A man looks at his armpit to see a large sweat stain on his work shirt.
Anxiety can trigger profuse sweating in social situations and in the workplace. (For Spectrum Health Beat)

Africa, circa 170,000 B.C.

A group of juvenile homo sapiens has gathered peacefully under the sparse shade of a tall tree, filling their hungry bellies on dates and nuts plucked from the savanna.

A lion approaches, licking his chops. The mannish creatures freeze in terror. The lion eyes one or two of them, making note of how Earth’s newest mammals look positively scrumptious.

What’s that they’ve got on them, glaze? They come like doughnuts, in a glazed variety?

No, no. That’s just their delicious, salty sweat, cooling them as they hyperventilate and prepare for a hysteric run.

“Early on, living with lions and stuff, sweat was maybe a helpful thing to cool us off while we were running away,” said Harland Holman, MD, of the Spectrum Health Family Medicine Residency Center. “Your body kind of decides on a fight or flight response. When you get anxious, that’s part of the response—your heart rate goes up, you get sweaty.”

So, in the Stone Age, that sweat turned out to be a handy tool.

In the Information Age? Not so much.

“Now, we’re in the board room,” Dr. Holman said. “It’s not so helpful.”

It’s an entirely different type of lion in the modern workplace. If you stress out in the office and your body breaks out in a cold sweat, your boss or coworkers will suspect you’ve got the flu or you’ve lost your nerve.

They’ll question your competence. They’ll eat you alive.

“You can run away from it, but it won’t help with your job,” Dr. Holman said.

And yet, just because you’ve always had hyperhidrosis—that’s a post-Paleolithic word for excessive sweating—doesn’t mean you have to tolerate it.

Rule out the bad   

Your body’s sweat glands can be activated by ambient temperature, physical activity, hormones and emotions such as stress and anxiety.

Hyperhidrosis is when the sweat glands are constantly over-productive for no apparent reason. There’s no known illness causing it, nor is medication to blame.

Before a doctor can even consider the possibility that your sweating is unrelated to illness or medication, he’ll want to know more about your health history.

“The one thing we always worry about … is the person who sweats at night,” Dr. Holman said. “Night sweats. That’s one sign of an underlying condition, such as cancer.”

The night sweats that he’s referring to here, however, typically involve severe sweating wherein the perspiration reaches a volume that practically soaks the sheets at night.

Cancer and cancer treatments can wreak havoc on the immune system and give rise to wild fluctuations in hormone levels, as well as causing sudden weight loss. Hyperthyroidism can do much the same, Dr. Holman said.

The first step, then, entails a close look at your health yesterday and today.

“Is there any reason to be concerned? If there’s unexplained weight loss and sweating, we might order some blood tests,” Dr. Holman said.

Certain medications are known to cause sweating, including the class of antidepressants known as selective serotonin reuptake inhibitors. Migraine and diabetes medicines can also cause excessive sweating.

“Sometimes if you have diabetes and you’re over-treating it … it can cause that reaction,” Dr. Holman said. “If you take your diabetes meds without eating, for example, it can cause sweating.”

Drier days ahead 

Barring any major underlying conditions, excessive sweating is indeed a likely case of hyperhidrosis—more specifically, primary hyperhidrosis, which means it’s not linked to an ailment or medication.

It affects about 1 in 33 people, according to the International Hyperhidrosis Society.

Keep in mind, hyperhidrosis doesn’t apply to the type of sweating that comes with strenuous exercise or physical activity. Rather, it’s an uncontrollable, extreme sweat that seems to happen spontaneously, in social situations, or when you’re under stress.

Sometimes there’s no explanation for it, sometimes it’s rooted in anxiety. In any case, it’s especially unsettling when it hits in a professional or social environment.

And it has all the makings of a cyclical nightmare: You sweat, so you feel anxious; because you’re anxious, you sweat some more.

“If (patients) are aware of the triggers of their anxiety, one of my first steps is to see if they’re interested in getting counseling,” Dr. Holman said. “There’s a type of counseling called cognitive behavioral therapy, where they redirect those triggers so you don’t feel anxious anymore.”

Deep breathing exercises and medication may prove effective, as may exercise, particularly before heading into a situation you suspect will get your nerves worked up.

Antiperspirant is a reliable tool, but not the common blend from your local Wal-Mart.

Doctors can prescribe an aluminum chloride antiperspirant that’s “a stronger concentration than you could get over the counter,” Dr. Holman said. It’s applied like regular deodorant, but it has plenty more kick.

“If that doesn’t work, and they’re still struggling, occasionally I will prescribe (medication),” Dr. Holman said.

Some blood pressure medications can tame the body’s reactions, and some anxiety medications can also help, although he cautioned about the obvious addiction risks of the latter.

There are also medications called anticholinergics, which can partly block sweat gland production, Dr. Holman said.

A surprising option: Botox.

Some patients sweat profusely, but they don’t want to take medications, Dr. Holman said. A Botox injection in the skin can stem excessive sweating for six months or more.

“Some people have this where they sweat really bad in their hands, for example,” he said. “It would be injected in that area.”

People with milder sweat problems may find relief by wearing moisture-wicking clothing, which pulls moisture away from the body.

There are many ways to battle the problem, but the first step is often the hardest: You have to talk about it.

Excessive sweating can be embarrassing for patients when it happens, Dr. Holman said, and it can be embarrassing to talk about.

“It seems like as patients get more comfortable, they feel more comfortable bringing it up,” he said. “If you get to know them after a few visits, they’ll mention it, and then maybe it’s not as embarrassing to bring it up with your doctor.”