Hyperhidrosis: causes and treatment
Sweating is a normal mechanism that the body uses to lower its temperature. In normal individuals, sweat is composed of 99% water and it is odorless. Sweat starts getting a characteristic smell because of bacterial action on the skin especially over the axillary areas. Some foods can produce a smelly sweat such as curry and fenugreek (mahlab) that is used in the production of the cured meat basterma. A normal healthy adult can produce up to 0.5 L of sweat in hot conditions. Hyperhidrosis is a pathological condition whereby there is visible excessive production of sweat in focal areas. 

It is important to evaluate a person who sweats excessively and to try to identify a pattern of sweating: does it occur mostly during the day? It is caused by an effort or an emotional stress? Or does the patient wake up at night drenched in sweat? These questions are very important in helping us differentiate between different types of excessive sweating: for example if a person complains of excessive dripping sweating affecting the hands and feet which is interfering with his daily life, then this patient probably has what we call primary hyperhidrosis. On the other hand if a patient who is having fever daily and severe drenching sweat at night, probably has a secondary hyperhidrosis caused by an underlying systemic disease that needs to be identified and treated. The pattern of the sweating and the symptoms associated with it are instrumental in helping us to classify the type of sweating and therefore customize the treatment.  

Primary hyperhidrosis is the most common type of hyperhidrosis. It affect individuals after the onset of puberty and is usually a long lasting problem. The main sites that are involved are the hands and feet as well as the axillae. The sweating is usually visible and excessive, affecting the life of the person, and it typically stops during sleep. Typically stressful situations increase sweating in these individuals and some patients have to carry around a towel to wipe their hands dry. Usually there is a familial history of such symptoms. 

Thankfully, there are several options for treatment of this bothersome condition. The first line treatment consists of a topical preparation containing aluminum chloride salts. It works by blocking the ducts of the sweat producing glands. These solutions need to be applied several times per week and in many cases they are quite effective at reducing the symptoms of primary hyperhidrosis. The second option is to use injections of botulinum toxin type A in the affected area. This treatment will produce almost complete discontinuation of sweating for a period of 4 to 6 months, often longer, which makes it a very popular treatment. These injections are virtually painless and well tolerated by patients. Another modality of treatment that works best for the hands and feet is iontophoresis. It’s a treatment that consists in sending mild electrical currents through water and into the skin to block the sweat ducts. Lately, microwaves have been used to destroy the sweat glands and lead to decreased sweating. This process requires local anesthesia results can be seen in one or two session. Finally, when all has failed, there are surgical options that can be contemplated, however they carry risks and are best avoided. 

In conclusion, remember that primary hyperhidrosis is a treatable condition and that it is important to get a medical evaluation if you complain of excessive sweating.