Sweats a chemical change
Excessive sweating (Hyperhidrosis, hyperhydrosis): Pathological hyperfunction of the sweat glands, v. a. on the palms of the hands, feet and under the armpits. As an independent clinical picture, excessive sweating occurs in 5% of the population, especially in connection with stressful situations. It is often found as secondary hyperhidrosis in obesity, as a side effect of general illnesses or as a side effect of medication.
Basic measures to prevent excessive sweating include personal hygiene, underarm shaving, deodorants, and hot showers. In addition, locally applied antihidrotics, low-voltage therapy or botox injections alleviate the symptoms. In the case of severe symptoms and high levels of suffering, surgical measures such as the removal of the sweat glands or the severing of the trunk (sympathectomy) are available in addition to medication.
- Excessive sweating that occurs either locally (e.g. in the hands or armpits) or all over the body
- A feeling of moisture, a smell of sweat and wet stains on clothing
- If there is a sweat on the hand, the palms of the hands are usually cool, possibly even bluish-white.
When to the doctor
Coming soon when
- sweating affects the quality of life
- increased sweating occurs suddenly and for no apparent reason
- sweating occurs at night, with a simultaneous reduction in performance and weight loss (as so-called B symptoms in severe illnesses).
The phenomenon of sweating
Sweating is a natural process by which the body releases excess heat and regulates its temperature. At normal temperatures and without physical exertion, people lose around 100 to 200 ml of sweat a day. In extreme situations (see below) the 2 to 3 million can be spread over the body eccrine However, sweat glands produce up to 14 liters of watery secretion. This sweat gets on the body surface, evaporates into water vapor and gives about 333W / m2 Body surface.
Are the triggers for sweat production
- high ambient temperatures
- increased heat production through vigorous physical work or sport
- Stress, strong emotions, fear, pain (regardless of the ambient temperature, controlled by the autonomic nervous system)
- Food (certain spices).
In addition to thermoregulation, the signaling effect is another task of sweating. Sweat contains sexual fragrances (pheromones) and other substances that are produced in the apocrine sweat glands. These glands are only located in the hairy areas of the armpit and genital region and do not develop until puberty. They are controlled by the autonomic nervous system and the neurotransmitter adrenaline and are particularly activated when there is fear, stress or strong emotions (emotional sweating). Your secretion mixture is distributed even better by additional watery sweat from the eccrine glands in these areas. Armpit and pubic hair help the sweat, including pheromones, etc. to spread even better through the larger surface.
Odor of sweat. Sweat itself is odorless. The unpleasant smells are caused by bacteria living on the skin, which mainly break down organic components of the secretions of the apocrine sweat glands under the armpit and in the genital region. With permanent overproduction of sweat, the number of odor-causing bacteria increases.
Idiopathic excessive sweating (primary hyperhidrosis)
In idiopathic excessive sweating, the production of sweat is excessively stimulated, an actual cause for this cannot be determined. The triggers are the same as in "normal" sweating (see above), but sweat production occurs much faster and in a much more pronounced manner.
The symptoms can affect the entire body (generalized hyperhidrosis) or individual body regions such as armpits, hands, feet, thighs or head (localized hyperhidrosis). Excessive sweat production for no apparent cause often begins as early as puberty. Spontaneously or triggered by nervousness, stress or minor physical exertion, real outbreaks of sweat occur - up to visible drops on the palms of the hands. In pronounced cases, generalized hyperhidrosis represents a considerable psychological burden. For fear of sweat stains, unpleasant body odor or the need to offer a wet hand in greeting, some affected people withdraw from social life.
In older age, excessive sweating can be found as secondary hyperhidrosis in the case of severe obesity and in the context of certain underlying diseases, e.g. B. Hyperthyroidism, Parkinson's disease or a chronic infection. Seizure sweats in the form of hot flashes are a typical and common symptom of menopause. In rare cases they give an indication of hormonal disorders, e.g. B. a pheochromocytoma. If excessive sweating occurs mainly at night, a thick duvet or a room temperature that is too high, but also a systemic disease, may be the cause. Night sweats are typically found in some rheumatic diseases, tuberculosis or lymphoma. In connection with weight loss and a drop in performance, one speaks of a B symptoms. In addition to the diseases mentioned, the use of certain medications can also trigger excessive sweating; antidepressants, nitrates, calcium channel blockers or opioids are known for these side effects.
Repeated sweating softens the skin and makes it more susceptible to eczema, e.g. B. Chronic-toxic contact eczema, and infections.
The doctor first clarifies whether the increased sweat production occurs as part of an underlying disease that requires therapy. When making a diagnosis, the anamnesis is very important, as neither laboratory values nor diagnostic equipment are really informative. To determine the severity of the disease, various tests can be carried out in the dermatologist's office:
- Gravimetry. The doctor determines the amount of sweat by placing a previously weighed, absorbent filter paper on a heavily sweating area of skin. After 5 minutes the paper is weighed and its empty weight subtracted. Hyperhidrosis is likely with> 100 to 150 mg sweat / 5 minutes, but there are no fixed limit values for this method.
- Minor sweat test. Here the doctor applies an aqueous iodine solution to the affected areas and dusts it with starch powder. The sweating areas then turn black and blue. The test is carried out before an operation, for example, in order to better identify the sweating areas.
If the cause cannot be determined or treated, in addition to basic measures (see "Your pharmacy recommends") various options are available to reduce perspiration:
- Medication. Tablets are able to reduce perspiration all over the body to a limited extent, but are rarely used because of considerable side effects. Anticholinergics such as methanthelium bromide (e.g. Vagantin®) or bornaprine (e.g. Sormodren®) are used.
- Low voltage therapy. If only the palms of the hands or the soles of the feet are affected, treatment with weak electricity (iontophoresis, also called iontopheresis) is often successful. Several times a week, the patient dips his hands or feet into a salty water bath through which direct current (10–15 mA) is passed.
- Botulinum toxin. Syringes with highly diluted botulinum toxin (Botox®) are suitable for treating increased armpit sweating. An occasional repetition is necessary, but at the earliest after six months.
- Removal of sweat glands. If only the armpit region is affected, there is also the option of a sweat gland suction (suction curettage), which can be carried out on an outpatient basis.
- Sympathectomy (endoscopic transthoracic sympathectomy, ETS). In this procedure, the part of the sympathetic trunk that is responsible for regulating the sweat glands in the armpit and hands is removed. The minimally invasive operation is performed under general anesthesia and improves symptoms considerably. As a complex procedure, however, it is limited to cases that cannot be treated differently. The most common complication is compensatory sweating on other skin areas such as the back, stomach or crotch, which occurs in up to 85% of cases.
Excessive sweating is a cosmetic problem, but if it is severe it can have a significant impact on the quality of life of those affected. The course of the disease varies from person to person. Surgical procedures such as the removal of the sweat glands or the sympathectomy are usually effective and effective over the long term.
Your pharmacy recommends
What you can do yourself
- Reduce sweating. In the case of normal sweating in individual body regions, commercially available cosmetic products (e.g. deodorant rollers, deodorant sprays) or special foot care products such as foot powder, foot sprays or similar (Gehwol®, Allgäu mountain pine, Hidrofugal®) help. However, local therapy should not be carried out too aggressively, as this will damage the normal skin flora.
- Antiperspirants with aluminum salts inhibit sweat production. Deodorants containing aluminum have long been criticized because they were thought to have cancer-promoting effects. However, current studies have not been able to prove such an effect.
- Deodorants with active ingredients such as chlorhexidine or triclosan counteract the bacterial decomposition of sweat and in this way reduce the unpleasant odor.
- If commercially available products are not sufficient, preparations with methenamine (e.g. in Antihydral® ointment) or tanning agents (e.g. in Tannolact® powder) are available in pharmacies. A 10 to 30% aluminum chloride solution has proven itself to treat excessive armpit sweating, the use of which leads to a long-term reduction in the size of the sweat glands. The armpits are treated initially daily, then two to three times a week, the best way to apply the solution using a nebulizer. Initially, there may be slight skin irritation, but this usually subsides again.
- Combat odor. Those who suffer from strong-smelling armpit sweat often benefit from an armpit shave: fewer odor-causing bacteria collect on the smooth skin. Perfumed deodorants only cover up unpleasant smells. Whether these achieve the desired effect depends on the intensity of the sweat odor.
- Adjust clothes. If there is increased sweat production, we recommend wearing breathable textiles, e.g. B. made of cotton or Gore-Tex®. Clothing worn in layers according to the onion principle enables rapid adaptation to the respective need for warmth.
- Toughen up. Regular alternating showers and endurance sports train the body to better deal with sweat-inducing stimuli.
- Avoid a sweaty diet. Since drinks containing caffeine, alcohol, hot spices, and large meals can increase sweat production, it is worth trying to avoid these triggers. Overweight people often lose their increased tendency to sweat when they normalize their weight.
Those affected often find themselves in a kind of vicious circle: They are so uncomfortable with sweating that they are afraid of it and even begin to sweat. In complementary medicine, in addition to the actual "fight against sweat", the clarification of psychological factors is in the foreground.
We recommend envelopes with cold water, which are changed every 5 minutes. A foot bath with sage or tomato juice (0.5 l of juice in 5 l of water) helps against sweaty feet.
A traditional plant against perspiration is sage in the form of tea (3–4 cups daily) or ready-made preparations (e.g. Salus® Sage Drops, Salvysat® Bürger). Sage has been shown to inhibit sweat production, although the effect only takes place after a few days . If you are less prone to perspiration, tanning baths or tanning powder made from oak bark, e.g. B. in finished preparations such as Tannolact® powder or Tannosynt® liquid. A brew made from the leaves of the walnut is also suitable for external use, for this purpose 4 tablespoons of leaves are mixed with 1 liter of water, boiled and strained. Caution: the brew stains textiles.
There are positive experience reports that acupuncture relieves an increased tendency to sweat; the relaxing effect should not be neglected here either.
Psychotherapy and relaxation procedures.
The first step is to observe your own behavior and - e.g. B. in the form of a diary - to document in which situations the sweats occur more frequently. In the next step, those affected learn to strengthen their self-esteem by means of behavioral therapy measures or in cognitive behavioral therapy, to lose their balance less quickly and to gradually reduce their fear of expectation by e.g. B. Learn relaxation techniques or breathing techniques.
AuthorsDr. med. Arne Schäffler, Dr. Bernadette Andre-Wallis in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 15:52
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