Hyperhidrosis? No sweat!

You know the feeling when you are about to go into the most scary exam of your life? You're sweating all over and frantically wiping your hands on your shirt. Double it. Now imagine that you are suddenly placed in a jet of cold air. The sweat starts to go all cold and trickles down your hands, falling in little drops on to the floor below. Sounds unpleasant? This is life with chronic hyperhidrosis.

I was first diagnosed with hyperhidrosis around the age of 14. I think that I might have been diagnosed earlier if my parents had not thought that my excess sweating was a trivial matter. Eventually, I went to my GP and was prescribed an aluminium chloride solution which you apply to the affected part at night and leave on. A practical solution? Try falling asleep while still remembering not to scratch your face or rub your eyes. Then tell me it is still practical.

After this failed to work, we moved on to iontophoresis, where dermatologists persuade you to place the affected part (usually a hand or foot) on a towel covered in sodium chloride solution and another part, usually the corresponding body part, on an opposite towel. They then turn on a machine and blast several volts through you for at least quarter of an hour, either side. This worked at first and I bought a set of my own, but it is not without its impracticalities. Firstly, it is very sore and you have to have someone on hand every night to turn it on, then come back 15 minutes later to turn it off, then repeat the process, allowing for the times it is too sore and you have to yell out of the kitchen window for someone to come and switch it off for you. My hyperhidrosis was mainly confined to the hands, although there was a bit of axillary and plantar as well but shoes and dark clothing could hide them.

The iontophoresis eventually began to fail. I was feeling more and more limited in the things I could and could not do by then. I could not write as drops of sweat fell on to the paper and blurred the ink. I could not play tennis as I could not grip the racquet. Even getting on and off a bus was problematic as this involved holding the handrail on the stairs which others would then have to hold on to and get slimed in the process. And as for boyfriends—I may as well have had leprosy.

I then tried oxybutynin hydrochloride, an anticholinergic, which I was given at the beginning of my second year at medical school, after we had been on the wards for a couple of months. My ward group was probably getting a little suspicious at me feeling faint and having to leave the room just before examination. When I did get noticed and dragged forward, the patient would invariably scream, “Oh, what cold hands you have.” Sweat is tolerable if it is warm; it's a thousand times more skin crawling when cold. I took one oxybutynin 10 minutes before wards until that started to fail too. I upped it to two but then started to experience regular dizzy spells. We connected this with the pills and so I finally went to the GP. I would have tried arsenic if it might have cured me. I learnt that there was an operation that could stop it altogether and my GP referred me to a respected surgeon. For the first time I felt that I had met someone who really understood what it meant to have a life disabling condition. He agreed to perform an endoscopic thoracic sympathectomy for me. He also explained the risks, such as Horner's syndrome and rebound hyperhidrosis. I was a bit concerned at the prospect of my face being blighted for life by a one sided eye droop but thought the risk was worth it. A lot of my family were against it, as they did not see why I needed such a big operation for a “little bit of sweating.” I was due in the theatre the following morning, and remember the fear of being wheeled off. What if it did not work? What if I got Horner's? What if I died on the table?

Morphine was my bedfellow for the next 24 hours. I was still very woozy and had six incisions down my back. They scarred as expected but faded after a year. And joy of joys, no Horner's syndrome. I felt very sore and to be honest, I have never felt more ill than I was for the six months after the operation. But would I change it? Not a chance. I can sew, write, give overhead presentations, play the piano, and palpate an abdomen. I even have a boyfriend. True, I have had problems with rebound back and leg hyperhidrosis, but they are infinitely more bearable than the palmar variety. Just remember the next time you are tempted to trivialise hyperhidrosis that there is a bit more involved than the textbook explanation of “excess sweating.”

The medical student who wrote this wishes to remain anonymous


studentBMJ 2001;09:357-398 October ISSN 0966-6494