Hyperhidrosis

Hyperhidrosis means sweat production well beyond what is needed to regulate body temperature. The underarms are most often affected, alongside the palms, soles and scalp. The burden is usually social: soaked clothing, avoiding certain fabrics and colours, unease when greeting people, presenting or attending appointments.

Investigation comes first.

A distinction is drawn between primary hyperhidrosis, which usually begins in adolescence, is symmetrical and eases during sleep, and secondary hyperhidrosis as the consequence of another cause. Candidates include an overactive thyroid, hormonal transitions, blood sugar disorders, infections, certain medications and, less often, haematological disease. Night sweats with weight loss or fever must always be investigated before any symptomatic treatment is discussed.

As a physician also working in general practice, Dr. Harris assesses these questions in the same appointment. Before any underarm treatment come the history and, where indicated, targeted blood tests.

How the treatment works.

The sweat glands are driven by cholinergic nerve fibres of the sympathetic nervous system. The medication used blocks the release of acetylcholine at these endings. For a limited period the signal to produce sweat no longer reaches the gland; the gland itself remains intact.

Injections are placed superficially into the skin of the affected area in an even grid. The effect begins after about two to seven days and in this indication typically lasts longer than in the face — frequently six to nine months.

Side effects — named honestly.

Treating the underarms involves numerous small, superficial injections; most people describe it as well tolerated. Redness, small bruises and a temporary sense of pressure are possible. In some people sweating increases slightly elsewhere on the body (compensatory sweating). When the palms are treated, a temporary slight loss of strength in the small hand muscles can occur — this is discussed separately. A residual risk cannot be excluded entirely.

When treatment is not the right answer.

If a secondary cause is present and has not been investigated. If first-line measures such as aluminium chloride antiperspirants have not yet been tried — they are simpler, cheaper and sufficient for some people. We do not treat during pregnancy or breastfeeding, or where a neuromuscular condition is present.

Insurance cover.

Where primary hyperhidrosis is pronounced and medically documented, cover by basic insurance is possible in individual cases, provided conservative measures have documentably failed. Whether the conditions are met is assessed individually and, where appropriate, clarified with the insurer in advance. No guarantee can be given beforehand.