Part 2: Sweating issues and abnormalities
Another common skin-related non-motor symptom of PD are sweating abnormalities, or sweating dysregulation. In its most pronounced form, people with PD describe episodes of sudden, profuse sweating that necessitate a change in clothing. But it could also mean reduced sweating for some people. These episodes can profoundly affect quality of life and can be understandably frustrating and embarrassing.
Sweating is also caused by autonomic dysfunction, more specifically the inability for your body to regulate its temperature correctly. In people with PD, there can be pathologic changes in the parts of your brain that regulate temperature, as well as in the nerves that regulate the sweat glands. People with PD may experience increased or decreased sweating, or a combination of both.
One common pattern is reduced sweating in the body with increased sweating in the face. Another temperature regulation symptom that some people with PD experience is the sensation of cold hands or feet.
Sweating dysfunction is being investigated as a biomarker of PD. A sudoscan is a medical device which can measure sweat gland function. It has been suggested as a potential diagnostic tool for Parkinson’s. More research needs to be done but it is encouraging whenever potential biomarkers are discovered because they may eventually help us diagnose PD earlier and more accurately.
Suggestions to alleviate excessive sweating
In some cases, episodes of profuse sweating take place as a medication dose is wearing off or during a period of dyskinesias. If the sweating episodes appear to be related to medication timing, then treatment may revolve around changing medication timing or dosages to reduce OFF time or dyskinesias. (This webinar addresses the issue of OFF time and dyskinesias.)
In other cases, the episodes occur at random, or occur primarily during sleep. Basic lifestyle recommendations to aid in the management of excessive sweating include:
wearing light, airy clothing
taking cool or lukewarm showers
drinking ample water
Using moisture wicking and cooling sheets, pajamas, clothing and socks. These products are made of materials that absorb more water and dry faster than standard fabrics and can be helpful for some people with excessive sweating, avoiding sweat triggers including spicy foods, caffeine and alcohol
If these simple suggestions are not effective, and often they are not, additional strategies are available. The following are treatments recommended for those suffering from excessive sweating in the general population, and have not been tested specifically in people with PD. In addition, these treatments are generally focal (applied to a particular area) and may not be as effective if sweating is widespread. Discuss these options with your physician:
Prescription-strength anti-perspirant – Almost all anti-perspirants available over-the-counter use an aluminum-based compound as their active ingredient. If these are not effective, there are anti-perspirants with a higher aluminum content that are available by a prescription. Both over-the-counter and prescription strength anti-perspirants can be used in sweaty areas other than under the arms, such as the soles of the feet
Topical glycopyrrolate – This is a gel (it also comes in the form of a medication-infused cloth) containing an anti-cholinergic medication that can be applied to areas that are typically sweaty. Anti-cholinergic medications can have side effects, including dry mouth, constipation and blurry vision, particularly as people age. However, a topical medication is thought to have fewer side effects than an oral pill whose impact is more widespread in the body
Oral medications – Despite the fact that side effects may occur, oral anti-cholinergics (such as oral glycopyrrolate) to control sweating may be appropriate for certain people with PD
Botulinum toxin injections of the underarms and palms are an effective treatment of excessive sweating in those areas
A variety of procedures are available to reduce sweating. These include:
Iontopheresis – used for excessive sweating primarily of the hands and feet. This is a medical device that applies a current across the skin which increases the permeability of the skin, or the ability of substances to pass through the skin. Treatments, conducted by placing the hands and feet in tap water and applying a current, have been shown to decrease sweating. If this is not effective, sometimes an anti-cholinergic medication is added to the water. Treatments must be repeated frequently (about once a week), but after an initial period, can be done at home.
MiraDry is a handheld device that delivers microwave energy to specific areas of the body thereby destroying the underlying sweat glands. Laser treatments can be used for this purpose as well