Extreme sweaters soaked with shame

Some change their shirt three times a day so co-workers won’t notice. Others carry a cold drink whenever they’re at a party so people won’t suspect when they shake hands. The young ones refuse to raise their hand in class for fear their classmates will spy the telltale underarm ring.

For those suffering from excessive sweating — medically known as hyperhidrosis — life is one long struggle to stay dry. While most of us sweat after exercise, as the temperature rises or when we’re anxious, those with hyperhidrosis have been known to short out computer keyboards because of the moisture that runs off their hands like a constantly dripping faucet.

“This is not an anxiety-related disorder that people have control over, it’s a medical condition and looks to be genetic,” says Dr. Dee Anna Glaser, professor of dermatology at Saint Louis University School of Medicine.

In 2004, Glaser and her colleagues surveyed 150,000 households nationwide and found that nearly 3 percent of the population (or a projected 8 million people) suffer from excessive or abnormal sweating, defined as perspiring so much that it significantly impacts one’s occupational, physical, emotional and social life (i.e., you have to “deal with it” every single day).

Thanks to recent research, there are now treatment options — most notably Botox injections, which essentially block the chemical that “turns on” the body’s sweat glands. Still, only 38 percent of people who have hyperhidrosis know about those treatments since they’ve never talked with a doctor about their condition.

“Oftentimes, people are too embarrassed to seek out help,” Glaser says.

“Since age 15, I’ve had uncontrollable sweating under my arms and on my forehead, just like that guy in ‘Broadcast News,’” says Jeffrey Cohen, a 42-year-old New Yorker, referencing the movie's scene where Albert Brooks almost drowns in flop sweat during a news anchor audition. “When I finally talked to a doctor about it, he laughed it off. But six months ago, I told a psychologist and she understood the seriousness of it. That set me on a search to find a solution.”

Drying out
Cohen’s quest led him through three weeks of online research and a host of experiments with antiperspirants and products such as “sweat-proof” T-shirts, which he says have worked the best for “keeping things contained.” At this point, though, he’s just relieved to know there’s a name for what he has.

Help for hyperhidrosis There's no cure, but there are treatments: Antiperspirants (either prescription or over the counter) are the first line of defense. Preparations containing aluminum chloride hexahydrate are the most effective and can be applied to underarms, hands, feet and sometimes the face. Oddly enough, applying an antiperspirant in the evening (for instance, right before going to bed) has been found to be most effective. Iontophoresis (for hands and feet) has a success rate of 83 percent when used correctly, according the American Academy of Dermatology. The treatment, which involves placing hands and feet in a tray of tap water through which a mild electric current is passed, is not recommended for women who are pregnant or people with epilepsy, cardiac conditions, pacemakers or metal implants such as joint replacements. Botox (used for armpits, hands, feet and face) received FDA approval in 2004 and has shown to be an effective treatment. In one study, 81 percent of 322 patients reported their sweating reduced by half. Unfortunately, injections can be painful and need to be repeated anywhere from every six to 16 months to maintain dryness. Oral medications such as anticholinergics are sometimes prescribed but are not recommended for long-term use because of side effects, such as heart palpitations, blurred vision and impaired speech.  The drugs, which prevent the stimulation of all sweat glands, have recently been shown to have greater effect when crushed and added to the water during iontophoresis. Surgery is another option (when all other treatments have been exhausted). However, some surgical procedures such as endoscopic thoracic sympathectomy — which involves cutting the nerve path between the spinal column and the sweat gland — can result in serious (and irreversible) side effects. Courtesy of the International Hyperhidrosis Society (sweathelp.org)

According to sweathelp.org, a Web site operated by the nonprofit International Hyperhidrosis Society (IHS), there are two types of hyperhidrosis. One is a medical condition, where people sweat excessively in focused areas such as the head or face, underarms, or hands and feet. The other, where people sweat in larger generalized areas (oftentimes while sleeping), can either be a symptom of another problem such as infection, menopause or diabetes or be a side effect of medication.

For people suffering from focused hyperhidrosis, like Cohen, symptoms often begin in childhood and can be the basis for a host of mortifying teen moments.

“One of my most horrible memories was when I was 16 and taking a modern dance class,” says Sophia Parente, 32, a teacher from Virginia Beach, Va. “We were doing warm-up exercises and after a while, I was literally standing in a puddle of water. The pianist stopped, the teacher stopped, the whole class just stopped and stared.”

After years of living with the condition — never raising her hand in class, having her palms smeared with ink whenever she read a paper, watching strangers do the “dreaded wipe” every time they shook her hand — Parente talked to her doctor and was eventually referred to Dr. David Pariser, professor of dermatology at Eastern Virginia Medical School in Norfolk, Va., and president and founding member of the IHS.

Pariser first recommended iontophoresis, a treatment that involves placing hands or feet in a tray of water through which a mild electrical current is passed. The current — coupled with the minerals in the water — is thought to microscopically thicken the outer layer of the skin, blocking the flow of sweat.

Although studies have shown a success rate of 83 percent, iontophoresis didn’t work for Parente. So her doctor turned to Botox, which worked “like a miracle.”

“For the first time in my life, I had to use lotion because my hands were dry,” she says. “It was like a black veil had been lifted off of me. I felt like I could conquer the world.”

Parente, who gets about 60 to 70 Botox shots in each hand every six months (as it turns out, the shots to her hands also help clear up the sweating on her feet), is fortunate in that her insurance covers the treatment.

Cosmetic confusion
“Most insurers consider this a cosmetic procedure so it’s not medically reimbursable,” says Dr. Joel Schlessinger, president of the American Society of Cosmetic Dermatology and Aesthetic Surgery.

Sweaty stats — Most extreme sweaters suffer from axillary hyperhidrosis (excessive sweating under the arms), followed by palmar and plantar sites (hands and feet). — More men than women experience facial or scalp hyperhidrosis. — In a survey of 508 patients, almost half noted a family history of hyperhidrosis. — Hyperhidrosis can be exacerbated by factors such as stress, heat, exercise and food. — Women talk to their doctor about their hyperhidrosis more often than men. — In a survey of 242 patients, the mean age of onset was 14 years. Know sweat? To find out more on the Web: How do you know if you’re sweating too much? Insurance tools to help you find treatment for hyperhidrosis Facts courtesy of Dermatologic Surgery, January 2007

Part of this perception may be due to celebrities and models who often get Botox shots under their arms to avoid “red-carpet rings.”

Since Botox can cost from $750 to $2,000 for one series of injections, and treatments need to be repeated anywhere from six to 16 months to maintain dryness, patients often have to choose between their money and their quality of life, a choice Pariser, the Virginia dermatologist, finds unacceptable.

“This is a disease — a disorder. It’s not cosmetic,” he says. “If it were extract of banana, nobody would care, but it’s Botox and that carries a cosmetic connotation.”

Ironically, other, more invasive treatments are often covered by insurance, such as endoscopic thoracic sympathectomy (ETS), which involves cutting the nerve path between the spinal column and the sweat gland. While some patients have had success with ETS, others have experienced compensatory sweating — excessive sweating in other parts of their body, such as the back, chest, face, groin or buttocks. Due to these side effects and the risks (the patient’s lung is temporary collapsed during surgery) the IHS recommends this procedure only as a last resort — and only when the patient has been fully informed of the risks.

Because hyperhidrosis can put such a severe damper on quality of life, some patients are willing to deal with any risk — or any cost.

Kim Behlmann, a 35-year-old St. Louis resident, participated in a three-year hyperhidrosis study. “I had free Botox injections for three years, but now my insurance isn’t going to cover it. And it’s $2,500,” she says. “I don’t want pay for it, but [hyperhidrosis] effects you so much. It can ruin your work and influence your whole life.”

Diane Mapes is a Seattle freelance writer and author of "How to Date in a Post-Dating World."

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