DEAR MAYO CLINIC: I'm a 57 year-old woman and am so warm all the time that I don't even wear a coat in the winter; just a heavy sweater. I sweat so much that it drips off my nose sometimes, and if I do any kind of physical activity — even just a short walk — I start sweating. It is uncomfortable but it is also embarrassing, and I stay away from social situations because of it. Is there anything that can be done for this? I don't see other women having this problem.
Excessive sweating such as you describe is called hyperhidrosis. Rest assured, effective treatment is available. In order to decide on the best treatment options for you, you will need a thorough evaluation with your doctor to review your symptoms and check for an underlying medical condition that could be contributing to the problem.
Sweating is your body's way of cooling itself. Your nervous system automatically triggers your sweat glands when your body temperature rises. Sweating also normally happens when you're nervous or under stress. Other factors that have an impact on when and how much you sweat include your age, sex, posture and diet, as well as the climate where you live. Your body's circadian rhythm — the 24-hour internal clock that helps regulate your sleep and wake patterns — can affect sweating, too.
The most common form of hyperhidrosis is called primary focal (or essential) hyperhidrosis. It happens when excess sweating is not triggered by a rise in temperature or physical activity. There is no medical cause for it and it tends to mainly affect the palms, face and soles of the feet, although in some cases it can involve the entire body.
Secondary hyperhidrosis is less common. It happens when sweating is due to a medical condition. Disorders that may lead to excessive sweating include diabetes, nervous system disorders, some infectious diseases, thyroid problems and some types of cancer, among others. Of particular note for your situation is a condition called paroxysmal localized hyperhidrosis. It primarily affects women after menopause and is caused by a nervous system disorder. Certain medications also can lead to excessive sweating.
To evaluate your condition, your doctor will likely talk with you about your symptoms and your medical history. He or she may recommend blood, urine or other lab tests to see if your sweating is the result of another medical condition. If it is, then treatment for that disorder may help decrease or eliminate the sweating.
If no clear cause can be found, treatment focuses on controlling excessive sweating. Prescription antiperspirant is often used first. Certain nerve-blocking medications and antidepressants can also reduce sweating. Injections of botulinum toxin, known by the brand name Botox or Myobloc, may help block the nerves that cause sweating.
A procedure called iontophoresis may also be an option. It is mainly used for excessive hand or foot sweating. Iontophoresis uses a device to deliver a low level of electrical current to the areas of your body prone to excessive sweating. This treatment typically is given daily for several weeks. It needs to be repeated on a regular basis to continue being effective.
If hyperhidrosis doesn't respond to other treatment, surgery could be another choice. It may include removing sweat glands, or it could involve surgery to impair the nerves that control sweating. Surgery is generally not an option for isolated head and neck sweating.
Make an appointment to see your doctor to have your condition evaluated. Even if a specific cause of your sweating cannot be identified, it's still likely that hyperhidrosis can be effectively managed in a way that will decrease your discomfort and embarrassment. — Robert Fealey, M.D., Neurology, Mayo Clinic, Rochester.