When that glow has to go
Summer temperatures make some people glisten and others drip, but, regardless, most of us want ways to dry off.
“Everybody is supposed to sweat to some degree,” said Dr. Mark Krasna, a thoracic surgeon at St. Joseph Medical Center in Towson, Md., who performs a sweat-combating procedure called a thoracoscopic sympathicotomy. “It’s one way the body regulates heat. But we all know friends or relatives who sweat more than others.”
A normal amount of sweating is about an ounce and half a day, or enough to fill a shot glass. Those with excessive sweating, called hyperhidrosis, can produce four times that amount or more. St. Joseph surgeons have treated a policeman whose hands were so slippery he had trouble handcuffing criminals and an orchestra conductor who struggled to hold a baton.
Though only 1% to 3% of Americans have the disorder, almost 12% of people in a recent survey by the International Hyperhidrosis Society reported that they sweat all the time and 15% say they sweat too much.
The amount has nothing to do with hygiene; rather it has more to do with heat, stress, genetics and some diseases and medications. Still, the wet T-shirt contest look is off-putting to pretty much everyone — your boss, your date, the guy next to you on the bus.
Extreme-sweating cases can be socially crippling.
First things to try
The first line of defense for sweating is an antiperspirant that blocks the ducts of eccrine glands, the body’s major sweat glands, which produce odorless water sweating. Deodorant does not control wetness, but it masks the odor produced by apocrine glands, found mainly in the armpits, which are responsible for oily, smelly sweat.
New “clinical-strength” antiperspirants have more of the active ingredient, most commonly aluminum chloride. That can add a few dollars to the cost, and not all doctors believe such products work better.
One doctor who says they can be effective, and thus worth trying, is Dr. Jeffrey Dover, president of the American Society for Dermatologic Surgery, who also contributes a skincare line to CVS pharmacy.
He recommends applying the antipersperant to a clean underarm at bedtime so it “settles in overnight and works even better than if applied in the a.m.” If that doesn’t work, he said, there is a prescription-strength product that has higher levels of aluminum. It’s called Drysol, but it can be irritating, he said.
Aluminum has come under fire from some scientists for its possible link to breast cancer because of the underarm’s proximity to breast tissue and lymph nodes, though Dover and other experts do not think that the evidence is credible.
The cancer research and support organizations Susan G. Komen for the Cure and the American Cancer Society agree that there are not strong epidemiologic studies supporting the link.
Some people, however, are allergic to chemicals in deodorants and antiperspirants, usually found in the “fragrance.” Stop using it if a rash develops and see a dermatologist if it doesn’t go away, said David M. Pariser, past president of the American Academy of Dermatology and a founding member of the International Hyperhidrosis Society.
For those whose sweating is overwhelming the products, or perhaps they have job interviews or a wedding coming, he said the next step is Botox, an injection of botulinum toxin commonly associated with treating wrinkles. It can have side effects such as weakness, and it can be pricey.
Having both armpits treated costs about $1,000, said Dr. Ron Schuster, a Lutherville, Md., cosmetic surgeon. He said most patients are women, and most patients have their armpits treated, though they also use Botox on the soles of their feet. He said that the procedure is virtually painless and that the results last about six months.
“It can have a dramatic effect on what kind of clothing they wear and their general self-confidence around others,” he said.
For the more excessive sweaters, other options are prescription oral medications and a treatment that involves placing a patient’s hands and feet in trays of water in which they are subject to a low electrical current. This treatment, administered for 20 minutes three times a week, interferes with the nerves promoting sweat.
If all else fails
The last-ditch procedure for the worst cases of hyperhidrosis is surgery called thoracoscopic sympathicotomy, which snips the nerves that lead to sweating. Doctors say it’s most effective on the hands and armpits but less so on other body parts. They also say it comes with significant side effects, including irreversible compensatory sweating (i.e. sweating somewhere else even more).
Krasna, the St. Joseph surgeon, said his research shows that compensatory sweating can be reduced when the amount and location of snipping is altered. Still, he pushes patients to try other measures first and ensures that they understand the risks and benefits before he performs the procedure.
It’s not for those dripping in the heat, either. It’s for those who excessively sweat even when it’s not hot outside and they find the wetness unbearable.
“It makes people very self-conscious,” he said. “The social message is that you’re not confident, you’re nervous. That can make you more worried, and then you sweat more. It’s a cycle.”
Dr. Whitney Burrows, an assistant professor and member of the University of Maryland Medical Center’s division of thoracic surgery
, said patients tell him how they’ve hidden the disorder by keeping wipes in their pockets and lining their underarms with paper towels or wearing layers of black that won’t show sweat.
For them, “the benefits of surgery can be extraordinary,” he said.
For everyone else suffering through the oppressively hot summer, he said, “I’d never prescribe anything more than frequent showers, cool clothing and air conditioning. And repeat application of regular antiperspirant.”