Gustatory sweating, or Frey’s Syndrome, is defined as sweating and flushing of the facial region that occurs when a person is eating, or even thinking about food.[5] This is quite different than when your face burns because you are already sweating. Most people experience sweating as a result of eating spicy food, but it is typically generalized and mild. For those suffering from gustatory sweating, the amount of sweat they produce can be copious and the results can be extremely embarrassing. It is well documented that hyperhidrosis and anxiety are often associated, and this is especially true in the case of gustatory sweating. This is because people often socialize while eating meals together, which would naturally trigger stress in those who can’t eat without it causing them to sweat excessively. Interestingly, gustatory sweating is not the same as craniofacial hyperhidrosis, although it could be considered to be a form of it.

Causes of Gustatory Sweating

There are several things that can cause gustatory sweating. The most common cause, by far, is injury to the parotid gland and its surrounding nerves.[5] The parotid gland is a salivary gland that is situated on both sides of the face, it is below and in front of the ear. The glands communicate with the mouth via a duct and aid in the secretion of saliva.[4] The parotid gland is usually injured during a type of surgery called a parotidectomy in which the parotid gland is removed. Injury can also happen during a face lift surgery or due to trauma in that region of the face.[5] It has even been known to be caused by war related injuries and occupational accidents.[2] In some unfortunate cases, the use of forceps during delivery has also been known to damage a baby’s face and later lead to the development of gustatory sweating.[1] Damage to the parotid gland and the subsequent sweating that occurs during eating is what is referred to as Frey’s syndrome.

Gustatory sweating can also be caused by medical conditions that cause secondary hyperhidrosis by damaging the nerves near the parotid gland, like neuropathy caused by diabetes. Diabetes can cause patients to sweat while eating because the disease causes nerve damage. If nerves near the parotid gland are damaged, then diabetes patients are susceptible to developing Frey’s syndrome when their nerves regenerate in an aberrant way. This is very similar to the way surgical patients develop the disease. There have also been cases of gustatory sweating caused by diseases like Parkinson’s, Shingles, Tuberculosis and others, although these cases are less studied.[5]

It is thought that Frey’s syndrome occurs due to sympathetic nerves regenerating in an inappropriate location after trauma caused by surgery. This problematic nerve regrowth is referred to as “aberrant nervous regeneration” in texts describing the disorder. These sympathetic nerves are then stimulated by foods that would normally cause salivation to occur, but instead sweating and flushing happen on the outside of the face because of the the incorrect way they regenerated. This is why sweating happens when a person with Frey’s syndrome looks at, eats or even thinks about certain foods.[5]

A Brief History

Gustatory sweating has been a medically documented phenomenon for the last 300 years. Early researchers wanted to understand why humans sweat under normal conditions, but they also sought to understand the pathological sweating some people experienced. Specific episodes of gustatory sweating have been noted as far back as 1740, but were not explored in detail until 1888 when the first official account was written by Paul Raymond. In the past most cases of gustatory sweating were noted after severe infections, hunting accidents or war injuries to the face. It wasn’t until World War II that German documents were found pertaining to Lucja Frey’s work on the subject. She was the first person to describe gustatory sweating as involving issues with with the parasympathetic and sympathetic nervous systems. Unfortunately, she was a victim during the war and subsequently died but the disorder is named after her for the massive contribution to its understanding that she provided. That is why gustatory sweating is referred to as Frey’s syndrome.[1]

Treatment for Gustatory Sweating

There are limited treatment options for those with gustatory sweating, however, the treatments that are available have been shown to be effective and improve quality of life. Many of the treatments that reduce and stop facial sweating caused by primary focal hyperhidrosis are the same ones that are effective for treating gustatory sweating. Botox injections are the primary treatment option for those with Frey’s syndrome. Botox is used for axillary hyperhidrosis treatment most commonly, and is FDA approved for this purpose and it has been successfully used to treat excessive sweating of the face.[5] One study looked at the connection between Botox treatment in patients with gustatory sweating and their quality of life. It was found that Botox treatment significantly improved how patients perceived quality of life.[6] Botox has the ability to stop gustatory sweating and has even lead to remission in some patients.[5] Botox is also frequently used for patients with craniofacial sweating and can even be used to treat upper lip sweating.

Prior to administering Botox injections a doctor will most likely perform a starch-iodine test to determine where the problem area is located and to confirm a diagnosis of gustatory sweating. Usually, a patient will be given food to eat and then the starch-iodine test will identify where the sweating occurs most. Botulinum toxin A is the most common type used to treat gustatory sweating. It’s effectiveness, as well as Abo-BoNT-A type, have been found to be the most effective in treating Frey’s syndrome. Patients typically need repeat treatments every 15 months or so. Some of the possible side effects include dry mouth, smile asymmetry and temporary weakness of the muscles involved in chewing.[5]

While other options like over-the-counter topical treatments and oral medications for hyperhidrosis can be used, they have not been shown to be affectatious.

The symptoms of gustatory sweating can be frustrating, but there are effective ways to manage them and stop excessive sweating from occuring while patients eat.

Sources

1. Daniels, E., & Watchorn, R. (2016). Unilateral facial flushing precipitated by eating. . BMJ : British Medical Journal (Online), 352. doi:10.1136/bmj.i1377
2. Dunbar, E. M., Singer, T. W., Singer, K., Knight, H., Lanska, D., & Okun, M. S. (2002). Understanding gustatory sweating What have we learned from Lucja Frey and her predecessors? Clinical Autonomic Research, 12(3), 179-184. doi:10.1007/s10286-002-0045-7
3. Freeman, G. L. (1998). Gustatory Sweating in the Differential Diagnosis of Food Allergy. . Allergy and Asthma Proceedings, 9(1), 1-2. Retrieved September 4, 2018, from http://ezproxy.co.wake.nc.us/login?url=https://search.proquest.com/docview/231721476?accountid=14867
4. Medical Definition of parotid gland. (2018). Retrieved September 4, 2018, from https://www.merriam-webster.com/dictionary/parotid gland
5. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.
6. Steffen, A., Rotter, N., König, I. R., & Wollenberg, B. (2012). Botulinum toxin for Frey's syndrome: A closer look at different treatment responses. The Journal of Laryngology and Otology, 126(2), 185-189. doi:10.1017/S0022215111002581

Everyone experiences increased sweating when exposed to a stressful trigger at some point or another, so this is an important topic to understand. The definition of stress sweat is: increased sweating caused by a stressful psychological stimuli. This is different than a person experiencing increased sweating due to heat or intense exercise, as it involves only a psychological component as the sweat inducing trigger. Normally, sweat works with body temperature in a way that helps the body keep its internal temperature stable even in hot conditions, but stress can trigger the same type of physical reaction as heat. For people with hyperhidrosis, stress can be one of the primary culprits that cause their excessive sweating. There are specific reasons that cause the body to produce sweat during certain psychologically stressful situations and it is one of the reasons why humans sweat. However, for a person with hyperhidrosis this process can be extremely excessive and embarrassing on top of an already psychologically tough situation.[3]

Symptoms of Sweat Stress

Hyperhidrosis is not bad for someone's health, but the symptoms that arise from the stress it causes can be. Stress sweat can occur on specific areas of the body and, at times, it can be distressing. Precipitating an episode of stress induced sweat a person will typically feel nervousness, excitement, or anxiety. The following symptoms may then occur:

• Craniofacial sweating (beads of sweat on the forehead)
• Palmar sweating
• Plantar sweating
• Axillary sweating
• Groin sweating
• All over body sweating (may occur but it is usually localized)
• Offensive body odor

Not everyone will experience all of these symptoms of stress sweat, and many may only experience one or two. Stress sweating usually effects localized parts of the body but can occur all over, this varies between individuals. Some people experience clammy hands and feet when dealing with stress sweating, while others soak through there clothes. It does often involve apocrine sweat glands, which are most densely located in the axillary and groin regions. Unfortunately, apocrine sweat glands are responsible for the odor that is sometimes a particular symptoms of stress sweat.[1] This is because of what the sweat is made of, bacteria readily break down the type of sweat produced by apocrine glands and this creates a foul odor. There are two types of sweat glands stress can activate, eccrine, which are located all over the body, and apocrine, which are described above.[4]

The Physiological Reasons Stress Sweat Happens

Stress sweat occurs in both healthy individuals and those with hyperhidrosis. It is most likely to occur on the palms, soles, face and armpits.[1] In a typical individual, sweat happens as a result of a psychological stressor because it activates a part of the autonomic nervous system called the sympathetic nervous system, which in turn activates eccrine (sweat) glands through specific neurotransmitters. The autonomic nervous system is responsible for maintaining homeostasis and is made of up two parts, the sympathetic nervous system which excites the body, and the parasympathetic nervous system which calms it down. In people with hyperhidrosis, the sympathetic nervous system is thought to be overactive, which leads to overactive sweat glands and an overabundance of sweat. During a situation that would induce sweat stress in anyone, a person with hyperhidrosis will experience a much greater volume of sweat than a typical individual.[2]

While the exact cause of hyperhidrosis is currently unknown, there are some ideas about what may lead to stress sweating. Interestingly, it can be demonstrated that the sympathetic nervous system is related to the excessive sweat created in people with hyperhidrosis. Sometimes patients with hyperhidrosis will have a surgery called endoscopic thoracic sympathectomy (ETS) done as a treatment for sweaty hands. ETS is a surgery which destroys the nerves that activate the sweat glands in the palms. Once this is done, people with hyperhidrosis will no longer experience the effects of stress sweat in that area. However, they still experience the change in blood flow that occurs from temperature changes. This means that there is a specific nervous system response that activates sweat glands that does not affect surrounding blood vessels or skin tissues.[2] All of this indicates that a psychological response can cause a host of physiological processes to occur which increases sweat in normal individuals, and which may be a causative factor in the overproduction of sweat in those with hyperhidrosis. This is also the reason that hyperhidrosis and anxiety are so closely related.

Situations that Cause Stress Sweat

Any situation that can trigger a nervous or excited feeling has the ability to elicit stress sweat. However, there are common situations that are highly associated with potential increased sweating, including:

• Public speaking and its effect on hyperhidrosis
• Intimate relationships (especially in the beginning)
• Performing (playing sports with hyperhidrosis, debating, acting etc..)
• Sudden panic moments (forgetting an assignment, realizing you missed an important deadline etc…)
• Intense social engagement

These are all things that everyone will face at some point, and struggling with the fear of sweat stress can make that even harder for those with hyperhidrosis.[4] It is also important to note that hyperhidrosis can cause anxiety and that this can cause a host of other related issues.

Treatments for Stress Sweat

There are many potential treatments for stress sweat depending on the severity of the case. For example, if stress sweat is severe and usually caused by social or performance anxiety the use of the oral medication for hyperhidrosis called propranolol, a type of beta blocker, might be appropriate to use.[4] If sweat stress is less severe it may make more sense to take a more conservative approach to managing your sweat. These techniques can include the use of stronger antiperspirant, choosing clothes wisely, deep breathing techniques and finding methods to generally reduce your stress. There are anxiety reduction methods that can lessen excessive sweating, especially in those who are dealing with stress sweating. If symptoms are pervasive and persistent there are ways to manage your hyperhidrosis sweat with a doctor through the use of iontophoresis, botox injections, local permanent procedures, surgeries and other resources that are available.[4]

Due to the fact that stress sweat often involves the apocrine glands of the armpit and groin it can be particularly prevalent for it to produce a bad odor. If this is the case, there are ways to stop body odor. It would prudent to use strong antiperspirant, shower often, change clothes after sweaty situations and see a doctor if the problem is especially troubling. There are antiperspirants for the face and groin that are made for areas with sensitive skin.

Sweat stress can stink, but it’s important that people don’t let it’s effects stop them from doing the things they want, even if they are stressful.

Sources

1. Harker, M. (2013). Psychological Sweating: A Systematic Review Focused on Aetiology and Cutaneous Response. . Skin Pharmacology and Physiology, 26(2), 92-100. doi:10.1159/000346930
2. Huddle, J. R. (2014). Hyperhidrosis: Causes, Treatment Options and Outcomes. New York, NY: Nova Science.
3. Macefield, V. G. (2009). Developments in autonomic research: A review of the latest literature. Clinical Autonomic Research, 19(3), 133-136. doi:10.1007/s10286-009-0016-3
4. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.

There are two types main types of hyperhidrosis, primary and secondary, of the two only 7% of the people suffering from hyperhidrosis have the secondary type. About 3% of the population has hyperhidrosis, so this is a relatively small population. Secondary generalized hyperhidrosis is a condition in which a person has excessive sweating due to an underlying issue. It is important to understand the basics of diaphoresis when discussing secondary hyperhidrosis. Diaphoresis is the term doctors use to describe unexplained excessive sweating and is often used in conjunction with a diagnosis of secondary hyperhidrosis, they can be used interchangeably to describe the condition. While the hyperhidrosis is not bad for a person's health by itself, the underlying causes can be.[1]

Secondary hyperhidrosis is usually categorized by generalized sweating that occurs all over the body and is often worse at night. The onset of secondary hyperhidrosis usually occurs after the age of 25 and it has a specific cause. These causes can be broken down into three main groups: drug induced, physiologic or pathologic. The most common cause of secondary hyperhidrosis are medicines and the side effects they cause. However, there are a variety of physiologic states and diseases that can cause secondary hyperhidrosis so it is important that patients with this type of hyperhidrosis manage it with a doctor.[1]

Physiologic States that Cause Hyperhidrosis

When discussing a physiologic cause of excessive sweating this describes the condition or state of the body or bodily functions that naturally occur and cause the symptoms of hyperhidrosis.[2] This means the underlying cause of hyperhidrosis is not a disease but it is caused by a natural change in the body that results in unwanted excessive sweating. One of the best examples of this is pregnancy - it is a natural state of change in the body that causes some people to produce too much sweat.

Women are often subjected to secondary hyperhidrosis resulting from normal hormonal changes they experience over a lifetime. The two main culprits are pregnancy and menopause. During pregnancy several factors can cause a woman to sweat more than normal including increased blood volume, hormonal changes and extra weight. This all places more stress on the body and causes pregnant women to feel hot which induces sweating. This is a normal occurrence and should not lead to concern. Menopause begins at a median age of 51 and up to 80% of women experience sweating and flushing by the time the process has ended. Many women going through menopause experience hot flashes which cause sudden, intense sweats and night sweating as a result of changing hormone levels. There are blood tests to check oestradiol and gonadotropins, types of hormones, to ensure a woman is in menopause. It is recommended to do this to definitively determine that a woman is in menopause and make sure her hyperhidrosis is not being caused by another unrecognized condition.[3] These types of hormonal changes eventually will resolve on their own but can be managed with medication if needed, especially in the case of a menopausal woman.

Other physiological states that can induce hyperhidrosis are obesity, excessive heat and fever. While obesity is not an optimal state for body function, it is a naturally occurring phenomenon. Excess weight can cause hormonal imbalances that impact thermoregulation and can cause a person to overheat more easily leading to excessive sweating. There is a reason why people sweat when they are sick with an infection or virus, this is known as fever. Fever is included in this section because it is a natural state the body induces for various reasons, most commonly to fight infection. It is important to note that a fever itself can be a cause of hyperhidrosis and not just the issue causing the fever. It causes excessive sweating as the body heats its core temperature and this initiates activates the sweat glands.[1][3]

Diseases that Cause Secondary Hyperhidrosis

There are many diseases and pathologic conditions that have the potential to cause secondary hyperhidrosis. Included is a list of the most common diseases that can cause excessive sweating, broken down by which body system they affect:

Endocrine Disorders

These are diseases and conditions that impact hormones and structures that control and secrete them. Here are the most common endocrine conditions that can cause hyperhidrosis:

• Hyperthyroidism: This is over-activation of the thyroid gland and can be a common cause of sweating.
• Diabetes: This is a very common cause of disease-related hyperhidrosis. It is a condition in which patients bodie’s cannot appropriately deal with insulin.
• carcinoid syndrome: A syndrome caused by certain kinds of tumors.
• Hyperpituitarism: Over production of hormones by the pituitary gland.
• Pheochromocytoma: Tumor of the adrenal gland.
• Acromegaly: The body produces too much growth hormone, this can result in gigantism.

Of these conditions diabetes mellitus and hyperthyroidism are the most common.[4]

Infections

Many infections have the potential to cause hyperhidrosis as a symptom, including:

• Acute bacterial or viral infections: These can include common illnesses that regularly circulate the population or more serious infections.
• chronic infections like:
  • Tuberculosis: A rare but serious bacterial infection of the lungs.
  • Malaria: A parasitic infection spread by mosquito.
  • Brucellosis: A bacterial infection often caused by exposure to animals or animal waste products.[4]

Neurological

A large variety of neurological issues, those that deal with the brain and spinal cord, can cause hyperhidrosis. Here is a look at the most common:

• Stroke: Caused by the brain being unable to obtain blood flow. Can be due to a brain hemorrhage or a blocked blood vessel. These a common, serious and require immediate medical attention.
• spinal cord injuries: The body can no longer regulate the nerve signals going to the brain and this can impact thermoregulation and cause sweating.
• gustatory sweating after parotidectomy
• Parkinson's disease: Degenerative condition of the brain that eventually leads to death.
• Encephalitis: Swelling of the brain.[4]

Cardiovascular Issues

Heart failure, due to any reason, can cause secondary hyperhidrosis as a symptom. Some reasons for heart failure can include but are not limited to congestive heart failure, a heart defect, endocarditis (infection of the heart) and many others.[1][4]

Cancer

There are several types of cancer that can cause hyperhidrosis to result. Lymphoma, in particular is known to do this. Depending on tumor location and individual reactions patients with other types of cancer may also experience excessive sweating.[1][4]

Other

There are several other conditions that can cause secondary hyperhidrosis like gout, arsenic intoxication, alcoholism and congenital conditions that are fairly common. This is not a comprehensive list of conditions that can cause excessive sweating.[1][4]

Due to the possible dangerous and debilitating conditions that may contribute to secondary hyperhidrosis, it is always important for a patient to manage the condition with a doctor. There are many natural and healthy reasons for why humans sweat but if excessive sweating has a sudden and intense onset it may be related to one of the conditions discussed above. Conversely, if you notice that you're body doesn't seem to sweat at all this can also be a worrisome sign. Any time you feel like your body is overproducing or underproducing sweat it is a good idea to speak to your doctor.

Sources

1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.
2. Physiologic. 2018. In Merriam-Webster.com. Retrieved August 16, 2018, from http://www.meririam-webster.com/dictionary/physiologic
3. Paisly, A. N., & Buckler, H. M. (2010). Investigating secondary hyperhidrosis. BMJ : British Medical Journal (Online), 341. doi:10.1136/bmj.c4475
4. Benson, R. A., Holt, P. J., & Loftus, I. M. (2013). Diagnosis and management of hyperhidrosis. BMJ : British Medical Journal (Online), 347. doi:10.1136/bmj.f6800

Secondary generalized hyperhidrosis is often a surprise, people who have otherwise been healthy adults suddenly have a significant sweating problem. This is called diaphoresis, or excessive sweating with no apparent cause. This is unlike primary focal hyperhidrosis, which often begins in adolescence and is a problem patients struggle with for the majority of their lives. A review in 2011 found that 93% of people diagnosed with hyperhidrosis struggle with the primary type - that means that only 7% of cases are comprised of secondary hyperhidrosis. However, when patients are diagnosed with secondary hyperhidrosis, it is imperative that the cause is found because it can often be a dangerous medical condition. This is because secondary hyperhidrosis can be caused by several medical conditions and diseases. Ironically though, medication side-effects are the most common cause of secondary generalized hyperhidrosis.[1] That means that most people who are diagnosed with secondary hyperhidrosis are being treated for another condition and the medication they are taking caused them to begin sweating in excess of what is considered normal. It is vital that a patient who suddenly displays hyperhidrotic symptoms starting in adulthood manage hyperhidrosis with a doctor to determine whether it is caused by a medication or another underlying medical condition.

If a patient suspects that the cause of their excessive sweating is a result of a medication then it is important to discuss this with a qualified doctor and discuss a plan of action. Below is a list of common medications that can cause secondary hyperhidrosis:

Types of Medication that Cause Secondary Hyperhidrosis

There are many types of medication that can potentially cause hyperhidrosis that treat a variety of conditions. Here is a list of medicines that can potentially cause excessive sweating:

Pain Medications:

Most of the pain medications that can cause hyperhidrosis as a side-effect are prescription drugs. However, in some instances, excessive sweating has been caused by the over-the-counter medicines Tylenol and Aleve.[1][2] Here is a list of several prescription pain medications that can cause excessive sweating:

• Opiates like: Hydrocodone/Vicodin, Morphine, Oxycodone/Roxicodone, Fentanyl/Duragesic, Ultra/Tramadol
• NSAIDs like: Toradol/Ketorolac, Celebrex, Relafen/Nabumetone
• Other pain medications: Marinol (made from cannabinoids)

Psychiatric Medications

Many psychiatric drugs can have secondary hyperhidrosis as a possible side effect. These medications include SSRIs, antipsychotics, ADHD medications and anxiolytics. Here is a list of these medications:

• Antidepressants, antipsychotics and anxiolytics: Elavil/Amitriptyline, Buspar/Buspirone, Tegretol/Carbamazepine, Celexa/Citalopram , Clozaril/Clozapine, Norpramin/Desipramine, Migranal/Ergotamine, Aricept/Donepezil, “Cymbalta/Duloxetine, Lexapro/Escitalopram, Lunesta/Eszopiclone, Prozac/Fluoxetine, Haldol/Haloperidol, Sinemet/Levodopa, Provigil/Modafinil
• ADHD medication: Adderall/Amphetamine

Hormonal Medications

Hormonal medicines, including many birth controls for women, can cause excessive sweating as a side effect. This list also includes steroids and other agents. Here is a list:

• Birth Control: Depo-provera,
• Other hormonal medications: Calcitonin/Fortical, Syntrhoid/Thyroid (for hypothyroidism), Evista/Raloxifene, Genotropin/Somatroin, Testoterone/Androgel, Antibodies/Tositumomab (cancer therapy)
• Diabetes Medications: Glucotrol/Glipizide, Insulin/Humilin, Vasopressin/Pitressin
• Common Steroid Medications: Prednisone/Orapred

Skin Medications

There are several types of skin medication used to treat a variety of conditions, some of which cause hyperhidrosis as a side effect, these include:

• Topical steroids
• Acne Medicine: Accutane/Isoltretinoin
• Numbing Medicine: Lidocaine/Carbcaine
• Other: Selsun/Selenium sulfide

Antibiotics

Antibiotics are used to treat bacterial infections, and despite being commonplace and saving lives, can cause hyperhidrosis. Here is a list of antibiotics that may do this:

• Acyclovir/Zovirax, Rocephin/Ceftriaxone, Cipro/Ciprofloxacin, Sustiva/Efavirenz, Foscavir/Foscarnet, Tequin/Gatifloxacin, Avelox/Moxifloxacin, Ketek/Telithromycin, Ribavirin/Copegus, Retrovir/AZT

The list above is not a complete list of all the medications that can cause secondary hyperhidrosis, just the most common. There are several other classes of medications that have certain drugs which can cause diaphoresis including certain cancer medications, heart and blood pressure medications, GI medications, blood and immune medications, lung medications, and genitourinary medications. The specific names of these medications was not included as they are less common, but if a patient is on a medication to treat one of these conditions and they suspect secondary hyperhidrosis they should consult a doctor.[1]

Options for Dealing with Medication-induced Hyperhidrosis

The most obvious solution for treating hyperhidrosis caused by a medication is to stop taking it. However, that is not always a viable option for certain patients. Some patients may need to continue taking the offending medication because it will be further deleterious for their health to stop taking it.[3] For example, a psychiatric patient may find it necessary to take medicine which causes hyperhidrosis in order to continue functioning. In this situation, discontinuing the causative drug is not in the best interest of the patient. This type of patient may benefit from taking another oral medication used to treat hyperhidrosis. While there are other therapies for treating hyperhidrosis, they are targeted at specific problem areas, and typically secondary hyperhidrosis occurs all over the body so a systemic approach is more appropriate. The medications most often used to treat excessive sweating in this situation are called anticholinergics. Most commonly doctors use either glycopyrrolate or oxybutynin if they are going to prescribe an anticholinergic.[1] There are many other situations like the example given above in which a patient may be at a higher risk from discontinuing their medication than from treating its side-effect.

Withdrawal from Medication or Drugs

In some cases, secondary hyperhidrosis is not caused directly by taking a medication but by not taking it. This occurs after a person becomes physically dependant on a drug or medication. Most commonly people can experience hyperhidrosis symptoms due to withdrawing from alcohol, and occasionally other substances. It can also be a symptom of intoxication from alcohol as alcohol is known to exaggerate excessive sweating. [4] Withdrawal can be a challenging and it is important to get medical supervision.

It is important for patients to manage hyperhidrosis with a doctor, especially if they suspect the onset may be due to a medication. The positive thing about hyperhidrosis induced by a medication is that there may be a simple solution to fix it, and for those who cannot stop taking their medications there are other drugs which can alleviate their symptoms.

Sources

1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.
2. Common Drugs/Medications Known to Cause Diaphoresis Listed by Therapeutic Class. (n.d.). Retrieved August 7, 2018, from https://www.sweathelp.org/pdf/Diaphoretic_Class.pdf
3. Cheshire, W. P., & Fealy, R. D. (2008). Drug-induced hyperhidrosis and hypohidrosis: Incidence, prevention and management. Drug Safety, 31(2), 109-126. Retrieved August 6, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/18217788.
4. Paisly, A. N., & Buckler, H. M. (2010). Investigating secondary hyperhidrosis. BMJ : British Medical Journal, 341. doi:DOI:10.1136/bmj.c4475

We all sweat! It’s annoying, uncomfortable, and surprisingly, life saving. Here’s why we sweat and what it means for our bodies.

Why Do We Sweat?

From a light sweat due to a brisk walk on a pretty day, to getting completely drenched when playing sports, all of us sweat. Although we all sweat to varying degrees - all people perspire in order to maintain their body temperature, specifically to cool down. The fancy word for this is thermoregulation. So, the simple answer as to why people sweat is this: to control our body temperature.

Curious about how this works? Keep reading!

The Science Behind Sweat

Sweat and body temperature work together in a feedback loop that’s used to keep the body balanced and in a state of homeostasis. Homeostasis is the word that is used to describe how the body regulates itself; like how it maintains its temperature, regulates breathing and many other processes.

Wondering how sweating regulates body temperature? These questions can be answered with a quick dive into the anatomy of sweating. 

In all humans, the body is constantly producing heat via a series of reactions. This heat is a result of both chemical reactions and physical actions inside the body. From heart tissues expanding and contracting, to intestinal organs absorbing nutrients, heat is almost always produced as a by-product of the body’s actions. 

Since the human body does not rely on outside environmental conditions to regulate temperature, humans are classified as endotherms (commonly known as warm-blooded. Whereas ectothermic (cold-blooded) species rely on heat via solar energy to maintain their body temperatures, endothermic species produce sufficient heat to warm themselves on their own. But what if we, warm blooded humans, get too hot? 

There are three primary ways humans get rid of excess heat: dissipating heat through their breath, sending heat to the outer layers of the skin via blood flow, and producing sweat that evaporates from the skin. The first two methods happen constantly, but sweat is reserved for specific occasions.

Sweat is utilized when the body temperature rises slightly from its resting temperature. The normal body temperature is 98.6 degrees Fahrenheit, although a resting temperature often varies between 97.7-99.2 degrees Fahrenheit. Once your body hits a higher temperature the sweating process begins.

Sweat glands produce liquid sweat, and the sweat travels from the glands to the surface of the skin. Sweat is mostly made of water, and a few other things. When the sweat evaporates (because it is mostly water), the heat in the sweat leaves the body as well. This cools the body off with amazing efficiency!

More Sweat Questions?

Check out what your body loses when you sweat or learn more about conditions that cause stinky sweat, too much, or too little sweat.

If you’re glad your body can sweat (so you stay alive) but you’d like to sweat a little bit less check out these amazing antiperspirant options. They can reduce sweat at its source and make it a little more comfortable on those hot days! 

Sources

1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Amsterdam: Elsevier Pub. Co., 2014. Retrieved from https://www.elsevier.com/books/hyperhidrosis-an-issue-of-dermatologic-clinics/pariser/978-0-323-32607-0>https://www.elsevier.com/books/hyperhidrosis-an-issue-of-dermatologic-clinics/pariser/978-0-323-32607-0
2. Nordqvist, C. (2017, December 21). Hyperhidrosis: Symptoms, causes, diagnosis, and treatment. Retrieved May 14, 2018, from https://www.medicalnewstoday.com/articles/182130.php
3. Kamudoni, P., Mueller, B., Halford, J., Schouveller, A., Stacey, B., & Salek, M. (2017, June 8). The impact of hyperhidrosis on patients' daily life and quality of life: A qualitative investigation. Retrieved May 21, 2018, from https://hqlo.biomedcentral.com/articles/10.1186/s12955-017-0693-x\

Do you struggle with excessive facial sweat? You’re not alone! When someone sweats excessively from their face for no apparent reason it’s called craniofacial hyperhidrosis. This type of hyperhidrosis can cause the scalp, nose, chin, and cheeks to produce more sweat than they typically should.[1] Primary focal hyperhidrosis, a form of hyperhidrosis that has no apparent cause and affects people over a lifetime, is the most common reason that people develop excessive craniofacial sweating. About 3% of the population struggles with primary focal hyperhidrosis, and of those people, around one in five will develop symptoms of facial sweating.[4] That means that there are a lot of people with this problem! It also tends to affect men more frequently than women. Unfortunately, craniofacial hyperhidrosis can have a negative impact on a person’s quality of life if it’s left untreated.[4][1][4] For example, many women are unable to keep makeup on, and sufferers can become very self conscious about their appearance. Many with craniofacial hyperhidrosis go on to develop anxiety because the face is so integral to social interactions and excessive facial sweating leaves people feeling self conscious about one of their most prominent features. It’s a problem that needs to be taken seriously, and treated with respect. Luckily, there are treatments available that can lessen the burden of sweat, and reduce both a person’s sweating and anxiety.[1]

Causes

There are two main subtypes of hyperhidrosis that can cause excessive facial sweating: primary focal hyperhidrosis and secondary hyperhidrosis. It’s important that you know which type is causing your sweating because secondary hyperhidrosis is caused by specific underlying factors that can affect how your condition is treated.[1]

If your doctor determines that your craniofacial sweating is caused by primary hyperhidrosis then it means that your condition has no well understood cause. Doctors are unsure why, but primary focal hyperhidrosis causes eccrine (sweat) glands to be overactive. People with hyperhidrosis have sweat glands that look and function the same as normal sweat glands, but they produce much more sweat. It’s known that stress can cause sweating on the face and neck to worsen, as can heat. It’s also more likely to occur in men and typically begins in early adulthood.[1] While some triggers of facial sweating are understood the cause of primary focal hyperhidrosis is not.

If your doctor suspects that your craniofacial sweating is caused by secondary hyperhidrosis it means that there is an underlying problem causing you to sweat excessively. There are a host of conditions and diseases that cause secondary hyperhidrosis which may be responsible for facial, scalp, and neck sweating. These can include anything from infections, endocrine disorders, ,the use of some medications, and even very serious issues like cancers.[1] If you have secondary hyperhidrosis, don’t panic. In most cases your doctor can treat the underlying problem so that your symptoms improve. Even if it sounds scary, receiving the medical treatment you need is in your best interest. The most common cause of secondary hyperhidrosis is a medication side effect, so make sure you inform your doctor about all the medications and supplements you are currently taking[5]

Many people find that their facial sweating is worse during times of high anxiety.[3] Often those who experience craniofacial sweating also suffer from stress sweating. If this is the case, then measures to reduce anxiety may also help to reduce the amount of sweating you experience. However, it’s important to understand that hyperhidrosis is not typically caused by an anxiety disorder. Therefore, treatment of hyperhidrosis along with stress reduction techniques will be the most effective to minimize symptoms.

Treatments

The type of treatment each patient requires depends on the cause of their craniofacial sweating. For those with primary hyperhidrosis, the goal is to reduce facial sweating and manage their symptoms via treatment. If a patient has craniofacial sweating caused by secondary hyperhidrosis, then the goal is to eliminate the underlying issue, or to manage symptoms if the causative agent can’t be reversed.

Antiperspirants, Creams, and Oral Medications

The first line of treatment when attempting to stop facial sweating is to use topical antiperspirant creams. There are over-the-counter topical creams for hyperhidrosis that contain aluminum chloride, a substance that reduces the amount of sweat eccrine glands produce. If this does not work then patients can move on to the use of a prescription topical cream that contains an anticholinergic, usually glycopyrrolate. According to the most recent research 2% glycopyrrolate cream seems to be an effective treatment for excessive facial sweating.[4]

If topical creams do not work then doctors often move on to a type of oral medication called an anticholinergic. This type of medication works on the entire body to reduce sweat production by interfering with the binding ability of a neurotransmitter called acetylcholine. There are not many studies on the efficacy of this treatment specifically for craniofacial hyperhidrosis. However, the studies that do exist show that oral medication does tend to help, but can come with side effects. The main side effect that bothered patients in the studies available was dry mouth, although others can occur[4]

Botox

Botox injections are a third line treatment for craniofacial hyperhidrosis. This means that they are used after topical therapies and oral medications have failed to help someone. Botox injections are used for the treatment of axillary hyperhidrosis most frequently, but they are used for facial sweating on occasion. However, there is no current consensus on the amount and type of botulinum toxin that should be used. Issues can also occur regarding aesthetic concerns due to Botox injections causing facial asymmetry and brow ptosis (drooping).[2] When Botox injections have been studied for the treatment of craniofacial hyperhidrosis Botulinum toxin A was used and it was shown to be a relatively safe and effective treatment. More studies need to be performed to demonstrate the safety and effectiveness of this treatment over time, and in a larger group of people.[1]

Endoscopic Thoracic Sympathectomy

This is a type of surgery in which the nerves of the sympathetic ganglia are disconnected from eccrine sweat glands. The sympathetic ganglia is the part of the nervous system that connects to sweat glands to the rest of the nervous system and which is responsible for the flight or fight response. When these nerves are disconnected it prevents the body from being able to sweat in a particular area of the body because it can no longer communicate with the sweat glands in that location. This is a viable treatment option for those suffering from craniofacial hyperhidrosis. Usually, to get rid of sweating on the head and neck, a surgeon will have to work on the T2 or T3 area of the spine. The nerves can be blocked by various means including clipping, transection, ablation and clamping.[4] While ETS is very effective at stopping excessive sweating of the face, it can come with some serious side effects. ETS comes with a potential complication called compensatory sweating, in which the body sweats excessively in areas the surgery was not performed on. Compensatory sweating can be so distressing that some patients decide to have the surgery reversed. There is a type of surgery called a needlescopic thoracic sympathetic block which essentially does the same thing as ETS but the nerves are just clipped. This way, if a patient experiences compensatory sweating, the procedure can more easily be reversed.[3] Surgery should be reserved as a last resort for severe cases of craniofacial hyperhidrosis.

Excessive facial sweating can be an extremely burdensome form of hyperhidrosis. The good thing is that new treatments are being developed each year and many effective treatments are already available. If you are struggling with this, then please, don’t give up! Keep trying treatments to see what works for you - there is hope!

Sources

1. Craniofacial hyperhidrosis can usually be managed pharmacologically, but surgery may sometimes be needed. (2016). . Drugs & Therapy Perspectives, 32(5), 191-194. doi:10.1007/s40267-016-0282-9
2. Huddle, J. R. (2014). Hyperhidrosis: Causes, Treatment Options and Outcomes. New York, NY: Nova Science.
3. Lin, T. S., & Chou, M. C. (2002). Needlescopic thoracic sympathetic block by clipping for craniofacial hyperhidrosis. . Surgical Endoscopy, 16(7). doi:10.1007/s00464-001-8231-6
4. Nicholas, R., Quddus, A., & Baker, D. M. (2015). Treatment of Primary Craniofacial Hyperhidrosis: A Systematic Review. American Journal of Clinical Dermatology, 16(5), 361-370. doi:10.1007/s40257-015-0136-6
5. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.