Many medical conditions such as an overactive thyroid gland, malfunctioning of the nervous system (autonomic dysfunction), anxiety disorders such as panic attacks, menopause, and even the night sweats associated with some infections such as tuberculosis (TB) or some cancers. For many people, no other cause is found, other than idiopathic (primary or essential) hyperhidrosis.

Can I cure excessive sweating_

Perhaps, depending on what is the underlying cause of the sweating. For patients with primary (essential or idiopathic) hyperhidrosis, there is no cure. Most of what is available for sweating are treatments that can decrease or help control the problem. Surgery may in some cases cure the problem of sweating, but almost every other method will never cure the condition, but can control it.

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Are treatments permanent_

No, most of the treatments mentioned here have to be done continuously or repeatedly, or the problem will come back. None of the medications will cure the condition, and if one stops the iontophoresis or use of antiperspirants, the excessive sweating will almost certainly return. Surgery may be permanent, but even with ETS, the nerves may grow back and the sweating may start up again in time. This all may vary depending on the cause of the sweating, the underlying medical problem, and the treatment used.

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If I stop a treatment, and the condition comes back, is there any harm_

No, most likely stopping a treatment will not cause any permanent harm. Sometimes, stopping a medication or treatment that has been working will cause the condition to temporarily become worse than before, but other times there may be no more of a problem than usual once the medication has worn off.

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Can I take anticholinergic medication only when I really need to control the sweating_

Certainly. Many people will find that they get more nervous in public situations, and this nervousness may make their sweating worse. Taking a quick acting medication such as glycopyrrolate (Robinul® and Robinul® Forte) may dry up the flow of perspiration, preventing embarrassing sweating. If the sweating is not a problem at home or in private, there is no real need to take medications to control it, unless you have problems such as handling paper, using a computer keyboard, holding objects, or rashes / irritation occur from the sweating (such as athlete's foot from excessive foot sweat). Most people will find that they do not need to take medication at night before going to bed.

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Can I treat it in advance of a situation_

Yes, you may take anticholinergic medications in advance of situations where you may have problems with sweating, or use an extra strong application of an antiperspirant. Many people will find that taking even one dose of an anticholinergic such as Robinul® and Robinul® Forte (glycopyrrolate) will prevent hyperhidrosis for hours, if they are in a situation where they might normally have excessive sweating.

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If I dry out (dehydrate), will I still sweat_

Yes. You would need to avoid drinking fluids for a very long time in order to dry yourself out enough to cut off the flow of sweat, and this would be dangerous because your body would lose its ability to control your temperature; this may lead to heat stroke (sunstroke). If you really dried out enough, you would run the risk of getting ill from dehydration, possibly causing kidney problems. Cutting down the amount of fluid moderately may help, but if you feel thirsty, you should drink enough fluid to quench your thirst. Dehydration is dangerous, but drinking excessive amounts of fluid will usually not increase the amount of sweat produced.

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Is sweating dangerous_

No, excessive sweat may make the skin more irritated or chapped and can help lead to problems such as fungal infection (athlete's foot) or a rash, but it does not cause serious medical problems. Some people may develop extreme shyness or become socially withdrawn due to embarrassment over their sweating, leading to true psychiatric problems (such as social anxiety disorder), and some psychiatrists have recommended treating the hyperhidrosis to treat the psychiatric disorder (Bohn, P & Sternbach H, Topical aluminum chloride for social phobia-related hyperhidrosis, Am J. Psychiatry 1996, 153:1368 (letter) and Telaranta T, Treatment of social phobia by endoscopic thoracic sympathicotomy, Eur. J. Surg. 1998, Suppl 580:27-32).

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I can't swallow pills - can I still take medication_

Yes, you may be able to take a liquid preparation made up by your pharmacist, or consider trying clonidine patches. According to the Pediatric Dosing Handbook text, a suspension of crushed glycopyrrolate (Robinul® and Robinul® Forte) tablets in simple syrup at a concentration of 0.1 mg/ml is stable for 2 weeks if refrigerated. It can be made into a liquid form by pharmacists by mixing 10 one milligram tablets crushed up in 100 milliliters of syrup or water (Lucas V & Amass C, Use of enteral glycopyrrolate in the management of drooling (letter), Palliative Medicine 1998 12(3):207-8). Two tehtmloons of this liquid provide as much medication as one Robinul® tablet; four tehtmloons would provide as much medication as one Robinul® Forte 2mg tablet.

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If I try something else, can I go on to have surgery (ETS) at a later time_

Certainly. If you have tried other forms of treatment, and nothing else works, then you should seek medical consultation to see if surgery is appropriate for you. Most physicians consider surgery a treatment to be done only if all else fails and some insurance companies may not pay for ETS or other " experimental" treatments.

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