailed consultation, and physical examination.

Physical Examination and Assessment

During the initial consultation, our dermatologists will assess your symptoms through:

Checking for underlying conditions – the purpose of this step is to rule out medical conditions such as hyperthyroidism, diabetes or infections that could contribute to excessive sweating.
Identifying potential triggers – by discussing factors such as stress, temperature, and physical activity, it will help our dermatologists determine your potential triggers that may exacerbate symptoms.
Symptoms severity assessment – this refers to evaluating how hyperhidrosis impacts daily life, including work, social interactions, and emotional well-being.
Sweat distribution analysis – the analysis is conducted to identify the areas most affected by excessive sweating.

Diagnostic Tests

In addition to a physical examination, our dermatologists may recommend specific tests to confirm the diagnosis, and assess the severity of the condition:

Blood tests – blood work may be conducted to rule out medical conditions such as hyperthyroidism, diabetes or infections that could contribute to excessive sweating.
Gravimetric sweat test – the Gravimetric Sweat test is performed to measure the exact amount of sweat produced over a specific period using a filter paper placed on the affected skin. This helps quantify sweating severity.
Starch-iodine test – a topical iodine solution is applied to the affected area, followed by starch powder. Areas of excessive sweating will turn dark blue, highlighting the most active sweat glands.
Thermoregulatory sweat test (TST) – a whole-body assessment where a special powder changes colour in response to excessive sweating, allowing for a comprehensive evaluation of sweat patterns.

How is Hyperhidrosis treated in Singapore?

Treatment for hyperhidrosis is primarily focused on managing the condition, and preventing it from exacerbating. As such, it includes a variety of treatment options, ranging from conservative measures to more invasive forms of medical intervention – all of which are tailored specifically to each patient.

Conservative Treatments

For mild to moderate hyperhidrosis, conservative methods can help manage excessive sweating:

Topical antiperspirants – topical antiperspirants, such as aluminium chloride-based solutions, work by temporarily blocking the sweat glands, reducing sweat production in targeted areas like the underarms, hands, and feet. For more persistent cases of hyperhidrosis, prescription-strength antiperspirants may be recommended.
Oral modifications – oral modifications like anticholinergic medications (glycopyrrolate or oxybutynin), suppress nerve signals that activate sweat glands.
Lifestyle modifications – wearing loose, breathable fabrics, using absorbent powders, and maintaining good hygiene can help keep moisture under control. Additionally, stress management techniques such as meditation, and breathing exercises may also reduce stress-induced sweating.

Minimally Invasive Treatments

For moderate to severe hyperhidrosis, medical treatments offer longer-lasting relief:

Botulinum toxin injections – Botulinum toxin temporarily blocks nerve signals responsible for sweat production. It is commonly used for underarm, hand, and forehead sweating, as botulinum toxin injections can provide relief for four to six months before requiring repeat treatment.
Iontophoresis – iontophoresis is a procedure that delivers mild electrical currents through water to temporarily disable sweat glands in the hands, and feet. This treatment requires multiple sessions for optimal results, and is particularly beneficial for palmar, and plantar hyperhidrosis.

Surgical Treatments

For severe hyperhidrosis that does not respond to other treatments, surgical interventions may be considered:

Endoscopic Thoracic Sympathectomy (ETS) – ETS is a procedure that involves cutting or clamping the sympathetic nerves that trigger excessive sweating. It is primarily used for palmar hyperhidrosis. However, it is considered a last-resort option due to potential side effects like compensatory sweating in other areas of the body.
Microwave Thermolysis – microwave thermolysis is an innovative treatment that uses microwave energy to destroy overactive sweat glands in the underarms. This procedure is minimally invasive, with long-lasting results, and requires minimal downtime.

Conclusion

Excessive sweating can be disruptive, and challenging to manage on your own. Thankfully, there are several medical-grade treatments that can help you manage hyperhidrosis symptoms effectively.

Schedule a consultation today for a detailed diagnosis and personalised treatment plan.

Frequently Asked Questions

How can I differentiate between normal sweating from excessive sweating?

Normal sweating occurs as a natural response to heat, physical activity or emotional stress, helping to regulate body temperature. It usually stops once the triggering factor subsides.

Excessive sweating, on the other hand, happens regardless of external conditions, and can interfere with daily activities. The key differences include:

Emotional or physical discomfort.
Frequent or persistent sweating.
Sweating without a clear cause.
Sweat dripping or soaking through clothing.

How common is hyperhidrosis?

Hyperhidrosis affects approximately 2 – 3% of the global population, with many cases remaining undiagnosed or untreated. This is largely due to a lack of awareness, and education related to the condition.

If I have hyperhidrosis, will I smell bad when I sweat?

Most people with hyperhidrosis do not experience body odour. However, to prevent body odour (bromhidrosis), you can:

Apply shoe spray to reduce odour.
Avoid foods like asparagus, curry, and garlic that may contribute to body odour.
Change socks and shoes frequently.
Use antiperspirants or deodorants under your arms.

Do the antiperspirants or deodorants used to treat hyperhidrosis trigger breast cancer?

There is no conclusive evidence linking regular use of these products to breast cancer. Many formulations, including natural and clinical-strength options, are available, allowing individuals to choose what suits them best.

What are the complications associated with hyperhidrosis?

It is important to seek medical attention for hyperhidrosis to prevent the following potential complications:

Difficulties handling objects due to sweaty palms
Emotional distress
Skin infections, and irritation
Social withdrawal

Are there side effects to treatments for hyperhidrosis?

Although treatment-related side effects are uncommon, it is important to be aware of the potential side effects. These side effects depend on the treatment method, but may include:

Blurred vision, and dry mouth from oral medications.
Skin irritation from topical antiperspirants.
Temporary muscle weakness from botulinum toxin injections.

Will treatments permanently cure hyperhidrosis?

It is important to understand that most treatments provide temporary relief. As such, it requires repeated sessions or long-term management. However, surgical options may offer a permanent solution, but they do come with their own set of risks.

Can hyperhidrosis be prevented?

While hyperhidrosis itself may not be preventable, triggers can be managed through lifestyle adjustments, appropriate treatments.

Are there some tips I can practice to better manage hyperhidrosis?

Yes, some lifestyle adjustments can help. This includes:

Managing stress through relaxation techniques.
Staying hydrated to regulate body temperature.
Using absorbent powders to keep skin dry.
Wearing breathable, and loose-fitting clothing.

Improving Quality of Life

Living with hyperhidrosis can be challenging, but effective treatment options are available. Our experienced dermatologist will work with you to develop a personalized treatment plan that addresses your specific concerns and provides lasting relief.

Ready to regain control over excessive sweating?

Schedule a consultation with Livingstone Dermatology today.

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