Perhaps you don’t sweat it. But up to five percent of Americans wish they were so lucky. They have hyperhidrosis — in other words, they perspire profusely.
For most, sweat serves as the body’s coolant, protecting us from overheating via evaporation. We’re covered from scalp to soles with 2 to 4 million sweat glands. They serve as our inner sprinkler system and are vital to survival — especially in warmer climates.
But some of us experience extreme sweating, a chronic condition with no known cause other than it runs in families. If a parent has it, one in four offspring have a risk they will too.
“We do not know why the nervous system fails to function well in this regard,” says Adelaide A. Hebert, M.D., professor of dermatology and director of pediatric dermatology at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).
With hyperhidrosis, the brain sends a false SOS, causing sweat glands to be stuck “on” — causing four to five times normal perspiration output.
“The most significant challenge is the enormous emotional impact,” says Hebert, who has a clinic at UT Physicians. “It’s very embarrassing to sweat excessively, whether you’re 5 or 65 years old.”
One of children’s first memories might be classmates shunning them. Later in life they may isolate themselves, avoiding intimacy or public professions and wondering: Are my sweat stains showing? Do I smell? Did someone notice my slick palms as we shook hands?
Nine of 10 afflicted have primary focal hyperhidrosis, which first appears in childhood or adolescence. This medical condition starts with palms, sometimes soles. By adulthood, glands in the armpits, cheeks, scalp, chest, buttocks and elsewhere may kick in, leading to at least one heavy sweating episode weekly.
Far less common is secondary hyperhidrosis, which is just that: a side effect of another condition, such as stroke, diabetes or cancer.
Though mortifying, hyperhidrosis is scent-free, as it involves eccrine sweat glands, which are plentiful on palms, soles, underarms, cheeks, foreheads and even scalps. These glands wash away odorous germs via water with traces of salt, protein and carbohydrates — but no toxins. (Detoxing is done by the liver and kidneys.)
Far less common apocrine glands in armpits and genitals produce a thick, fragrance-free fluid, but even it only smells when it collides with germs on the skin’s surface. Odorous feet similarly sprout from bacteria that multiply in warm moisture.
Incidence of the primary form of excessive sweating is year-round and evenly distributed among genders, ethnicities and professions, whether you’re in housekeeping or medicine.
“I have treated dentists who have had sweat drip out of the rim of their gloves, which is not ideal for patient or dentist,” Hebert says. “Trial lawyers say they look like the guilty party in court because they are sweating so much.”
Most of us only face “flop sweat” — and accompanying fear of failure or embarrassment — before delivering a speech or presentation. Unlike standard sweating, the amped-up version doesn’t occur due to stress, spin class, hot drinks, caffeine, spicy food, obesity or scalding showers.
Symptoms have no relation to polite euphemisms for female perspiration from the past: dew or glow. But judging from reports of her patients, Hebert says, synonyms and associated words for “sweat” in the dictionary are apropos: anguish, torment, angst, labor, pain, trouble, agita, worry, anxiety, strain and struggle.
Shame leads to sufferers not sharing their symptoms with family or doctors. And when they do, their concerns may be dismissed by physicians.
“This often is devastating to patients. The emotional impact of hyperhidrosis is under-recognized and under-appreciated by medical practitioners,” Hebert says. ““There is a great unmet need in medicine with regard to hyperhidrosis — and it is critically important it be served.”