What is Excessive Sweating (Hyperhidrosis)? Symptoms and Treatment Methods

Excessive sweating, medically known as hyperhidrosis, is a condition where the body produces much more sweat than normal, completely independent of its need to regulate temperature. Sweating on a hot summer day in Istanbul, during an intense workout, or in a stressful moment is a perfectly natural bodily response; however, for hyperhidrosis patients, this occurs without any trigger. Usually concentrated in the hands, feet, underarms, and face, this problem can seriously affect a person's daily quality of life, social relationships, and psychological well-being. Anyone wondering what hyperhidrosis is should know that it is not just a cosmetic issue, but a medical condition that requires professional care.

In Brief:

• Excessive sweating can develop without an underlying disease (primary) or due to another condition (secondary).
• Regional (local) sweating problems are generally more common in young adults between the ages of 21 and 25.
• Treatment options include creams containing aluminum chloride, iontophoresis, Botox, and medication.
• Offering a permanent and effective solution, ETS surgery is completed in about 30 minutes using a closed surgical method.
• General sweating that wakes you up at night or starts suddenly can be a sign of a serious systemic illness.

What is Excessive Sweating (Hyperhidrosis)?

Sweating is a vital function that keeps body temperature balanced. When body temperature rises, the nervous system stimulates the sweat glands to secrete fluid, and the evaporation of this fluid cools the body. In cases of excessive sweating, the nerves controlling this system work in overdrive, even when there is no physical activity or increase in temperature. This condition can be seen all over the body or just in a specific area (local). Localized sweating most commonly manifests in the hands, face, underarms, and feet.

According to clinical observations, localized sweating problems usually begin more frequently in individuals aged 21-25. Patients over thirty, on the other hand, mostly apply to the clinic with complaints of generalized sweating. Generalized sweating is felt all over the body, not just in a single area, and is mostly considered a symptom of a systemic disease. If sweating makes it difficult for a person to perform daily activities, restricts clothing choices, or disrupts social life, it is medically considered hyperhidrosis and requires a treatment plan.

What Causes Excessive Sweating and What Are the Risk Factors?

The answer to what causes excessive sweating varies depending on the type of sweating. In medicine, this condition is divided into two main categories: primary and secondary hyperhidrosis. Accurately identifying the causes directly affects the success rate of the treatment applied.

• Primary Causes: This is the overactivity of the nerves that stimulate the sweat glands without any underlying medical condition. It usually affects the hands, feet, and underarms. At least half of the patients have a family history; meaning genetic predisposition is quite prominent. The likelihood of this condition appearing in children of parents who sweat excessively is high.
• Secondary Causes: This is sweating that occurs as a side effect of another disease or condition. It generally affects the entire body. Cancers, heart diseases, respiratory tract diseases, hormonal disorders like thyroid issues, infections, anxiety disorders, diabetes, gout, and obesity fall into this group. Additionally, secondary hyperhidrosis can be seen during periods of intense hormonal changes, such as pregnancy, or in cases of substance abuse.

What Are the Symptoms of Excessive Sweating?

The symptoms of excessive sweating are quite different from normal sweating and complicate a person's life in concrete ways. The most prominent complaints include clothes getting soaked without any exertion, and hands constantly feeling wet or clammy. People experiencing hand and foot sweating may struggle in daily life to turn a doorknob, keep paper dry while writing, or grip the steering wheel while driving. Foot sweating paves the way for rapid wear and tear of shoes, fungal infections, and unwanted odors.

Besides physical symptoms, the psychological effects of excessive sweating are also quite heavy. Many people looking for an underarm sweating solution hesitate to raise their arms in social settings and feel compelled to constantly choose dark, loose-fitting clothes. Avoiding handshakes in job interviews or social gatherings damages a person's self-confidence. If treatment is delayed, this constant state of anxiety can drag the person into depression and social isolation. If complaints persist, one should not hesitate to seek both physical and psychological support.

How is Excessive Sweating Diagnosed?

The diagnosis of excessive sweating is made by a specialist physician listening to the patient's medical history and conducting a physical examination. For localized excessive sweating seen in the hands, face, and underarms, history and examination findings are usually sufficient for a definitive diagnosis. The physician asks the patient in detail exactly which areas the sweating is concentrated in, its frequency during the day, and whether it continues during sleep.

Whether there is excessive sweating during sleep at night is a critical question; because primary hyperhidrosis usually stops during sleep, while secondary hyperhidrosis tends to continue at night. Furthermore, the extent to which sweating affects daily life and restrictions in work and social life are evaluated. These answers guide the physician on whether the patient is suitable for surgical treatment. If the doctor suspects another underlying systemic disease (such as a thyroid condition or diabetes), they may request additional detailed tests like blood tests, hormone panels, or radiological imaging for a differential diagnosis.

Excessive Sweating Treatment: Non-Surgical Methods

Excessive sweating treatment is planned individually according to the severity of the patient's complaints, the sweating area, and the patient's general health status. The answer to whether excessive sweating goes away on its own is mostly no; although spontaneous reduction is seen in very rare cases, medical intervention is usually necessary. If there is an underlying disease (secondary), the sweating will not stop unless that disease is treated. For primary hyperhidrosis, the following medical methods are evaluated before surgery:

Creams and Roll-ons Containing Aluminum Chloride

This is the first-line treatment for mild to moderate sweating. These medical products containing aluminum chloride hexahydrate temporarily block the sweat gland ducts, preventing sweat from reaching the skin surface. It is usually applied to dry, clean skin before going to bed at night and washed off in the morning. With regular use, it can significantly reduce sweating, but it may cause redness, itching, and irritation on the skin in some patients.

Iontophoresis Treatment

This is an effective method especially preferred for hand and foot sweating. The patient places their hands or feet in a special tub containing tap water. A very low and safe level of electrical current is delivered to the water via a device. This mild current temporarily halts the activity of the sweat glands. Sessions applied a few times a week are continued at less frequent intervals as maintenance sessions once the sweating is brought under control.

Botox (Botulinum Toxin) Injection

This is a popular method frequently used for underarm, hand, and face sweating. Botox stops sweat production by blocking the stimulating signals going from the nerve endings to the sweat glands. The procedure is performed in a clinical setting with fine needles and takes about 15-20 minutes. Its effect is not permanent; it lasts on average between 4 to 6 months depending on the patient's metabolism. Once the effect wears off, the procedure needs to be repeated.

Medication

Systemic anticholinergic drugs work by blocking the chemical messengers that stimulate the sweat glands in the body. However, because these drugs affect not only the sweat glands but also other systems in the body, they can cause side effects such as dry mouth, blurred vision, constipation, and heart palpitations. Therefore, they are generally used with caution under a doctor's supervision in patients who do not respond to other treatment methods.

Effective and Permanent Treatment: ETS Surgery

The most effective and permanent method for treating excessive sweating in specific areas such as hands, underarms, face, and feet is Endoscopic Thoracic Sympathectomy, or ETS surgery for short. Our patients frequently ask, "What does excessive sweating in the hands have to do with the chest cavity? Why do you perform the surgery from inside the chest cavity rather than the hand?" The reason is that the sympathetic nerve network responsible for sweating in the hands, face, and underarms is located inside the chest cavity on both sides of the spine. In this area, the sweating nerve is seen very clearly, and this is the easiest, safest area to intervene on the nerve.

ETS surgery is performed under general anesthesia using a closed surgical (endoscopic) method and takes an average of 30 minutes. During the surgery, one or two very small incisions are made through the armpit. A tube-shaped device called an endoscope with a lighted camera at the tip is inserted through this incision. The chest cavity is projected onto the screen via the camera, and the problematic nerves causing the sweating are identified. Entering through the other incision with the help of another instrument, a titanium clip is placed on the nerve to eliminate the effect of the nerve stimulating the sweat. Thus, the nerve is blocked, and the sweating problem is resolved. The surgery for the right and left sides is performed in the same session, within a single surgical process. Patients usually recover quickly and return to their daily lives; during the postoperative recovery period, adequate protein intake and a balanced diet accelerate tissue repair.

Complications and Risk Groups

As with any surgical intervention, ETS surgery has its own specific risks and possible complications. The most common situation is increased sweating in another part of the body after the surgery. This is called "reflex sweating" or "compensatory sweating." To balance the sweat it cannot excrete from the hands or underarms, the body may start to sweat from the lower back, abdomen, back, or leg areas.

To reduce and manage the risk of reflex sweating, a clip method that allows for reversibility should be used in surgery. Placing a clip instead of cutting or burning the nerve provides a chance to intervene if an undesirable situation occurs. If severe reflex sweating occurs at a level that disturbs the patient despite everything, the inserted clip can be pulled out and removed. If the sweating does not stop despite the removal of the clip, nerve joining (nerve graft) surgery can be performed. However, it should not be forgotten that the success rate of this reversal procedure is around 40%, and the decision for surgery should be made by discussing all these details with the physician.

When to See a Doctor?

Although sweating is harmless most of the time, some specific situations can be a sign of a serious underlying health problem. If you experience any of the following symptoms, it is recommended that you apply to a healthcare facility without wasting time:

• If your sweating complaint started suddenly without an obvious reason,
• If you experience night sweats intense enough to wake you from sleep only at nights,
• If sweating is seen only on one half of the body (asymmetrical),
• If sweating is accompanied by unexplained weight loss, constant fatigue, or a stubborn fever.

Emergency Warning: If sudden and cold sweating is accompanied by chest pain, a feeling of pressure in the left arm or jaw, shortness of breath, dizziness, or nausea, this could be a sign of a heart attack. In such a scenario, you must absolutely call the 112 Emergency Call Center without wasting time or apply to the emergency department of the nearest hospital.

Excessive Sweating Treatment Process at BHT CLINIC

As BHT CLINIC İstanbul Tema Hastanesi, we offer diagnosis and treatment services with a multidisciplinary approach to our international and local patients presenting with excessive sweating complaints. Our Pulmonology (Chest Diseases) and Thoracic Surgery departments work in coordination to investigate the underlying causes of sweating and plan surgical treatment. In addition to respiratory diseases such as persistent cough, shortness of breath, COPD, and asthma, advanced technology devices and current surgical techniques are used in the treatment of hyperhidrosis in our department.

When you visit our hospital, our specialist physicians listen to your medical history in detail, perform the necessary tests, and determine the most appropriate surgical or non-surgical treatment method for you. For our patients who are decided to have surgery, ETS surgery is safely performed in our highly equipped operating rooms. For unexpected situations, our fully equipped emergency room, providing 24/7 service, is always by your side. To remove the sweating problem from your life and evaluate treatment options, you can book an appointment to consult with our specialist physicians.

Frequently Asked Questions

What disease is excessive sweating a symptom of?

Generalized body sweating can be a symptom of thyroid diseases (hyperthyroidism), diabetes, heart failure, infections (like tuberculosis), or certain types of cancer (lymphoma). Regional sweating seen only in the hands, feet, and underarms is usually due to genetic predisposition and is not a symptom of another disease.

Which doctor should I see for excessive sweating?

For excessive sweating complaints, you can primarily apply to Dermatology, Pulmonology, or Internal Medicine departments. If there is no underlying disease and surgical treatment (ETS surgery) is planned, the process is managed by Thoracic Surgery specialists.

Does excessive sweating go away on its own?

The probability of primary (regional) excessive sweating going away on its own is very low; although it generally tends to decrease with age, it does not disappear completely. In secondary sweating, complaints only disappear when the underlying disease causing the sweating is treated.

What is the most effective method for an underarm sweating solution?

Medical creams and Botox injections yield highly successful results for underarm sweating. However, the effect of Botox lasts 4-6 months. For suitable patients looking for a permanent and definitive solution, ETS surgery is considered the most effective method.

Is reflex sweating permanent after ETS surgery?

Reflex sweating is a condition that can be seen in some patients and is generally mild. In cases where it is severe, sweating can largely be reverted to its original state by removing the clips used in the surgery. For this reason, the clip method, which allows for reversibility, is preferred in surgery.

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