Sweating and body odorSitting in the heat of the sun, working out at the gym, giving a presentation at work — all of these activities can make you sweat. It's both natural and healthy to sweat under these conditions. In fact, when you're exposed to heat, exercising strenuously or under extreme emotional stress, you may lose several quarts of fluid in perspiration. A pea-sized bead of sweat can cool nearly 1 liter (about 1 quart) of blood 1 degree Fahrenheit.Sometimes, however, the complex mechanism of perspiration goes awry, resulting in either excessive perspiration (hyperhidrosis) or little or no perspiration (anhidrosis). Excessive sweating can be embarrassing and may sometimes signal a more serious health problem. Anhidrosis is potentially life-threatening.Yet for most people, sweating is simply a minor nuisance. The odor that sometimes occurs when you sweat is probably more upsetting. Although perspiration is basically odorless, it can take on an unpleasant smell when it comes into contact with bacteria on your skin. If you find this offensive, you're not alone — Americans spend hundreds of millions of dollars a year on antiperspirants and deodorants.Signs and symptomsHealthy people sweat. But when, where and how much varies widely. Factors that cause most people to sweat include:Exercise, especially strenuous exercise Hot weather Nervousness, anxiety or stress Perspiration that's triggered by emotion is most likely to occur on your face, your underarms, your palms and the soles of your feet. But how much you sweat and even the way your sweat smells can be influenced by your mood, certain foods and beverages, some drugs and medical conditions, and even by your hormone levels. What's more — unfair as it seems — some people inherit a tendency to sweat heavily, especially on their soles and palms.Because it's almost impossible to define normal sweating, try to learn what's normal for you. That will help you pinpoint any unusual changes.CausesMost cases of anal itching are caused by a harmless problem. Occasionally, however, anal itching can be a sign of more serious medical issues. Possible causes include:Dry skin. As you age, skin in and around your anus is more prone to dryness. Dry skin can cause persistent, intense anal itching. Too much moisture. Moisture around your anus from excessive sweating or from moist, sticky stools can be irritating. Anal itching can also be caused by frequent diarrhea or the escape of small amounts of stool (fecal incontinence). Excessive washing. Excessive wiping with dry, harsh toilet paper or excessive scrubbing with harsh soaps can cause or aggravate anal itching. Failure to rinse away the soap completely also may cause irritation. Chemical irritants. Certain laundry soaps, colognes, douches and birth control products contain chemicals that can irritate skin in and around your anus. Scented or colored toilet paper can be irritating to people with sensitive skin. Food irritants. Anal itching may be the result of irritating chemicals in some foods, such as those found in spices and hot sauces. Similarly, some foods may directly or indirectly irritate your anus as they exit your colon. Common culprits include chocolate, fruits, tomatoes, nuts and popcorn. Consuming certain beverages, including milk or caffeinated drinks, may cause some people to experience diarrhea followed by anal itching. Medications. Anal itching may be a side effect of certain medications, including some antibiotics, that can cause frequent diarrhea. Overuse of laxatives. Excessive or improper use of laxatives can lead to chronic diarrhea and the risk of anal irritation and itching. Hemorrhoids. Hemorrhoids are engorged veins located just under the membrane that lines the lowest part of your rectum and anus. They often occur as a result of straining during a bowel movement. Anal itching can be a symptom of hemorrhoids. However, most hemorrhoids don't itch. Infections. Sexually transmitted diseases may also involve the anus and can cause anal itching. In children, the parasite that causes pinworms can cause persistent anal itching. Other parasites may cause similar itching. Skin disorders. Common skin problems — such as psoriasis, seborrhea and eczema — can involve and irritate the area in and around your anus. Yeast infections. This common infection, which usually affects women, can irritate your genital and anal areas. Anal abrasions and fissures. An anal abrasion is a small tear in your anus, usually caused by forced bowel movements through a tight anus. An anal fissure is a deeper tear. Both conditions can cause anal itching, as well as painful bowel movements and bleeding. Anal tumors. Rarely, benign or cancerous tumors in or around the anus may be a cause of anal itching. Other causes. Anal itching may be related to anxiety or stress. Sometimes, the cause remains undetermined. Although anal itching is almost never a problem of cleanliness, your own actions may contribute to the problem. Whatever the cause of anal itching, your natural reaction is to scratch the area. But scratching worsens the problem by removing superficial layers of skin. In addition, the natural tendency in response to an irritation is to wash the area frequently with soap and a washcloth. However, excessive washing can aggravate the condition by removing your skin's natural protective oils.Maker says Botox can help excessive sweating disorderWASHINGTON (AP) — Doctors have found a new use for Botox, the wrinkle-smoothing botulism toxin: It seems to curb excessive sweating. People with a condition called hyperhidrosis produce four or five times the amount of sweat as is normal. There are various treatments, including powerful antiperspirants, drugs to prevent sweat gland stimulation, even surgery on those glands. Botox, a weakened form of the food-poisoning toxin botulism, already is widely used to treat wrinkles. It is being tried to treat excessive sweating because it seems to temporarily paralyze a nerve that stimulates sweat glands. Researchers gave 322 patients underarm injections of either Botox or salt water. They received 12 to 14 injections per armpit. Although injection site pain was the main side effect, lead investigator Dr. Dee Anna Glaser of St. Louis University School of Medicine said the needles are so tiny that most patients weren't bothered. A month later, 75% of the Botox users reported a significant decrease in sweating, compared with a quarter of the placebo patients, said Glaser, who is to present the study at this weekend's American Academy of Dermatology meeting. Patients could get additional rounds of injections every few months, but 43% got relief for a year from the first treatment, Glaser said. The median duration of response was about six months. Allergan Inc., the maker of Botox, funded the study, which was submitted to the Food and Drug Administration in hopes of formal approval of the drug's new use, Glaser said. But dermatologists already are offering Botox to hyperhidrosis patients; such off-label prescription is legal. Treatment costs about $1,000 for both arms, she said.Excessive Sweating is a Medical Condition that Can Be TreatedPHILADELPHIA ? June 21, 2004 ? Hyperhidrosis, or excessive sweating, is a common medical condition affecting an estimated 7 million Americans that often goes undiagnosed. With two to four million sweat glands in our bodies, many believe we just normally sweat. However, when people sweat far more than is necessary to regulate body temperature, and consequently suffer extreme embarrassment and anxiety, and limit activities in their personal or work lives, they likely have a form of hyperhidrosis. And this medical condition is clearly worthy of visit to a doctor particularly knowledgeable about the disorder.Thanks to The International Hyperhidrosis Society, for the three percent of the population living with hyperhidrosis, help is now just a mouse click away. This month, the International Hyperhidrosis Society launched a worldwide Physician Finder directory on its website (www.SweatHelp.org), a database of doctors experienced in diagnosing and treating the condition. Whether you live in Peoria or Prague, you?ll be able to find a physician who can offer a range of treatment alternatives. More than 300 physicians from as far away a Malaysia have met the International Hyperhidrosis Society?s standards for registration in the Physician Finder database, and that number is growing daily.I've lived with hyperhidrosis for more than 20 years and it has dramatically impacted almost every day of my life, whether it's that wet handshake or my feet slopping around when I wear sandals,? said Michael, a medical student in Philadelphia. ?I have been to many doctors over the years and tried many treatment options. But, thanks to the International Hyperhidrosis Society?s Physician Finder, I finally found a doctor who has many years of experience treating hyperhidrosis and I feel confident he will find the right way to conquer it.? As with any medical condition, proper diagnosis is the key to successful treatment. Patients with primary hyperhidrosis typically complain of excessive sweating in focal areas of the body -- under the arms, of the hands, face and/or feet. Sometimes there is a family history of the disease and symptoms often begin during adolescence.?There are many highly effective treatment options for this condition, however, physicians need to be trained in the clinical guidelines for each. As the central resource for physician education and public information about hyperhidrosis, the International Hyperhidrosis Society hopes to link patients to physicians who are knowledgeable, understand and can help,? said David M. Pariser, MD, International Hyperhidrosis Society president, secretary/treasurer of the American Academy of Dermatology, and a professor of Dermatology at Eastern Virginia Medical School in Norfolk. For more information about the International Hyperhidrosis Society?s Physician Finder, visit www.SweatHelp.org.The International Hyperhidrosis Society, founded in 2003, is a non-profit organization working to increase the understanding, awareness, research, and education of excessive sweating (hyperhidrosis) for both patients and healthcare providers. The International Hyperhidrosis Society is the central worldwide clearinghouse for the latest treatment and research information about hyperhidrosis. It offers a global network of physicians providing treatment and relief for what can be a serious medical condition.International Hyperhidrosis Society Unveils New Web Site and Free Handbook for Teens Who Suffer from Excessive SweatingThe International Hyperhidrosis Society (IHHS) launched a new Web site today targeting teenagers who suffer from excessive sweating, or hyperhidrosis. Through the Web site, accessed through www.SweatHelp.org, the IHHS is offering a free 50-page book called ?Teen Sweat 101? to those interested in learning about coping with this condition and finding effective solutions. Worksheets from the book can be downloaded from the site or the entire book can be ordered through the site or by emailing info@SweatHelp.org. Hyperhidrosis is estimated to affect three percent of the population in the U.S., or nearly eight million people, although up to 48 percent of teens sometimes feel that their perspiration is a problem. [1] Excessive sweating starts before the age of 21 in 77 percent of sufferers [2] and can be embarrassing as well as socially and mentally devastating to young people, who may endure constant teasing by their peers, avoidance by teachers and exclusion from friends and social activities. In fact, a full 90 percent of those who suffer from excessive sweating say that they have experienced cruel reactions from others in regards to their sweating. [3]Both the Web site and the book provide useful information on tackling hyperhidrosis, providing thought-provoking situations and questions that will help teens gauge how excessive sweating impacts their life. Teen Sweat 101 urges teens to assemble a support ?team? that will lead them to find realistic solutions to their sweating. Other highlights include: o Listing activities which are avoided because of interference by excessive sweatingo Estimating sweat-related habits, i.e. how often one changes their clothes throughout the dayo Reading case histories of teenagers with hyperhidrosiso Understanding available treatment options and creating a plan for taking action In addition, the Web site hosts an ?Ask Frances? column which allows teens to email questions that can be answered by Frances Rivers, a 16-year-old girl who suffered from underarm and hand sweating for years before finally getting treatment and wants to offer insight and help other kids recognize that they are not alone. The IHHS Web site provides an international Physician Finder index of more than 900 physicians who treat hyperhidrosis as well as an electronic newsletter, SweatSolutions?, which provides monthly updates on the latest developments in hyperhidrosis care. Hundreds of thousands of people visit www.SweatHelp.org annually and there are currently more than 12,000 patients and 1,000 physicians registered as part of the IHHS global community, with more added each day. If you have teenage readers or viewers, this information could be essential. Please contact Maggie O?Rourke at 212-229-8486 if you are interested in learning more about hyperhidrosis or receiving a copy of the Teen Sweat 101 book. We can also offer interviews with:. Teen hyperhidrosis patient Frances Rivers. A dermatologist with expertise treating excessive sweating. Lisa Pieretti, Executive Director of the International Hyperhidrosis Society Teen Sweat 101 is funded by unrestricted educational grants from the Secret? antiperspirant brand and Allergan, Inc.Notes:[1] From survey conducted by Numark Laboratories February 2005 via Harris Interactive YouthQuery[2] From IHHS database[3]From survey conducted by IHHS January 2005 via Harris Interactivehttp://www.sweathelp.org/English/TEEN_Home.asp HyperhidrosisHyperhidrosis can manifest itself in many forms. The most common form is excessive sweating. The sweating can occur in the hands (palmar hypherhidrosis), feet (plantar hyperhidrosis), face and armpits (axillary hyperhidrosis). No one really knows what causes hyperhidrosis but it is thought to be endocrine system related. The endocrine system regulates chemicals that the brain produces such as epinephrine, nor-epinephrine and seritonin. These chemicals control anxiety levels, mood and appetite. People either have primary hyperhidrosis, which has no known cause or secondary hyperhidrosis, which can be caused by diet, weight, medications, etc. (the cause here can be traced). While the condition is not harmful physically, the condition can be socially devastating. Most people who suffer hyperhidrosis complain of dripping hands, armpits, face, etc. They avoid shaking hands, public speaking or anything that would draw attention to their condition. Hyperhidrosis can also include facial blushing. Again,the cause is most likely chemically related to the endocrine system. People who have elevated levels of catecholemines or the chemicals mentioned above, tend to have anxiety, bouts of rapid heart beat, stage fright and panic attacks. The blushing occurs because the brain releases chemicals which have receptors in the vessels in the face. When these vessels receive the chemicals, they dilate and the result is more blood rushing through them and a resulting red or flushed face. Facial blushing can be devastating socially. People often develop vast avoidance behavior to deal with the blushing episodes. Medications that can be very helpful for facial blushing include beta blockers such as atenolol. Beta blockers help the heart rate from racing and can reduce anxiety associated with public speaking. Alpha blockers, a class of drugs that help control blood vessel constriction and dilation can be very helpful when used by themselves or combined with beta blockers, to control facial blushing. SSRI's (selective seritonin reuptake inhibitors) such as Paxil, Zoloft and Prozac can be helpful to reduce anxiety that causes the flushing. Valium, Xanax, Lorazepam and other benzodiazapine medications can also be very effective for controlling the anxiety that results in facial blushing. SymptomsClassification and Causes Causes* primary = essential = idiopathic (unknown cause) * secondary (known cause) Locations:* palmar (hands) * axillary (armpits) * plantar (feet) * facial (face) * truncal (trunk) * general 1. Hyperhidrosis as part of an underlying condition (secondary hyperhidrosis) Some conditions can promote excessive sweating, as a rule involving the whole body: Hyperthyroidism or similar endocrine diseases Endocrine treatment for prostatic cancer or other types of malignant disease Severe psychiatric disorders , Obesity and Menopause2. Hyperhidrosis without known cause (=primary or essential hyperhidrosis). This is a far more frequent condition than secondary hyperhidrosis and appears, generally, localized in one or several locations of the body (most often hands, feet, armpits or a combination of them). It usually starts during childhood or adolescence and persists all life. Nervousness and anxiety can elicit or aggravate sweating, but psychological/psichiatric disturbances are only rarely the cause of the disorder. Manifestations of Primary Hyperhidrosis Facial Hyperhidrosis Sweat pouring down from the forehead in conditions of stress can be very distressful, inducing the patient to think that others may consider him/her nervous and insecure. Palmar Hyperhidrosis Excessive sweating of the hands is, generally, by far the most distressing condition. The hands are much more exposed in social and professional activities than any other part of our body. Many individuals with this condition are limited in their choice of profession, because unable to manipulate materials sensitive to humidity (paper etc) or reluctant to shake hands; some patients arrive to the point to avoid social contact. The degree of sweating varies and may range from moderate moisture to dripping. Most patients notice that their hands not only feel moist, but also cold. Axillary Hyperhidrosis Also hyperhidrosis of the armpits can be embarrassing causing large wet marks and sometimes a white halo of salt from sweating on the cloths. Plantar Hyperhidrosis Other locations Less frequently, it is located only to the trunk and/or the thighs. Other patient are suffering from copious sweating in the face. * Many individuals suffer form a combination of the above cathegories. * Sweating can appear suddenly or manifest itself more continuously. * It can be elicited by high outside temperatures or emotional stress, or appears without any obvious reason. * Generally, it worsens during the warm season and gets better during winter. Non Surgical Treatments for HyperhidrosisThere are about 4 popular non-surgical treatments that I am aware of for hyperhidrosis and excessive sweating. This page will briefly describe my experience with those that I have tried in addition to any information I have obtained for the ones that I haven't used. Since ETS surgery does not work for armpit sweating, the first treatment for excessive sweating in the armpits that I was made aware of by word of mouth was a unique antiperspirant called Maxim for armpits, hands, face and feet. I should let the reader know that since this site has gone up, many people continue to contact me to see where Maxim is available. People are saying that they have heard good things as well, but can't find it. I am providing a link at the request of those who continue to email me. You can find some good information on Maxim at www.stopsweat.com. I just saw a review of Maxim in Platinum Magazine. Ditropan is a must for those who are having excessive sweating of the head. It is used for the treatment of incontinence but the side effects can cause your head to stop sweating. People are taking 3 5mg tablets per day. I have recommended it to a friend with excessive sweating in his head and the change is unbelievable.I used to sweat profusely under my armpits and could never find an antiperspirant that would work until the antiperspirant my physician recommended Maxim. It is very different from conventional antiperspirants because you apply it at night time. The reason you apply it at night is because that's when your sweating is minimal and the active ingredient works to get into the sweat pores to shrink them. It is recommended that you use Maxim ever night. I can get by with about 4 applications per week. The antiperspirant can have some side effects which can include some minor compensatory sweating. Compensatory sweating is when you sweat in other parts of your body besides the armpits, including the chest and back areas. Again, this is very minor and only occurs when I exercise. The other main side effect that Maxim can have is some minor itching and burning. It has never really bothered me but some say it can be bothersome. What these people do is apply cortisone and benedryl and I have heard that works quite well to alleviate the itching. This antiperspirant is recommended by Dr. Reisfeld and Dr. Garza for moderate hyperhidrosis, who are leading ETS surgeons. The cost of the antiperspirant is about $13.95 plus shipping and will last you about 2-3 months if used every night. It's pretty cost effective at about $6.00 per month to prevent excessive sweating.I think Xerac is similar but may require a prescriptionl. I have not been able to locate Xerac, outside of doctors. DRIONIC? is a machine that can be purchased for about $135.00 and uses the passage of a small electric current (around 15 mA) through the skin, which tends to stop the sweat glands from working for quite a while. This process, called iontophoresis, works by "injecting" electrically charged ions into the skin, which interact with the sweat glands and ducts to cause them to stop secreting sweat; it may work by plugging the ducts up in a manner similar to the antiperspirants. Regular tap water is used, as it has dissolved salts and minerals that can carry the electric current, rather than more expensive electrolyte solutions. Some physicians have recommended the iontophoresis of medications such as Robinul? (glycopyrrolate) to further cut down on sweating. There are some machines that can only be used by physicians, but there is one commercial machine, the Drionic? device, that can be purchased with a doctor's prescription, and used regularly at home. This machine comes in two forms, one that only works on hands or feet, and the other that is designed to work only on the underarms. Both use tap water and batteries to administer the current to the skin between the two pads of the Drionic? machine. Treatment usually requires 20 minutes of use at each site for a few times a week, and then once the perspiration has stopped, the machine is not used until it starts up again. Although this device has been proven safe and effective, and has been very useful to many, it can only treat the hands/feet and underarms, and cannot be used on the head, face, groin, chest or back; in addition, it does not control the flushing that is often associated with hyperhidrosis. For people who have many areas of excessive sweating, this may not prove practical, but for people who are bothered at treatable locations, this machine and treatment may be an option, after receiving a doctor's prescription and instruction for the safe use of this medical device. I have used the device and have found it to be moderately affective on the armpits, but it can be somewhat cumbersome and time consuming. I have also talked to people who complain of shocking and the breaking of blood vessels. As discussed above, Robinul or glycopyrrolate (Robinul? and Robinul? Forte) come in tablets of two different strengths (Robinul? 1mg and Robinul? Forte 2 mg), so the dose can be easily adjusted. The tablets can also be crushed up and given mixed with soft foods such as applesauce, pudding, ice cream, etc., or made into a liquid form by a pharmacist, if swallowing tablets are a problem. Glycopyrrolate is usually taken 1 to 3 times a day, in doses of 1 or 2 mg at a time, depending on the severity of the sweating. Side effects are few and usually very mild and not that bothersome. Some patients may develop a dry mouth. Patients who tend to get diarrhea frequently may find that the glycopyrrolate tends to help control that, as it is used for diarrhea in other countries. Glycopyrrolate does not cross the blood-brain barrier, therefore Central Nervous System (CNS) side-effects are virtually non-existent. Robinul is a drug in the class known as anticholinergics. I do not have experience with Robinul but I hear it can be a good alternative for hyperhidrosis in all parts of the body.Lastly, a new non-surgical treatment that is being promoted is an injection of botulism toxin or Botox. Botox in its concentrated form is one of the most deadly nerve poisons known to man. However, doctors have developed a concentration that is so small that it can be used safely to treat things from wrinkles in the forehead, sweating and even stuttering. The way Botox works is by injecting it into the nerves that trigger sweat. It temporarily paralyzes these nerves responsible for triggering the neurotransmitter called acetylcholine. Acetylcholine is responsible for activating the sweat glands. I have not had this treatment and have heard it may be painful, and expensive (around $400.00 per treatment), and will only work for the small areas of skin around the injection site; however, for people who are bothered by hyperhidrosis at only a few sites (such as the hands or armpits. The injections will only last about 3-4 months as well. Nonetheless, this can be a very effective treatment.Surgical Treatments ETS or Endoscopic Thoracic Sympathectomy is a surgery that has gained popularity in the past 3 years, although it was first performed in 1987. The following is a detailed description of the surgery as described by Dr. Reisfeld who was my surgeon who performed the surgery: Under general anesthesia, a small incision, approximately one centimeter in length is made under both armpits. Air is inserted though the incision into the chest cavity. Endoscopic equipment (a fiberoptic camera and a working instrument) is then inserted. The sympathetic chain is located along the ribs head. The endoscopic instrument is then used to clip or cut the T2 segment of the sympathetic nerve node responsible for the sweating. Once completed, the air inflating the chest cavity is removed, along with the instruments and the lung returns to it's normal position. The incision is then sutured internally with absorbent sutures which eliminate the necessity for sutures removal. The process is then repeated on the other side of the chest. Clipping as a method is performed as well, although it requires one additional port. The theory behind the Clipping is theoretical possibility of reversal if the side effects are too severe for patients to tolerate and if it is done in the appropriate time interval. Dr. Reisfeld does these cases after complete discussion and understanding by the patient about this particular method. At present Clipping is the procedure of choice and the one recommended by Dr. Reisfeld. The main reason for that is the theoretical possibility of reversal. Scarring is minimal, as the skin cuts made are small and well hidden in the folds of skin in the armpit. I would like to add a personal note about Dr. Reisfeld. He is the most caring surgeon you are ever going to meet. He provided excellent service and was very attentive to me the day of my surgery and followed up with me in my hotel room across from his center at least 3 times before I flew back home. Dr. Jim Garza is also a very nice surgeon. I have spoken with him personally and know people who have had surgery from him. He comes highly recommended as well. Patients with axillary hyperhidrosis who are unresponsive to medical therapy can be effectively treated by excision of the axillary sweat glands. If sweating extends beyond the hairy portion of the axilla, several skin incisions may be needed, sometimes resulting in formation of hypertrophic and/or constrictive scars.
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