When ‘Sweating Buckets’ Is a Medical Ill
Antiperspirant commercials rarely inspire me to think about much, other than reaching for the remote control. But the other day I was watching a ballgame when an ad for Old Spice’s Red Zone caught my attention. According to the voice-over, this roll-on is “just for guys who sweat big.”
I wondered: Who are these big-sweating guys? So I called Procter & Gamble, which makes Old Spice products. A spokesman for the company told me that 25% of teen and adult males consider themselves “heavy sweaters,” according to its research. Some of these men put on an extra undershirt each day to sop up their perspiration, the spokesman said, or wear dark clothes to mask wet stains.
However, if you find yourself coming up with fashion strategies to deal with dampness, or you avoid certain social situations because of your prodigious perspiration, you may need more than heavy-duty toiletries. You may, in fact, have a medical condition known as hyperhidrosis.
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Humans sweat to release heat, enabling us to maintain a healthy body temperature. Hot weather and exercise cause us to get dewy, of course. So can stress and anxiety, revving up activity in the sympathetic nervous system, which operates our “fight or flight” response. However, explains Dr. Richard Fischel of Chapman Medical Center, in the city of Orange, “people with hyperhidrosis sweat when they shouldn’t. Their thermostats are set wrong. There are guys with hyperhidrosis who can shower, towel off, and then immediately start dripping sweat.” The cause of hyperhidrosis isn’t known.
Overactive sweat glands may not be life-threatening, says Fischel, but they’re a serious matter, nonetheless. He treats an equal number of men and women for the condition; males, he says, are more likely to complain that sweaty palms and soaked dress shirts are interfering with their careers. Fischel tells of one patient who feared approaching his manager with business ideas that could have earned a promotion. What if the boss wanted to congratulate him with a hearty handshake?
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Doctors can prescribe medications that may calm over-excited nerves. They sometimes recommend a special prescription-only, sweat-reducing solution that’s applied at night to underarms, palms and other areas with excess perspiration. However, the solution may cause a rash, and the skin must be wrapped in plastic film overnight. Injections of Botox--a purified version of the toxin botulin--can paralyze the nerves that induce sweating, but they wear off. According to a recent review of the scientific literature published in Surgery Today, the only method known to stop these sweat assaults permanently is a procedure known as a sympathectomy.
Doctors have known for several decades that blunting the activity of a nerve found on each side of the lower rib cage prevents the body from producing underarm and palm sweat. There are various ways to put these perspiration producers out of business. Most surgeons either burn, clip or snip the nerve in half.
There are a few risks with this surgery. If nearby nerves are damaged, the patient can end up with other problems, such as drooping eyelids. What’s more, a common side effect of sympathectomy is known as “compensatory sweating.” That is, all the perspiration that would have been gushing from your armpits and palms seem to be channeled to the chest, back and other body parts. Fischel says that he and a colleague have discovered a way to overcome the problem of compensatory sweating: Remove the sweat-making nerve altogether. Sounds drastic, but he says the technique is safe and eliminates the problem of rerouted sweat. Fischel has been following the outcomes of a group of his former patients and plans to publish his findings in the journal Surgical Rounds later this year.
The sympathectomy used to involve a large incision and the removal of a portion of several ribs. Lengthy hospital stays and recovery periods were necessary. But thanks to the development of surgical scopes and improved instruments, a sympathectomy can now be performed through a few small incisions in the back, each no bigger than the end of a drinking straw. The operation is performed on an inpatient basis.
Most insurance plans cover the cost of treating hyperhidrosis, Fischel says, underscoring that it’s not merely a cosmetic problem. Doctors should rule out other potential medical conditions that may cause excessive perspiration, such as hyperthyroidism or adrenal tumors. But since most people diagnosed with hyperhidrosis have been plagued by super-sweats since they were kids, it’s usually pretty easy to spot.
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Massachusetts freelance writer Timothy Gower is the author of “Staying at the Top of Your Game” (Avon Books, 1999). He can be reached by e-mail at tgower@mediaone.net. The Healthy Man runs the second Monday of the month.
