By Anna Medaris Miller for U.S. News
As a fourth-grader, Sophia Wastler was afraid to raise her hand. When she took notes, she folded squares of paper under her palms. When other girls held hands with boys at the roller skating rink, Wastler stayed home. “I definitely didn’t want to do that,” says Wastler, now 40.
As she grew up, Wastler developed new coping mechanisms. When someone reached out to shake her hand, for example, she apologized and said she just washed them. Wearing flip-flops, playing sports that require a grip like tennis or using touch screen technology? “Forget it,” says Wastler, who founded the children’s fitness program Starz and lives in Richmond, Virginia.
“It’s not just, ‘OK, I’m going to sweat a little bit more,” she says. “It’s every day — day in, day out.”
While there’s a wide range of how much people sweat and how willing they are to tolerate it before seeking treatment, about 3 percent of the population suffers from excessive sweating, or hyperhidrosis, according to the International Hyperhidrosis Society.
“Everybody sweats — it’s our body’s mechanism to cool down when body temperature goes up,” says Dr. Marie Jhin, medical director at Premier Dermatology in the San Francisco Bay Area. “But in hyperhidrosis or excessive sweating, it’s kind of like you’re just sitting there and you’re sweating.”
What Is Hyperhidrosis?
Focal hyperhidrosis — the kind Wastler has — is a genetic condition that causes excessive sweating in concentrated areas such as the palms, feet or armpits. It usually begins around puberty or even earlier, and the episodes happen at least once a week, and often daily, says Dr. David Pariser, a founding member of the International Hyperhidrosis Society and professor of Dermatology at Eastern Virginia Medical School who eventually treated Wastler.
“If you have hyperhidrosis, you may not sweat all the time, but you will be sweating at times when you are not stressed, not hot and not exercising,” he says.
In people with secondary hyperhidrosis, which is less common, the sweating can be caused by another condition such as an endocrine disorder, tumor, medication or menopause, Jhin says. The sweating in this case tends to be more spread across the body, and the symptoms hit people more suddenly later in life — say, at the onset of menopause or when they start taking a new medicine.
Doctors rule out secondary hyperhidrosis with a thorough medical history and sometimes medical tests before turning to one of several treatments for focal hyperhidrosis — options many people don’t know exist, Jhin says.
Treatments: Antiperspirants to Surgery
One day when Wastler was 30 years old, she wasn’t in the mood to tell a lie. So when a new doctor reached out to shake her hand for a routine appointment that day, for the first time, she told the truth. “I said, ‘I’m sorry, my hands are sweaty, I don’t know why they’re sweaty,” Wastler remembers. “And the doctor said, ‘Oh, you have hyperhidrosis!’ and I said, ‘What? There’s a name?’”
Wastler’s reaction is not uncommon, Jhin says. “I think most people who really do have [hyperhidrosis] know there’s something wrong. They just don’t realize how prevalent it is and they don’t realize there are treatments,” she says. “And they’re very, very embarrassed by it.”
Among Jhin’s patients with hyperhidrosis, the first defenses are prescription antiperspirants, which typically contain aluminum to block the sweat ducts. They can be spread on any part of the body that sweats too much, including the face, hands, feet and underarms, Jhin says.
If an antiperspirant isn’t effective enough, or if patients’ skin gets too irritated, Jhin usually suggests Botox, which blocks the chemical that stimulates sweat glands. The treatment is FDA-approved for use in the underarms and is often covered by health insurance, Jhin says.
For Wastler, Botox was effective for more than five years before she “got tired of all the injections,” which can be uncomfortable, and added up to two office visits a year. Now she uses an at-home weekly treatment called iontophoresis. The process involves a medical device that passes an electrical current through her hands and feet, which she places in water.
A riskier treatment is a type of surgery called an endoscopic thoracic sympathectomy, during which surgeons cut a nerve on each side of the patient’s chest to disrupt the signal that tells sweat glands in the hands and underarms to turn on. The procedure is a last resort since its side effects — including sweating in other places — can be severe, and it doesn’t address foot sweat, says Dr. Malcolm Brock, a surgeon and medical director of the Center for Sweat Disorders at Johns Hopkins Medicine.
“There are a select group of patients who really after trying everything, they don’t get relief from sweating, and it’s these patients that come for a thoracic sympathectomy,” he says.
One promising new treatment — miraDry — uses microwave energy to target fat where sweat glands reside in an effort to destroy them, Jhin says. The biggest problem? It costs up to $4,000 per treatment, and insurance doesn’t cover it yet, she says. But “the fact that we’re coming up with newer treatments says that [hyperhidrosis] is definitely an issue,” she adds.
When Life Started
At Johns Hopkins’ Center for Sweat Disorders, treatments often include a psychological component since people with hyperhidrosis have higher rates of stress-related conditions, including anxiety and depression, says Carisa Perry-Parrish, an assistant professor of psychiatry and behavioral medicine at Johns Hopkins who works with the center. “When you’re in a socially stressful situation, it’s normal for anybody to sweat more,” she says. So when people are evaluated for hyperhidrosis, she explains, “there’s this question of is it sweat resulting from anxiety versus some other physiological explanation?”
Brock says the center’s preliminary research shows that, more often than not, the social anxiety experienced by people with hyperhidrosis is a result — not a cause — of the condition itself. “What we’ve found is that as soon as you get that effective therapy, whatever is personalized for that patient… when it works, then that’s when you see a tremendous mitigation in this whole social phobia,” he says.
For Wastler, learning that her problem had a name and treatments was more than a confidence boost. “I can truly say that’s when life started for me,” she says. “I left a secure teaching job, I created a company, really, I did things that I never would have believed.”
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