How to combat excessive sweating

As soon as I enter a crowded tram, I get the urge to rip off any warm layers of clothing. But because the ride is usually short, and all the seats usually taken, I more often than not keep on my winter jacket. A sweaty affair. However, the production of sweat isn’t necessarily a result of the outside or inside temperature; there can be other causes. Dermatologist Hero Schnitzler, MD explains what else can cause you to sweat – and how to combat it.

Why do we sweat at all?
Dr. Hero Schnitzler, MD: Perspiration is vital in regulating body temperature. As soon as we get hot, our sweat glands produce a watery secretion that cools the body as it evaporates from the skin. This is the body’s way of protecting itself from overheating.

So, what happens in the winter?
Whether we sweat doesn’t necessarily depend on the indoor or outdoor temperature; we also sweat during physical exertion and when eating spicy foods. Perspiration also acts as a signal: the pheromones, or odours, in sweat are a form of non-verbal communication. These sex pheromones determine who we find attractive and who not.

To return to the question: when heat accumulates under warm and air-impermeable winter clothing, our organism can no longer keep up with its evaporation needs. This can happen when we, for example, enter a heated store after walking down Bahnhofstrasse in freezing temperatures.

How can I prevent sweating?
Ingesting things like coffee, alcohol and spicy foods can increase perspiration. Proper clothing also plays a role. Garments made of breathable materials, such as cotton and linen, ensure optimal heat exchange. Stay away from synthetic fibres, such as polyester and acrylic, as they’re not breathable. Special antiperspirants, in the form of deodorants or lotions for your hands and feet, reduce sweat production by narrowing the opening of the sweat glands.

How can I tell if I’m sweating «normally» or excessively, and suffering from hyperhidrosis?
There’s no hard line, as sweating in hyperhidrosis is also uncontrollable and happens regardless of heat or cold, time of day or season. Scientists distinguish between congenital (primary) and secondary hyperhidrosis, the latter being the result of a disease.
In primary hyperhidrosis, symptoms usually begin to appear in childhood or adolescence. Sweat production occurs locally on the hands, feet, forehead and/or armpits. In secondary hyperhidrosis, the entire body is affected. These are usually (accompanying) symptoms of an underlying illness, such as fever.

What are the causes of hyperhidrosis?
In contrast with secondary hyperhidrosis, which often has an underlying disease, the cause of primary hyperhidrosis is unknown. Scientists assume it’s genetically determined, as it appears more often in related individuals.

When is treatment necessary?
The degree of suffering varies greatly from person to person. Action is only required when the person affected feels restricted in everyday life. This depends on the severity and frequency of the condition.

Which treatment do you recommend to patients?
I recommend the local application of botulinum toxin, which is a low-pain treatment. The injected Botox blocks your sweat glands from activating and, in doing so, reduces perspiration. The effect lasts up to one year and is partially covered by health insurance. Surgical or intrusive methods, on the other hand, are suboptimal, in my opinion. They can be painful and risky, not to mention I don’t always achieve the desired results. Even the much advertised «Gleichstromtherapie» (iontophoresis, a form of electrotherapy), rarely delivers long-term results.