Scott Webb (Host): Hyperhidrosis is a condition that causes people to excessively sweat, which can affect their lives, jobs, and more. Joining me today to discuss hyperhidrosis and what he can do to help folks is Dr. Robert Korst. He's the Chief of Oncology Surgical Services and Thoracic Surgery at The Valley Hospital and the Director of the Hyperhidrosis Center at Valley.

 Welcome to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. I'm Scott Webb.

Doctor, thanks so much for your time today. We're going to talk about hyperhidrosis and what that is and what that means. And as I was mentioning to you, I've had debates with my wife about whether or not everybody sweats, whether or not that's normal. So, great to have an expert on today. Let's just start there. What is hyperhidrosis?

Dr. Robert Korst: So technically, hyperhidrosis means excessive sweating. So, everyone does indeed sweat, and you have to understand that sweating is a mechanism by which the body cools itself down. And so, body can regulate how much sweating occurs depending on how much the body needs to cool down. And this is all automatic and it's regulated by a part of the nervous system called the autonomic nervous system, specifically the sympathetic nervous system. Now, hyperhidrosis simply means that a person sweats more than is needed to cool the body down. And so, that's really a general definition of hyperhidrosis in the strictest terms.

Host: Yeah, I see what you mean, that it's an involuntary thing. We don't tell our body to cool down, it just does it for us. And this is where the debate comes in with my wife, because my feet sweat, whether I'm doing anything, you know, that's getting my heart rate up or not. If I'm just sitting around streaming Netflix, my feet are probably sweating. So, I guess that's my question, is how do we know the difference between normal sweating and cooling down and hyperhidrosis?

Dr. Robert Korst: When sweating becomes so severe that it interferes with how people function, then people will start to seek medical attention for it. So to give you an example, I've had patients come in and they will say things to me, you know, librarian will come in and say that she's going to lose her job, because she's sweating all over the books. Patients will come into the office and they will sit there in the office with a cup to collect the sweat from their hands. Otherwise, it will just drip on the floor. It's really profound sweating, enough that it interferes with someone's life and quality of life, that, you know, really becomes clinically relevant hyperhidrosis.

Host: Yeah. I see what you mean, it's affecting our lives, our jobs, we're just sitting there in the office and we're sort of sweating profusely. Let's talk about the presentation of hyperhidrosis. Is this something that folks are generally born with, and even as a kid, they're just sweating more than other kids, and parents would say, you know, "Maybe we should see an expert about this"? Or is it something that happens over time as we age?

Dr. Robert Korst: So, I'll just say that, as clinicians, we'll divide hyperhidrosis patients into two types. The first type are patients who will have what we call generalized sweating. So, that means sweating on all parts of the body, which they feel is abnormal. And then, there are patients who have what we call primary focal hyperhidrosis. And that means patients who sweat on specific parts of the body excessively. And again, none of this is controllable by thoughts and you can't will it to stop. So, generalized sweating is usually due to an underlying medical condition, okay? And so, there are some medical conditions that can cause people to sweat excessively. These can be, you know, thyroid conditions or things like diabetes or other general medical conditions. Obesity is another one.

And the key when someone has generalized sweating is to find what the root cause is, and then correct that root cause or treat the root cause. The primary focal hyperhidrosis is completely different. So, these are people who do not have any other type of medical condition, but they notice they sweat on specific parts of the body excessively. And those parts are usually four parts: the palms of the hands, the soles of the feet, the face and the scalp, and then the armpits or the axillae. Those are the four parts. And like I said, there's no medical condition associated with this. These are patients that usually notice this in childhood or in the teen period. They will notice that they sweat more and it may get worse once they reach puberty, and it can become very severe on these parts of the body.

Host: Yeah. So, let's talk about that. I wanted to ask you if there's any medical concerns, right? So, you mentioned, you know, quality of life, affecting perhaps a librarian's job, handling books, so jobs, lives, and so on. What are the medical concerns about heavy sweating?

Dr. Robert Korst: I'll speak mainly now about primary focal hyperhidrosis. So, there are no real medical repercussions of having excessive sweating on the palms of the hands or the soles of the feet. But what can happen is kids who begin to have this problem, they may seek some medical attention, they may run into issues at school. And one of the ways I can articulate this is to actually give specific examples, okay?

So, I remember a kid who was, you know, pre-teens, maybe 11 years old or so. And he was being evaluated, because of a nervous tic and he developed this nervous tic. And no one could figure out why he had a nervous tic. And the nervous tic was that he would take his hands, and he would be constantly, you know, rubbing them on his pants. And so, finally, it was determined that he was rubbing his hands on his pants because his palms were excessively sweating and it wasn't a nervous tic. And it's not that uncommon that a child or a teen will go to their pediatrician. And pediatrician will see, you know, sweaty hands or face or armpits. And they think that the patient has an anxiety disorder, and that's causing the excessive sweating. And so, they'll treat the child with an anti-anxiety drug. You know, hoping that, "Well, if I treat the underlying anxiety disorder, the sweating will get better." That's wrong, okay? So, the important thing to understand is that anxiety does not cause hyperhidrosis, but hyperhidrosis causes anxiety, okay? And that's really the key relationship there.

Host: That's very interesting. I'm just taking this in. I see what you mean, right? That the hyperhidrosis caused that particular person, that patient to wipe their hands excessively, which made, you know, providers think it was something else, which came first, you know, the chicken or the egg, so to speak. So, really interesting. So, what do we do then, doctor? If we suspect that we have hyperhidrosis or we've been diagnosed, what are the next steps?

Dr. Robert Korst: So, primary focal hyperhidrosis is not an all-or-none phenomenon. So, some kids will have it very severe. And then, there are other people who just have clammy hands, and they really don't drip. And so, options are different for, you know, the severity of it, okay? And not only that, for the location of it. And so when patients have it bad enough that they do make it into, you know, a hyperhidrosis center or an expert that deals with hyperhidrosis, usually it's pretty bad at that point, and I'll question the patient. I'll give them specific questions. And if they're not actually sweating in the office, what I'll do is for patients who sweat excessively on their face and scalp, I'll have them, you know, at home take a video and text me the video of that happening. I just want to, get a feel for how bad it is, okay? Because, you know, depending on how bad it is, we'll sway what we do about it, okay? So, kind of the first line of defense, if you will, are topical agents. And topical agents, they're most appropriate for people who have armpit sweating or palms of the hands or soles of the feet. It's hard to use a topical agent on the face or the scalp. And so, what these are, are essentially aluminum chloride antiperspirants. And the way aluminum chloride antiperspirants work, it's really basic. The aluminum chloride gets in and clogs openings of the sweat glands. And that is what prevents sweating. But, you know, the aluminum chloride antiperspirants are challenging, especially for kids and teenagers and people in their early 20s who are going out in the world and who are socially active, you know, because they have to be applied in a certain way. They have to be put on after patients shower at night. They put these things on, but they can't shower in the morning. Otherwise, they'll wash it off time and again. And so, getting, especially kids, to use that religiously is challenging. So, they do work, but it's challenging, you know, in a compliance sense. That's the first line.

And then from there, if that doesn't work, there are other, you know, potential approaches. We don't use a lot of medications on these kids with hyperhidrosis. Because there is no FDA approved medication for hyperhidrosis. What we do is we give medications sometimes for patients with generalized hyperhidrosis. What we do is we relied on the side effects of other types of medications, like medications for high blood pressure or for overactive bladder. One of the side effects of some of these medications is they dry you up. And so we can, you know, use that in certain patients. But I tend to avoid that in kids, because there are better options and I don't want to put a kid on a chronic medication. So, we kind of skipped through those.

Depending on, you know, the part of the body that sweats, there are other approaches that can be used. One is a concept called iontophoresis. And iontophoresis means that, you can get a little device that you fill with water and it's a water bath and it puts a little electric current through the water, you put your hands in that for approximately half an hour a night. And what that does, you know, in simplest terms is the electric current will kind of confuse, if you will, the electric current in the sweat glands and get them to slow down in their secretion or stop sweating. But again, you run into compliance issues, especially with young people. And so, that has limited usefulness as well.

The other treatment strategy that's used a lot is Botox injection. Botox can be injected into the palms of the hands, into the soles of the feet, into the armpits. And even into the face and the scalp if necessary. And Botox works very well. But the problem with Botox is that it's not a permanent solution. It does not last more than a few months. And so, patients have to keep going back for it. And it's obviously not pleasurable to have multiple injections into the palms of your hands of Botox.

And so, you know, some of the other treatments that are out there. So for, armpit sweating, it's possible that there are some procedures to actually remove the sweat glands in the armpits. And then, the other thing we have is an approach to try to interrupt the nerves that are responsible for primary focal hyperhidrosis. So, remember we talked earlier that, you know, the involuntary nervous system regulates sweating. And so if we can interrupt the nerves that are responsible for that, then we can stop sweating. And so, that is a procedure which is called sympathectomy, because we divide the sympathetic nerves. And that's a minimally invasive surgical procedure. It's a same day procedure. People will come in in the morning, go home the same day, and it's very effective at stopping sweating. So, these are all, you know, kind of options and the tools in the tool chest, if you will.

Host: Yeah. You know, doctor, I have hosted, I don't even know how many podcasts, medical podcasts, maybe a thousand or more, and I've never done one on hyperhidrosis. I was really excited about this today because I felt like I was going to learn a lot, and I completely have. And I'm sure listeners have as well, not only, you know, really what hyperhidrosis is, but also all of the treatment options, as you say, all the tools in the toolbox or the tool belt or however you're carrying your tools around, right? I think I just want to finish up here, doctor, and just say or ask you, is there any chance that hyperhidrosis resolves on its own? Does it resolve naturally in any way, or do we really need an expert like yourself?

Dr. Robert Korst: It usually does not resolve on its own. And what happens is patients will fall into a couple different buckets. This usually happens obviously when people are young. And if it's not that severe, you know, people will learn to live with it. If they have hyperhidrosis of the soles of the feet, for example, they know what kind of shoes and socks they need to wear, they know they need to be careful with things like flip flops, and they make lifestyle adjustments. For patients where it's extremely severe, it's not something that's going to resolve on its own, and those are usually the people that I see in the office.

Host: Yeah, I see what you mean. Because my feet sweat a lot, I try to buy socks that allow my feet to breathe, right? So as you say, we make these lifestyle adjustments. But in some cases, it's so severe that there's just nothing we can do and we need your expertise and all the different things from Botox and all the other stuff you mentioned here today. So educational. I really appreciate your time. You stay well.

Dr. Robert Korst: Thank you so much.

Host: For more information about the Valley Hospital Hyperhidrosis Center at Valley, please visit valleyhealth.com/hyperhidrosis or call 1-800-VALLEY-1. That's 1-800-825-5391 to schedule an appointment.

And if you found this podcast helpful, please share on your socials and check out our entire podcast library for topics of interest to you. And thanks for listening to Conversations Like No Other presented by Valley Health System in Ridgewood, New Jersey. For more information on today's topic or to be connected with today's guest, please call 201-291-6090 or email valleypodcast@valleyhealth.com. I'm Scott Webb. Stay well.