I don’t know about you, but I’m more than ready for fall and its cooler temperatures. The late-summer heat always seems to be the hardest to tolerate! If you’re anything like me, you sweat – a lot. While sweating is our body’s natural way of cooling itself down, it can create several challenges, especially for those of us with sensitive or acne-prone skin.
First, a note on the association between heat, sweat, and acne. Warm weather and sweating can exacerbate acne through multiple mechanisms. Sweat can clog the pilosebaceous (hair and oil) follicles, trapping moisture and debris, creating the perfect environment for an acne lesion to develop. Heat and humidity also keep sweat sitting on the skin longer, worsening this obstruction and inflammation. Aside from acne exacerbation, sweat can cause a multitude of other frustrating effects, including heat rash (miliaria), stained clothing, and general discomfort.
Fortunately, we have several ways to minimize the effects of sweating on your skin. For patients with acne-prone skin who experience mild to moderate sweating, using a hypochlorous acid spray is one of my favorite recommendations. Applying it on the go after sweating can help reduce acne-related bacteria and calm down inflammation in the skin. At Hamilton Dermatology, we carry LaserSense dermal spray in the office. Over-the-counter products are also available, including Prequel, Good Molecules, and Tower 28. These are especially helpful for students heading back to school, where long days of classes, sports practices, and extracurricular activities often mean prolonged periods of sweating. Keeping a hypochlorous acid spray or wipes in a backpack or gym bag makes it easy to freshen up throughout the day. Additionally, utilizing a benzoyl peroxide wash (like Panoxyl) in the shower can help further reduce acne-causing bacteria on high-sweat days.
If you suffer from severe sweating that is not controlled by over-the-counter antiperspirants, you may have a condition called hyperhidrosis. Hyperhidrosis is caused by overactivity of the eccrine sweat glands due to increased sympathetic nerve stimulation. Eccrine sweat glands are found nearly everywhere on the body, empty directly onto the skin, and are involved in body temperature regulation. They differ from apocrine sweat glands, which empty directly into hair follicles and are involved in the production of body odor.
Hyperhidrosis typically occurs in the underarms, palms, soles, or forehead – all areas that are rich in these eccrine sweat glands. Interestingly, in patients with hyperhidrosis, sweating tends to cease overnight during sleep and can improve with age. Although some cases of hyperhidrosis can have an underlying cause, such as medications, endocrine disorders, or neurologic disease, the vast majority (around 90%) have no identifiable underlying cause. The condition can run in families, suggesting that genetics may play a role.
First-line treatment for hyperhidrosis is usually topical aluminum chloride (brand name Drysol), which is a physical blocker of the eccrine sweat glands and prevents sweat from reaching the skin’s surface. If topical therapy is insufficient, we can use Botox in the underarms or hands to address hyperhidrosis. When injected into the dermis (second layer of the skin where the eccrine glands live), Botox directly blocks acetylcholine release from the overactive sympathetic nerves, preventing activation of the eccrine sweat glands in the first place. Botox treatment can reduce sweating to at least 25%, often to less than 10%, of baseline, and results typically last 4-12 months, with an average duration of about 7 months.
Additional treatment options include oral medications such as glycopyrrolate, which is an anticholinergic that blocks eccrine sweat gland activation temporarily, as well as newer topical options such as sofpironium (Sofdra) gel and glycopyrronium (Qbrexa) wipes, which are anticholinergic wipes for the underarm area. For severe, resistant cases, surgical intervention may be considered.
If excessive sweating made this summer miserable, or if you’re struggling with sweat-related acne, schedule a visit with one of our providers at Hamilton Dermatology to discuss treatment options and develop a plan to help you stay comfortable year-round.
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