Ask the Expert
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| Dr. Glaser | Dr. Hebert |
Answering your questions are Dr. Adelaide Hebert, Professor in the departments of Dermatology and Pediatrics at the University of Texas Medical School at Houston, USA, and, Dr. Dee Anna Glaser Professor and Vice Chairman and Director of Cosmetic and Laser Surgery, Department of Dermatology, Saint Louis University School of Medicine, USA.
Keep in mind that we cannot respond to all questions, nor do we offer medical diagnosis or individual treatment recommendations. The information provided in the doctors' answers is theoretical and does not constitute an individual treatment plan. For information related to your specific circumstances, please fully review this site and then talk to your doctor.
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When you write to the International Hyperhidrosis Society, your questions, suggestions, and stories are appreciated. Please recognize that we reserve the right to edit submissions, which may be published or otherwise used in any medium. Such use, however, is always in keeping with our privacy policy. Your privacy is important to us and respected. All submissions become property of the International Hyperhidrosis Society.
Check back often as we post new questions and answers regularly, and yours may be one of them!
Questions & Answers
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My 3-year-old son sweats profusely on his head and face and the rest of his body can be cold and clammy, too. His sweat is stinkier than normal. He's had blood tests and the results were normal. How should he be treated?
My 14-year-old daughter has been diagnosed with hyperhidrosis of the underarms. She's tried topical medicines but they gave her welts. Is she too young for Botox? Would the Drionic iontophoresis machine be an option for her?
I am 15-years-old and I sweat like crazy under my arms and on my feet. I've tried to tell my mom but she just looks at me like I'm a lunatic. There's no way we could ever afford Botox shots. Is there a way to fix my problem?
Is there any way to stop sweating without using knives, needles, or stitches?
How can I control bad body and foot odor?
What's the most effective way to use over-the-counter antiperspirants?
What's the difference between primary and secondary hyperhidrosis?
My problem is embarrassing facial flushing, is there anything I can do about it?
My 3-year-old son sweats profusely on his head and face and the rest of his body can be cold and clammy, too. His sweat is stinkier than normal. He's had blood tests and the results were normal. How should he be treated?
Dr. Hebert: That fact that you indicated that your son's sweat is "stinkier than normal" makes me think that there might be something else (an underlying medical condition other than primary hyperhidrosis) going on. If I were to see you and your son in my office, I would review his history, files, and test results very carefully, and perhaps re-administer some tests. If the tests indicated that your son's sweating was being caused by another medical condition (such as a metabolic disorder), we would treat that other medical condition in the hopes of solving both problems.
Of course, it is possible for a three-year-old to have primary hyperhidrosis in which case we would probably start treatment with Certain Dri. Certain Dri is a topical antiperspirant containing what is probably the weakest of the aluminum chlorides (the ingredients that make antiperspirants for excessive sweating work). If Certain Dri didn't provide satisfactory results, we might move on to a stronger topical antiperspirant such as Drysol. The important thing to remember when using either of these products, and other similar products, is to apply them to completely dry skin. If the skin is at all wet, the water and the aluminum chloride will combine to create a weak acid which can lead to skin irritation. Of course, a three-year-old child often has sensitive skin and strong antiperspirants like Certain Dri and Drysol can cause irritation even in adults. If skin irritation becomes or is likely to become a problem, I would recommend Zeasorb powder. The powder granules in Zeasorb are much smaller than those in other powders. This gives the Zeasorb granules more surface area from which to absorb moisture -- making Zeasorb one of the most effective moisture and friction absorbing powders available. Zeasorb won't stop the sweating but it can help to make the child more comfortable. Zeasorb is a specialty product so you are more likely to find it in a specialized pharmacy. Ask a dermatologist for a recommendation.
When the child is older and if sweating is still a problem, other treatments may be tried. For instance, as his skin matures we might be able to try antiperspirants, or stronger antiperspirants, again.
The most important thing for any child suffering with excessive sweating is to find experienced help. Excessive sweating can interfere with a child's education, socialization, and self esteem so proper treatment is critical. To find a physician who is familiar with hyperhidrosis and its treatment, check the Physician Finder on this site. For a child this young, a pediatric dermatologist would be ideal but because board certification in pediatric dermatology is relatively new it may be difficult to locate such a specialist in your area. If this is the case, a dermatologist with an interest in treating children is a good choice.
My 14-year-old daughter has been diagnosed with hyperhidrosis of the underarms. She's tried topical medicines but they gave her welts. Is she too young for Botox? Would the Drionic iontophoresis machine be an option for her?
Dr. Hebert: The U.S. Food and Drug Administration (FDA) has not yet approved Botox for the treatment of hyperhidrosis in teenagers but physicians are already using the treatment "off-label" for this purpose. The term "off-label" refers to the practice of prescribing drugs for a purpose outside the scope of the drug's approved label, most often concerning the drug's indication. It is entirely legal in the United States and in many other countries to use drugs off-label. Some drugs are used more frequently off-label than for their original, FDA-approved indications.
As I mentioned, physicians are using Botox to treat excessive sweating in teens and clinical trials are underway as part of the process of receiving FDA approval for this purpose. Additionally, I know of at least one study in the medical literature (peer-reviewed medical journals) citing a case of a 13-year-old girl successfully treated with Botox for excessive sweating and I have peers who are treating children as young as 13 in this manner. If your daughter truly has primary, focal hyperhidrosis she may be a good candidate for Botox treatment. How much does the sweating interfere with her life? Would she be cooperative during the injection process? Would she recognize that there might be some discomfort during the injections and accept that discomfort in return for a long period without underarm sweating? These would be important questions to consider prior to Botox treatment.
That said, I might still recommend the use of topical antiperspriants, first. Although you mention that a topical product gave your daughter "welts" it is possible that a different product, or more clear instructions on how to use the product, could prevent such a side effect in the future. For instance, topical antiperspirants should only be applied to completely dry skin and if there is any skin irritation (from the product or from the excessive sweating itself) that irritation should be allowed to clear before the product is tried again. The practice of "occlusion" (covering the affected area with plastic wrap after an antiperpsirant has been applied) is not recommended as it often leads to irritation and has not been shown to improve the effectiveness of antiperspirants. We might also adjust the frequency of applications and the length of time that the product is left on the skin (many strong antiperspirants should be washed off after eight hours, for example). Often, with the right precautions and careful instructions, skin can become "used" to antiperspirants and irritation can be avoided.
In reference to the Drionic Unit, while I am a believer in iontophoresis using the Fischer Galvanic Unit for the treatment of hyperhidrosis of the hands and feet, the Drionic Unit has been shown to be often ineffective and iontophoresis is, in general, not recommended for excessive sweating of the underarms. My fear would be that your daughter would try the Drionic Unit, not achieve the dryness she needs and would then become disillusioned and disappointed. This would be particularly unfortunate as there are other treatments that I believe she could truly benefit from.
I am 15-years-old and I sweat like crazy under my arms and on my feet. I've tried to tell my mom but she just looks at me like I'm a lunatic. There's no way we could ever afford Botox shots. Is there a way to fix my problem?
Dr. Hebert: As hard as this may sound, the first thing I recommend is that you try again to explain to your mother how and why your sweating is a serious problem. To break the ice and to help her to learn more about hyperhidrosis, show your mother this Web site (www.SweatHelp.org). There is a good chance that your mother, like many people, has not heard of hyperhidrosis and that once she learns more about the condition she will be sympathetic. If you continue to have trouble getting your mother to understand the seriousness of your sweating concerns, enlist the help of another trusted adult, such as an aunt, uncle, teacher, coach, school nurse, or school counselor. Explain your dilemma and ask this trusted adult to speak to your mother on your behalf. For more tips on how to talk to your parents about excessive sweating, visit our Ask Frances column in the Teen area of this site.
You mention that you think your family would be unable to pay for Botox injections for excessive sweating. Still, I would encourage you to talk to a dermatologist about your problem and about the most appropriate treatment for your individual circumstances. Perhaps you would be best served by topical treatment, which is relatively inexpensive. Or, perhaps, unbeknownst to you, your family's health insurance plan will cover the cost of your treatments.
Use the Physician Finder on this site to locate a physician in your area who is familiar with the treatment of hyperhidrosis.
Is there any way to stop sweating without using knives, needles, or stitches?
Dr. Hebert: The author of this question is just 12-years-old and I can tell that she really wrote this from the heart. Her question is heartwarming and heartrending at the same time. Here is a child who could really benefit from education about all the different hyperhidrosis treatment options. As I often do, I would start this child with topical antiperspirant treatment, or iontophoresis if she has excessive sweating of the hands or feet. Antiperspirants and iontophoresis are certainly treatments that a 12-year-old can learn to manage on her own. And, these treatments are not painful.
If topicals and iontophoresis could not provide her with relief, I would educate her about the benefits of Botox injections and hopefully help to alleviate her fears.
How can I control bad body and foot odor?
Dr. Glaser: To better understand where odor comes from, and how to control it, it helps to know a little bit about sweat glands. Humans have two different types of sweat glands: the eccrine glands and the apocrine glands. Eccrine sweat glands are found in large numbers on the soles of the feet, the palms, the forehead, the cheeks, and in the armpits. These glands produce large volumes of watery, odorless sweat. Hyperhidrosis, or excessive sweating, affects the eccrine glands.
Apocrine glands are different. They are found in the armpits and genital region. They produce a thick, viscous, usually invisible fluid. When this fluid comes in contact with bacteria on the skin's surface, it produces a characteristic potent smell.
Interestingly, people who suffer from true hyperhidrosis, or excessive sweating, often do not have problems with body odor. This is because the large volume of sweat that their bodies produce comes from their eccrine glands and that sweat tends to wash away bacteria and apocrine sweat. Body odor can occur, however, if a person sweats sporadically and the sweat is allowed to dry on the skin. In this circumstance, apocrine sweat would have the opportunity to react with bacteria on the skin and produce odor. If you are experiencing an odor problem, with or without hyperhidrosis, the first step is to keep the body area in question dry. Antiperspirants, powders, and frequent clothing changes can help in this regard. The next step is to wash regularly with an antibacterial soap like Dial, Safeguard, or Zest. To mask odor, a deodorant may be helpful (many antiperspirants also include deodorants). Sometimes changes in diet can also help. If these methods do not work, consult a dermatologist.
If you are experiencing severe foot odor, wetness and the body's "regular" bacteria may not be the sole problems. Extreme foot odor is often caused by an overgrowth of a different type of bacteria. This bacteria particularly likes the warm, moist environment of the feet. To solve the problem, both the bacteria and the moisture must be addressed. To control moisture, change your shoes and socks frequently and use powders or antiperspirants as recommended above. If necessary, a dermatologist or podiatrist can help you find additional ways to control foot moisture.
To help control bacteria, wash with an antibacterial soap, and discard any moist, odoriferous shoes or socks. Additionally, it will most likely be necessary for you to see a physician, such as a dermatologist or podiatrist. He or she may prescribe a topical or oral antibiotic.
While foot odor can be embarrassing, it doesn't have to prevent you from kicking off your shoes and relaxing. Talk to a podiatrist, dermatologist, or another physician about your concerns and use the tips above to start managing foot odor. Healthier, happier feet may just be a few steps away.
What's the most effective way to use over-the-counter antiperspirants?
Dr. Glaser: According to a recent study funded by Procter & Gamble Beauty, the makers of Secret Platinum, more than 90% of Americans use an antiperspirant product to control underarm wetness and odor, with most of us ranking our use of antiperspirants among our top two or three grooming priorities.
Interestingly, the researchers found that by applying over-the-counter antiperspirants twice per day, in the morning and later in the day (like in the afternoon or evening), consumers experienced the same type of wetness and odor control that they would if they used a stronger aluminum chloride based-product to treat sweating.
The researchers concluded that applying antiperspirants in the morning and evening was significantly more effective than applying them in the morning alone. But if you're not sure you want to, or can't find the time to apply your antiperspirant more than once a day, you can still improve its efficacy, say the researchers. Just change the time of day that you apply it. This study showed that applying an antiperspirant just in the evening, as opposed to just in the morning, gave users better results.
While not everyone who experiences annoying wetness or more severe excessive sweating will find that topical application of an antiperspirant is enough, it's certainly worth trying a change in your antiperspirant routine to see if it can be made more effective. Keep in mind that it is best to apply your antiperspirant to completely dry skin. This lessens the risks of irritation.
What's the difference between primary and secondary hyperhidrosis?
Dr. Glaser: When we talk about hyperhidrosis here at the International Hyperhidrosis Society, we're usually talking about primary hyperhidrosis. Primary hyperhidrosis is a medical condition unto itself and usually occurs at a particular location, or locations, on the body such as at the hands, feet, underarms, face, or head.
Because the symptoms of primary hyperhidrosis are commonly focused on just one or two body parts, it's often called "focal" hyperhidrosis. Depending upon where a person experiences primary focal hyperhidrosis, treatments may include topical antiperspirants, iontophoresis, Botox injections, or, as a potentially risky last resort, surgery. No one knows what causes primary focal hyperhidrosis.
Secondary hyperhidrosis is excessive sweating that's caused by another, underlying medical condition or by a medication that a person is taking. Often, secondary hyperhidrosis is characterized by sweating that occurs all over the body and even at night when a person is sleeping. When sweating occurs over large areas of the body, as opposed to just a couple of focused areas, it's called generalized hyperhidrosis.
Medical conditions that can cause this type of hyperhidrosis include: hyperpituitarism, hyperthyroidism, diabetes, cancer, neurological problems, menopause, spinal cord injury, gout, hypoglycemia, angina, heart attack or another cardiovascular problem, drug or alcohol withdrawal, and chronic infections like tuberculosis.
Additionally, some medications that are taken to treat medical conditions other than hyperhidrosis can cause excessive sweating as a side effect.
If you experience excessive sweating over large parts of your body or at night when you're sleeping, talk to your doctor. The key to helping to relieve secondary hyperhidrosis is finding it's cause - whether it be another medical condition or a medication.
There are cases of localized, or focal, hyperhidrosis that are caused by a secondary medical condition as well. Such cases of secondary focal hyperhidrosis may be caused by a variety of health issues, including a neurologic injury, skin syndrome, spinal cord injury, stroke, tumor, and rheumatoid arthritis.
As with other types of excessive sweating, it's important to talk to your doctor about your symptoms, your medical history, and any medications and supplements (over-the-counter, prescription, or herbal) that you may be taking. Finding the cause - and then the appropriate treatment - for your symptoms is a little bit like a puzzle and your doctor needs to know about all the pieces before he or she can effectively help you.
My problem is embarrassing facial flushing, is there anything I can do about it?
Dr. Glaser: A number of our visitors have recently asked about treatments for distressing blushing and face redness. Facial flushing, blushing, or redness can be associated with excessive sweating, or hyperhidrosis. But experts indicate it's much more common for blushing and redness to be related to another, separate condition. For instance, women experiencing menopause may experience facial flushing. Or, flushing may be a symptom of an anxiety disorder. And commonly, the skin condition rosacea can cause facial redness. (For more information about rosacea, visit the National Rosacea Society at www.rosacea.org.).
Because flushing can either be a condition unto itself or related to a separate medical condition, it is very important that you talk to a physician about your problem so that he or she can determine the reason for the flushing and the appropriate treatment. Possible treatments may include lifestyle changes or prescription oral medications (such as beta blockers).
A number of different types of physicians may treat facial flushing, including your primary care physician and/or a dermatologist. Either of these physicians may also refer you to another specialist, such as a mental health expert, depending upon what they believe may be causing your facial flushing. If you experience flushing, blushing, or facial redness, don't suffer in silence. Talk to a healthcare professional. Help may be available.
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Important Submission Information
Thank you in advance for writing to the International Hyperhidrosis Society. Your comments, suggestions, and stories of experiences are appreciated. As you write to us, please recognize that the International Hyperhidrosis Society reserves the right to edit submissions, which may be published or otherwise used in any medium. Such use, however, is always in keeping with our privacy policy and your privacy is important to us and respected. All submissions become property of the International Hyperhidrosis Society.