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The question: My boyfriend is always sweating, and it's usually his underarms that are affected. He sweats right through suit jackets. He thinks he may have hyperhidrosis. What's the cause of this condition and what can he do?

The answer: Sweating is our natural way of cooling the body down. When our body temperature rises, our nervous system is triggered to stimulate sweat glands to release fluid onto the skin's surface. As the fluid or sweat evaporates, it cools the body. Excessive sweating that is not related to exercise or keeping the body cool is called hyperhidrosis. The most common areas affected include the armpits, palms and soles of the feet. In rare cases, it can affect the face or scalp. While there may be a genetic predisposition to developing hyperhidrosis, for most there is no known cause that can be found.

Hyperhidrosis can have a significant impact on social and professional interactions. People may feel embarrassed by wet hands, the potential odour, or sweating through their clothes. For some, it can interfere with day-to-day activities such as shaking hands, grasping items and driving. Despite its potential negative impact, many people don't seek care due to their embarrassment.

The good news is that there are multiple options available for treatment.

First, see if there is a trigger to the sweating. For some, emotional stress can cause excessive sweating so work on relaxation techniques that can help with the physical symptoms.

For mild symptoms, over-the-counter antiperspirants that contain a low dose salt (i.e. Drysol) can work to block the opening of the sweat glands. Apply nightly until the symptoms improve (should be within a week) and then space out the applications to every few days to once a week as maintenance. If this option doesn't work, there are prescription strength antiperspirants that your doctor can suggest. The potential side effects of antiperspirants include redness and skin irritation, which can be minimized by applying the product at night when sweating is less and washing it off in the morning.

Your doctor may also consider prescribing you an oral medication to control the sweating, but these have generally fallen out of favour due to the potential side effects of dry mouth, constipation, blurred vision, and headache.

If these options do not work, a referral to a dermatologist is warranted. Iontophoresis is one therapy that consists of placing the affected body part in water and delivering a small electric current that can temporarily block sweat glands. The main drawback is that it can be time consuming, as treatments are initially required 30 minutes daily.

A mainstay of treatment for hyperhidrosis is botulinum toxin or Botox. Beyond the well-known cosmetic uses of Botox, it has been found to be helpful with severe hyperhidrosis – especially for the palms and armpits – by blocking nerves that trigger sweat glands This is not a permanent block and requires repeat treatments every few months.

In rare and severe cases, surgical removal of sweat glands or a severing of the nerves that supply sweat glands can be considered. This is a permanent solution but can result in increased sweating from a different part of the body such as the back or legs to compensate for the change made through surgery.

If the sweating is generalized (all over the body), it is important to rule out other potential causes that could be related to a medical condition such as a hormonal abnormality (thyroid disorder, diabetes), infection, cancer, menopause and medications such as antidepressants and anti-nausea agents.

Dr. Sheila Wijayasinghe is the medical director at the Immigrant Womens' Health Centre, works as a staff physician at St. Michael's Hospital in their Family Practice Unit and at Hassle Free Clinic, and established and runs an on-site clinic at Women's Habitat Shelter in Etobicoke.

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