Ask Dr James: Why am I so prone to heavy sweating?

In his regular column, Dr James Le Fanu answers your questions. This week: a reader who struggles with heavy sweating throughout the day

I am very prone to heavy sweating that starts as soon as I wake and begin to move about, continuing intermittently throughout the day. The slightest physical exertion and the perspiration pours off of me. I have given up going to the theatre or concerts unless I can be sure to be sitting in a draught. Hot weather is intolerable. I feel that I need to be in a continual breeze to lead a comfortable life.
Sweating, as we all know, is the primary means for neutralising the adverse effects of overheating – whether due to hot weather, physical exertion or a feverish illness. Put very simply, a small cluster of cells in the hypothalamus of the brain on detecting a rise in body temperature relays messages to the millions of sweat glands in the skin to produce generous quantities of watery fluid whose evaporation cools the body. It is a commonplace that some sweat more readily than others but there are two distinct types of “excessive sweating”.
The first is “focal” and confined to one or more regions of the body: the hands (affecting manual tasks, writing or using tools), the feet (ruining footwear and predisposing to fungal infections), the armpits and, most dramatically, the head and face: “perspiration literally runs down my face in rivulets dripping off my forehead and chin – so I must be continually mopping it with a large handkerchief”. This “focal” sweating runs strongly in families so is presumed to be essentially genetic. The second type “generalised” or “total body sweats” is epitomised most obviously by the hormonal changes of the menopause.
There are, however, other reasons you may be sweating and they may be a sign of these underlying health issues.
“Four years ago I began to suffer from heavy sweating”, reports a woman in her late sixties. “The perspiration would literally pour off me and would cease only to start up again after half an hour or so. Soon after I was found to have type 2 diabetes, now [it’s] well controlled with pills. The sweats still happen but not as badly as before”.
The characteristic features of an overactive thyroid – palpitations, tremor, weight loss – also include heat intolerance causing sweating on even the mildest of days or brought on by minimal exertion.
The recent onset of generalised sweating, especially at night always warrants attention as it may be an early sign of blood disorders such as lymphoma or the infections Tuberculosis and Brucellosis. “Twenty five years ago out of the blue my husband would be woken by such drenching night sweats he had to change his pyjamas. He turned out to have Hodgkin’s lymphoma, gratifyingly cured, along with the night sweats, with chemotherapy”.
Despite appropriate investigations it is not possible to identify an underlying treatable cause in most troubled by “total body sweats” – which rather is most likely due to some age-related disturbed functioning of temperature regulation.
The simplest remedy is the regular application of aluminium chloride which prevents the release of sweat onto the skin. Sweat bands can also be useful. A few years ago I bought a towelling headband as worn by tennis players. This has drastically reduced my facial perspiration. Beyond that both forms of sweating may be alleviated by the drugs propantheline and oxybutynin that inhibit the action of the nerves to the sweat glands. Their use however may be limited by their inevitable tendency to interfere with the function of nerves elsewhere in the body resulting in variously blurred vision, dry mouth and constipation.
Email queries and comments in confidence to [email protected]
Recommended