By: Howard LeWine, M.D., Harvard Health Publishing
Q: I tend to sweat a lot, especially my hands and in my armpits. It makes me anxious when I am in any group setting and need to shake hands. Is the problem medical or psychological?
A: Excessive sweating that goes beyond the body’s needs to cool down is known as hyperhidrosis. Focal hyperhidrosis is the term used when excess sweating occurs over one part of the body, such as under the arms, on the palms of the hands, on the soles of the feet, or on the forehead. These are all areas that have a high concentration of sweat glands.
Millions of years ago, humans evolved a protective mechanism for avoiding or dealing with danger — it’s called the fight-or-flight response. Sweat glands are activated as part of this response. When you’re nervous, you may also feel your muscles tense, along with a quickening of your heart rate or your breathing.
Most doctors tend not to think of hyperhidrosis as an emotional disorder. Rather, they think the glands responsible for sweat production are particularly sensitive to emotional stimuli. They try to manage the sweating rather than the emotions that may be triggering it.
For focal hyperhidrosis doctors usually first recommend products containing aluminum chloride, which is the same chemical used in many over-the-counter antiperspirants. If a topical solution doesn’t work, your doctor may discuss botulinum toxin (Botox) injections. This substance, which is used as a cosmetic aid (for example, to smooth facial wrinkles), can also reduce sweating by inhibiting the nerves that trigger the sweat glands.
Your anxiety in group settings may be exaggerated by your worry about sweating. If you get the sweating under control, your confidence may increase and you may feel less anxious going into social settings.
On the other hand, your anxiety about social situations may persist even if the sweating stops. In that case, I suggest you consult a mental health professional to deal with the anxiety directly. Many types of psychotherapy can help you understand and cope with the sources of your anxiety about meeting new people.
Anxiety medications can also help. If the anxiety crops up only in the context of a performance (that is, giving a speech or presentation), a doctor may recommend a beta-blocker. These are drugs that block the sympathetic nervous system and can thus reduce sweating. For more general forms of social anxiety, an SSRI (selective serotonin reuptake inhibitor) may help. Examples are sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac). When these drugs are effective, they solve more than just the sweating problem. In the best case, you feel less anxious and in turn you should sweat less.
(Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)
(C)2022 President and fellows of Harvard College. All rights reserved. Distributed by Tribune Content Agency, LLC.
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