What Causes Excessive Sweating and What Are the Treatment Options?

Excessive sweating, medically known as hyperhidrosis, is a condition where the body produces much more sweat than necessary to maintain its thermal balance. Genetic predisposition, thyroid diseases, diabetes, or hormonal changes like menopause often lead the list of causes. For treatment, a wide variety of methods—ranging from creams and Botox to clipped ETS surgery, which offers a permanent solution—are successfully applied depending on the patient's condition.

• Hyperhidrosis is a condition of excessive sweating that develops independently of the ambient temperature.
• Underlying causes can be genetic, or they may be linked to diabetes or thyroid diseases.
• Targeted sweating solutions include antiperspirant creams, iontophoresis, Botox, and surgery.
• Clipped ETS surgery yields permanent results for sweating of the hands, face, and underarms.
• In cases of night sweats or sudden-onset sweating, you should consult a doctor without delay.

What is Excessive Sweating (Hyperhidrosis)?

Our bodies activate sweat glands to lower rising body temperatures and maintain an ideal thermal balance. However, in hyperhidrosis, the nerves stimulating the sweat glands are overactive, and the body continuously produces sweat even when there is no physical exertion or high temperature. This is a clinical condition that deeply affects a person's daily life, social relationships, and psychological well-being.

Modern living conditions often force people to live in enclosed, limited spaces. Some individuals spend almost their entire twenty-four hours working and resting in small, closed rooms. These enclosed environments make it difficult for the sweat load on the hands and body to be naturally expelled. For people spending long hours indoors, skin problems due to the inability of moisture to evaporate from the skin surface are just as common as diseases transmitted through air conditioning.

Assoc. Prof. Dr. Orhan Yücel, a Thoracic Surgery Specialist at BHT CLINIC İstanbul Tema Hastanesi, summarizes this situation quite strikingly. Noting that sweat literally drips from the hands, faces, and underarms of some patients, Assoc. Prof. Dr. Yücel states that these intense complaints quickly drive patients toward alternative treatments. However, without a proper treatment plan, it becomes difficult for patients to achieve lasting solutions.

What Causes Excessive Sweating?

The underlying causes of excessive sweating are divided into two main categories based on the type of the condition. This distinction plays a determining role in the hyperhidrosis treatment that will be applied.

Primary Causes

Primary hyperhidrosis is a type of sweating that occurs without any other underlying medical condition. It usually begins in childhood or adolescence. It affects specific areas of the body, particularly the hands, feet, underarms, and face.

The main cause of this type of sweating is an overactive sympathetic nervous system. Emotional states like stress, excitement, or anxiety can trigger it. A family history is frequently encountered in primary hyperhidrosis cases; meaning, genetic predisposition plays a major role.

Secondary Causes

Secondary hyperhidrosis affects the entire body and emerges as a symptom of another underlying disease or condition. An overactive thyroid gland (hyperthyroidism) speeds up metabolism, increasing body temperature and leading to excessive sweating.

In diabetic patients, a sudden drop in blood sugar (hypoglycemia) triggers adrenaline secretion in the body, causing cold and intense sweating. In menopausal women, fluctuations in estrogen levels mislead the brain's temperature-regulating center, leading to hot flashes and sudden sweating attacks.

Additionally, certain infections, neurological diseases, and specific medications (such as antidepressants) can be counted among secondary sweating causes. Therefore, in cases of secondary hyperhidrosis, the primary goal is to treat the underlying condition.

What Are the Symptoms of Excessive Sweating?

Hyperhidrosis symptoms are much more severe and bothersome than normal sweating. A person might sweat heavily enough to soak their clothes even while sitting in a cool environment. This situation not only causes physical discomfort but can also turn into a serious social phobia.

Sweating in the hands, in particular, can make writing, using technological devices, or shaking hands with someone nearly impossible. Excessive sweating in the feet paves the way for rapid shoe wear and bad odor. In severe cases, the following symptoms are observed:

• Formation of noticeable, large sweat stains on clothing.
• Sweat dripping in beads from the hands or face.
• Whitening, peeling, or softening of the constantly damp skin.
• Recurrent fungal or bacterial infections in sweating areas.
• Avoidance of social environments and a loss of self-confidence.

How is Hyperhidrosis Diagnosed?

When you visit a hospital with a complaint of excessive sweating, your doctor will first take a detailed medical history. Questions such as when the sweating started, which areas of the body it affects, and whether there are night sweats form the basis of the diagnosis.

During the physical examination, a starch-iodine test or special paper tests may be applied to measure the intensity of the sweating. These tests are highly useful for mapping out which areas sweat more actively.

If your doctor suspects secondary hyperhidrosis, they may request blood and urine tests to rule out underlying diseases. Thyroid hormone levels, fasting blood sugar, and infection markers are examined to determine the true source of the sweating.

Excessive Sweating (Hyperhidrosis) Treatment

Excessive sweating treatment is planned entirely on a personalized basis, depending on the severity of the person's complaints, the sweating area, and the underlying cause. People have been struggling with this problem for years, seeking different targeted sweating solutions.

Antiperspirant Creams

The first step of treatment usually consists of antiperspirant creams and lotions containing aluminum chloride. These products temporarily block the sweat gland ducts, preventing sweat from reaching the skin surface. They are easy to use but can cause irritation on sensitive skin.

Assoc. Prof. Dr. Orhan Yücel warns against the uncontrolled use of cream treatments recommended on social media or the internet. Noting that creams applied unconsciously for excessive sweating can lead to heavy metal exposure, he emphasizes that this exposure may pave the way for various psychological and neurological disorders in the future.

Iontophoresis

Iontophoresis is a non-surgical method preferred especially for hand and foot sweating. The hands or feet are placed in a shallow basin of water, and a low-level, safe electrical current is passed through the water. This current temporarily halts the activity of the sweat glands.

Sessions, initially applied several times a week, are done less frequently for maintenance purposes in later periods. Although iontophoresis is a reliable method, it does not offer a permanent solution and requires regular, ongoing sessions.

Botox

Botulinum toxin (Botox) works by blocking the nerve signals that stimulate the sweat glands. It is considered one of the gold standards, especially for underarm sweating treatment. It is injected into the sweating area using fine-tipped needles.

The effect of the procedure usually begins a few days after application and lasts an average of 4 to 6 months. When its effect wears off, the procedure needs to be repeated. Botox can also be applied to the hands and feet, but the procedure can be slightly more painful in these areas.

Clipped ETS Surgery

When non-surgical methods fail to solve the problem, clipped ETS (Endoscopic Thoracic Sympathectomy) surgery, which has a very high chance of providing a permanent effect, comes into play. Assoc. Prof. Dr. Orhan Yücel states that surgery is the most effective and permanent treatment for regional excessive sweating. In this minimally invasive surgery, titanium clips are placed on the sympathetic nerves causing the sweating.

It is of vital importance that the surgery is performed with the right indications. Assoc. Prof. Dr. Yücel notes that if your hands, face, or underarms do not sweat when you lie down to sleep at night, you might be a suitable candidate for surgery. Patients with sweating limited to the hands, face, underarms, and feet should definitely be evaluated for clipped ETS surgery. For generalized body sweating, surgery is not effective.

In the past, electrocautery was used to burn the nerves in these surgeries. However, this could lead to excessive damage to the nerve tissue, a decrease in heart rate, and an increased frequency of reflex sweating across the body. In the clipped method, the nerve is not cut or burned. If the patient is uncomfortable with their general condition after surgery, they can largely return to their previous state when the clips are removed.

Complications and Risk Groups

When excessive sweating is left untreated, the skin remains constantly damp, making it vulnerable to fungal and bacterial infections. Stubborn skin problems can arise, especially between the toes and in the underarms. In addition to physical complications, experiencing social isolation and falling into depression are common psychological impacts.

Surgical treatments also carry their own unique risks. The most common problem is reflex sweating. After surgery, excessive sweating may begin in other parts of the body (such as the back or abdomen). Assoc. Prof. Dr. Yücel notes that they pay great attention to proper patient selection and the surgical method used before the operation to reduce the risk of reflex sweating.

Those with a family history of hyperhidrosis, diabetic patients, and individuals experiencing thyroid dysfunction are in the high-risk group for excessive sweating. These individuals should consult a specialist physician without neglecting their sweating complaints, just as they would when protecting against respiratory diseases.

When Should You See a Doctor?

Although sweating is usually a natural process, in some cases it can be a harbinger of a serious health problem. If your daily quality of life is declining and you have started to avoid social environments, it means it is time to seek medical support.

You should visit a healthcare facility without delay if you experience any of the following warning signs:

• If your sweating complaint started suddenly and inexplicably.
• If you experience night sweats intense enough to wake you from sleep.
• If sweating is accompanied by involuntary weight loss, high fever, or a persistent cough.
• If sweating occurs on only one side of the body (asymmetrical).
• If sweating is accompanied by chest pain, shortness of breath, or numbness in the left arm (This could be a sign of a heart attack; you must call 112 immediately).

The Process at BHT CLINIC İstanbul Tema Hastanesi

In our Chest Diseases and Thoracic Surgery departments at BHT CLINIC İstanbul Tema Hastanesi, our patients with complaints of excessive sweating are evaluated using a multidisciplinary approach. Our specialist physicians meticulously investigate the underlying causes and offer you the most appropriate medical or surgical treatment plan.

In our hospital, surgical procedures requiring advanced technology, such as clipped ETS surgery, are safely performed by experienced surgeons. With our 24/7 emergency service and fully equipped polyclinics, we are by your side as you take a step toward a healthier life. You can book an appointment via our website for a detailed evaluation.

Frequently Asked Questions

What is reflex sweating?

Reflex sweating is a condition where, in response to the cessation of hand or underarm sweating after ETS surgery, a new, compensatory excessive sweating begins in different areas of the body, such as the back, abdomen, or legs. It is the most well-known side effect of this surgical treatment.

Can ETS surgery be reversed?

If the nerves were not burned with a cautery during the surgery, and titanium clips were used instead, the surgery can largely be reversed. When the clips are removed, nerve conduction can resume, and the patient can return to their previous state.

Are night sweats dangerous?

Intense night sweats experienced despite a normal room temperature can be a symptom of serious illnesses such as infections, thyroid problems, or certain types of lymphoma. Therefore, night sweats must definitely be evaluated by a physician.

Are targeted sweating solutions permanent?

Targeted sweating solutions like antiperspirant creams, iontophoresis, and Botox provide temporary relief and need to be repeated regularly. Only clipped ETS surgery, when applied to the right patients, offers a permanent solution.

What is the best method for underarm sweating treatment?

For underarm sweating, the first choice is usually Botox application; it provides a high rate of dryness for 4-6 months. In cases where Botox is insufficient or a permanent solution is sought, surgical options are evaluated.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.