By Meg Nugent Imagine sweating so profusely from your underarms that you need to take three or four shirts to work because you have to change several times a day. Imagine perspiring so much from your feet that your shoes and socks look as if you'd just come in from a downpour, even on a sunny day. East Brunswick resident Connie Bryson, a retired elementary school teacher, has coped with excessive sweating from her hands, feet and underarms since she was young. "The part that's the real deal-breaker is the hands," said Bryson, 67, a pianist who gave up pursuing a career as a musical performer because of all the sweat. She tried a year of formal piano instruction when she was 18 and in college. "It was so mortifying. It was too stressful for me to continue - having people watch you play, and sitting there and sweating all over everything." As a result, Bryson taught herself to play the piano and to compose music and lyrics. "You can't imagine this," she added, "unless you walk around for a couple of days with an open pot of water next to you and you dip your hands in and then try to do something." Bryson is one of an estimated 8 million people living with hyperhidrosis, a chronic medical condition in which the body produces much more sweat than it needs to maintain a normal temperature. "This is not a psychological disease, (even though) it can drive you crazy and ruin your life," said Dr. Lewis Stolman, a Livingston dermatologist who routinely treats people with hyperhidrosis. "It affects every aspect of one's life." It can be especially devastating on a person's ability to maintain relationships with others. "You get this sort of pariah sense, even when people care about you and love you," Bryson said. "People just cringe at somebody who has wet hands. Nobody wants to take or hold your hand. If they're tactful, they try to furtively wipe their hand off real quick." The exact cause of hyperhidrosis is unknown, but it tends to be an inherited condition, Dr. Stolman said. In people with hyperhidrosis, the sweat glands seem to overreact to various stimuli and may also be overactive in general, resulting in the over-production of sweat. The palms, feet and armpits are the most common areas of excessive sweating, although people can also sweat profusely from the face, according to the International Hyperhidrosis Society. There are two types of hyperhidrosis, according to the society. While primary hyperhidrosis is unrelated to other medical conditions, secondary hyperhidrosis is caused by an underlying medical condition, such as diabetes, cancer, the use of certain medications or menopause. Health professionals said hyperhidrosis has physiological roots, as opposed to psychological or emotional ones. "It is made worse by anxiety and tension and heat, but it's not caused, per se, by them," Dr. Stolman said. "Even when they're not anxious or not tense or not hot, they sweat more than they have to, more than is normal and natural." Hyperhidrosis tends to surface during adolescence, said Dr. Stolman, but it can also begin during childhood, sometimes during infancy "and even in the newborn nursery." One of his patients, a 14-year-old Essex County resident who asked that her name not be used, said she has had the condition, which affects her hands, feet and underarms, since she was 6. Sometimes the sweating gets so bad, she has to leave school to go home, the teenager said. While she has a close circle of friends who know and understand her condition, she said, she becomes nervous around strangers. "If my hands sweated, I tried to hide it from people. I would give the excuse that I just washed my hands." If she would leave sweat on a public keyboard at school, she would pretend ignorance, saying, "I don't know how that got there." Many people don't seek treatment because they don't realize that hyperhidrosis is a medical problem, said Dr. Stolman. Or, he said, "they go to a doctor who's not familiar with the problem, so they don't get the kind of help they need and want." "You wind up blaming yourself for this," said Cheri Fiory, 29, who was raised in Summit and now lives in Pennsylvania. She recalled being told repeatedly by doctors who didn't know about the condition that she was nervous or anxious and just needed to relax. "You get the idea that, if you could just change your attitude, you would be normal." There is no cure for hyperhidrosis, but there are treatments that are designed to significantly reduce excessive sweating. One of the newest involves injections of botulinum toxin (Botox) into the affected areas. Botox, which has been used cosmetically to reduce wrinkles, works by interfering with or freezing the nerve that sends messages to the sweat gland to produce sweat. "All sweat glands are connected to a nerve, and they need a signal from the nerve to produce sweat," Dr. Stolman said. The U.S. Food and Drug Administration has not yet approved the use of Botox for hyperhidrosis, according to dermatologists. Paul Frank, a dermatologist at New York University Medical Center and assistant clinical professor at the NYU School of Medicine, explained that doctors can legally use Botox "off label" to treat hyperhidrosis because it has previously received FDA approval for another purpose, to reduce wrinkles. Bryson said the excessive sweating in her hands virtually disappeared after Dr. Stolman gave her Botox injections three months ago. Just last week, she went back to Dr. Stolman to receive injections to her underarms. "It certainly changed my life for the time it's been working for me," she said. For example, Bryson said, she attended a party three weeks ago and was asked by a fellow guest to play one of her pieces on the piano. "It was the first time I sat down at a piano in a public place without anxiety. It was the first time in my life that that ever happened." The treatment does have its side effects, said Dr. Stolman. He explained the drug can reduce the strength of the muscles in the area of treatment, which can affect dexterity and the ability to carry out certain manual tasks. Bryson said she experienced a feeling of weakness in her hands. "I knew there was a different and a slight, uncoordinated feeling. It didn't affect my playing, and he (Dr. Stolman) said it might. And I said, even if it does a little bit, I'm so happy to have this trade-off." Another downside is that medical insurance doesn't always cover Botox treatments for hyperhidrosis, which can cost $1,000 to $2,000 and which have to be done every six months to remain effective. Some patients have found success with prescription anti-perspirants that contain 12 percent to 20 percent aluminum chloride, according to the American Academy of Dermatology. These products can irritate the skin of some people. Another option is surgery to remove sweat glands or clip the nerves that transport messages to the sweat glands to perspire. Clipping the nerves, however, often results in a condition called "compensatory hyperhidrosis." This means that, although excessive sweating is stopped in one area, another area of the body begins to experience profuse sweating. People with hyperhidrosis in their hands or feet can find relief from a treatment known as iontophoresis. Using a battery-operated device, a gentle electric current is passed through the palms and soles of the feet, causing what Dr. Stolman describes as an "invisible thickening" of the skin. You can't see the thickening, but it's enough to block the flow of sweat to the skin's surface. "When they sense a barrier to the delivery of sweat to the skin surface, the sweat glands shut down. They no longer produce sweat, and you have dry hands or feet," Dr. Stolman said. Fiory has found great relief from iontophoresis. But the procedure can be time-consuming, she said, explaining it takes her about an hour each time she uses the device, which is usually three or four times a week. She said she has also experienced dryness in certain areas of her skin. None of these treatments would cause the body to overheat, according to Frank. The underarms, hands or feet represent only about 1 percent of the body's total area of sweat glands, he said. "You have a sweat gland everywhere on your body. Your body just adjusts. It doesn't make a difference." "Inappropriate, excessive perspiration serves no function,"
Dr. Stolman said. "So, if you turn it off, you don't
lose anything. You would still sweat normally from other body parts
- your arms, tummy, chest and back." The International Hyperhidrosis Society suggests these questions
to help guide you in making a self-assessment. But remember that
a true diagnosis can only be made by a medical professional, so
take these questions along when you visit your doctor:
No sweat: Ways to limit perspiration In addition to medical treatments for hyperhidrosis, you can do
things in your everyday life to help manage excessive sweating.
Suggestions from the International Hyperhidrosis Society include:
For more information, contact the International Hyperhidrosis Society,
18 S. Third St., Philadelphia, Pa. 19106; www.sweathelp.org; (215)
351-9050. | |||||
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