The difference between someone sweating a lot normally and excessive sweating can be difficult to determine.
The biggest problem at the moment with people thinking that they have “excessive sweating” is the number of people who have listened to bad advice given by companies selling bottled water or members of the beauty of fitness industry who also earn money by selling water.
It is quite common for people to be told that they need to drink “2 or 3 litres” of water a day and are often told this is to “detox” or to keep their skin healthy. In fact, it is excessive water which can cause problems with metabolites in the blood leading to lack of concentration and irritability as well as excessive sweating.
A normal 70 kg person needs 1.5 litres of water a day – which includes all of the water hidden in their food, tea, coffee, fruit juice or squash, wine, beer etc. We generally have approximately 0.5 litres of water hidden in our food and so most people only need 1 litre of water a day which includes tea, coffee, fruit juice or squash, wine, beer etc. Of course if you go to the gym, or play sport, you may need to add another amount to this but it is rarely more than 0.2 to 0.5 litres.
Therefore people who eat and drink normally and then have another 2 or 3 litres of water on top of this are massively overdrinking. It is not uncommon for them to have 4 to 5 litres per day when it is all been added up. Not surprisingly, they sweat excessively.
The simple way to check whether you are drinking too much is to look at your urine. Unless you are eating or drinking things that colour your urine, such as a high protein food or drinks, beetroot etc., then most normal people’s urine should be yellow. If your urine is clear, you are almost definitely overdrinking and will be sweating excessively due to your own drinking habits and not due to hyperhidrosis. You will often be to get rid of most of your sweating problems by drinking normally.
Other causes of normal but excessive sweating include people who are very fit and who exercise regularly have a raised metabolic rate and often sweat easily and more than normal people. This is not hyperhidrosis but is merely normal excessive sweating.
In addition, people who are overweight or who dress inappropriately with many layers and very warm clothes in conditions where they are not needed, can force themselves to sweat excessively which again is normal.
Some people find social situations incredibly stressful and whenever they have to meet other people or go into an uncomfortable situation, they can start sweating excessively. This again is not hyperhidrosis but is excessive sweating due to anxiety. This is best treated by cognitive behavioural therapy, hypnotherapy or counselling and not medical treatments.
There are two main sort of hyperhidrosis, primary hyperhidrosis due to the way the body is set up and secondary hyperhidrosis, usually due to another medical or non-medical cause.
We will look at both of these in turn.
Cocaine causes abnormal excessive sweating for reasons that we do not fully understand. Unfortunately, it is almost impossible to treat these patients and even with treatment that would be effective on other patients, something in the cause due to the cocaine usage means that it is almost impossible to treat this condition.
Patients, usually men, who inject or take steroids as part of a bodybuilding regime are replacing their own testosterone with the anabolic steroids they are taking. As such they switch off their own testicles as they do not need to produce testosterone. Unfortunately they also switch off the natural production of other steroids that they need, and so although they may gain muscle mass and reduce fat, they also undergo a male menopause and so get abnormal and excessive sweating. Of course there are even worse problems with taking such steroids and these patients often get very irritable and angry (the so-called “steroid rage”), impotence and obstructive heart disease.
It is the patients with primary hyperhidrosis who need the new treatments sweating and also get the best results from the treatments.
With primary hyperhidrosis, there is no underlying cause. Patients usually have one or two areas that they sweat excessively from, even though their total sweating output is the same as everybody else. They are not overdrinking (and so have normal yellow urine) but sweat excessively from one or two areas, usually the underarms but often hands, feet, groin or head.
Secondary hyperhidrosis is abnormal excessive sweating due to another condition.
This might be a medical condition such as hyperthyroidism (a high thyroid level), menopause or two medical rarities either a phaeochromocytoma (a rare tumour of the adrenal glands that secretes adrenaline and noradrenaline) or carcinoid syndrome (where carcinoid tumours of the bowel spread to the liver secreting a substance called serotonin).
More commonly, secondary hyperhidrosis can be due to things that people do to themselves. Two of the most worrying are patients who take cocaine and patients who inject or take steroids as part of a bodybuilding regime.
Because there is not a generalised hyperhidrosis problem, nor another medical problem, these patients are suitable for treatment and also tend to get the best results.