Emotion not the only trigger for excessive sweating

Q: I sweat profusely when I get nervous. This is especially true when I'm about to meet new people. I really get a lot of sweat on my forehead. It's very embarrassing for me. Any suggestions?

A: Sweat glands help you maintain your body temperature, particularly in hot weather or when you exercise.

Physicians use the word "hyperhidrosis" to refer to sweating that goes beyond what you need. They call it focal hyperhidrosis when excess sweating occurs over one part of the body, such as under the arms, on the palms of the hands, the soles of the feet, or--as in your case--on the forehead. These are all areas that have a high concentration of sweat glands.

This problem can be socially embarrassing and, in some cases, can interfere with doing your job. One famous and public example from nearly 50 years ago: Many people thought that Richard Nixon's sweating during the televised presidential debates in 1960 cost him the election to the cool-looking John Kennedy.

Emotions can cause sweating because they activate the same part of the nervous system as heat and exercise do. Dermatologists think that, in hyperhidrosis, the glands responsible for sweat production are particularly sensitive to emotional stimuli.

I suggest a discussion or visit with your doctor, because something other than anxiety could cause the sweating, such as an overactive thyroid or a side effect of medication. Assuming you don't have any of those problems, your doctor may recommend applying a topical antiperspirant solution to your forehead. If that doesn't work, botulinum toxin (botox) injections may. These shots reduce sweating by blocking the nerves that trigger sweat glands.

If your anxiety about social situations persists, I suggest you consult a mental health professional.

Many types of psychotherapy can help you understand and cope with the sources of your anxiety about meeting new people. Medications can help, too. Beta-blockers, which mute physical symptoms of anxiety (like tremulousness and sweating), may help if you know exactly when you're going to be anxious (before going to an event where you're likely to meet new people). If your social anxiety crops up more broadly, an SSRI (selective serotonin reuptake inhibitor) may help. Examples are sertraline (Zoloft), paroxetine (Paxil) or fluoxetine (Prozac). When these drugs are effective, you feel less anxious overall and in turn, you should sweat less.

(Michael Craig Miller, M.D., is an Assistant Professor of Psychiatry at Harvard Medical School and an associate physician at Beth Israel Deaconess Medical Center in Boston. Dr. Miller is the editor-in-chief of the Harvard Mental Health Letter.)

(For additional consumer health information, please visit www.health.harvard.edu.)


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