Dr. Malcolm Brock treats patients suffering from hyperhidrosis at the Center for Sweat Disorders at Johns Hopkins.
For about three percent of the population, the old expression “sweating buckets” is a little too close for comfort.
“In elementary school, when you write you put your hand on your piece of paper and then move your hand,” says 18-year-old Cecily Ober, “When I’d raise my hand there’d be a mark, and then it’s like, ‘Oh, that’s weird!’”
Cecily experienced other elementary-school issues during gymnastics practice.
“That was always embarrassing because you’re walking on mats without shoes on, and it’s like, ‘Oh, like, I’m leaving footprints! Like, this is really weird!’” she says.
And all this “weirdness” was mystifying every doctor she and her parents consulted. Some thought she might have hormonal problems; others guessed it was diet-related. But not one of them could make the sweating stop.
So, in 2008, when Cecily was 12 and soon to enter that grand social experiment known as high school, she says, “I gave up and was going to resign to the fact that I have this weird thing that prohibited me from shaking people’s hands or really feeling comfortable with interaction.”
That’s when she and her parents found Dr. Malcolm Brock, a thoracic surgeon here at Johns Hopkins Hospital. Dr. Brock’s interests happen to include the condition he eventually diagnosed Cecily with: hyperhidrosis.
“People will come in and tell you they can actually just stick out their hands or their hands will drip,” he explains. “Or all of a sudden you’ll see you’re sweating so much that you can fill up a small beaker in about five minutes.”
Just to give you an idea how that compares to people who don’t have hyperhidrosis: You use an instrument called a VapoMeter to measure how much water vapor is coming off the skin, and the last time Dr. Brock tested himself, his level was 25. When Cecily Ober got her levels checked back in 2008, they were 10 times that — roughly 250 to 300.
Many treatments are available to help combat overactive sweat glands — topical sprays and ointments, oral medication and Botox-injection therapy, though it must be repeated every six to nine months. There’s also microwave thermolysis, branded as miraDry: A new, non-invasive treatment that uses electromagnetic energy to attack sweat glands.
But what Cecily Ober wound up opting for was a Thoracic Sympathectomy: a surgical procedure where you pinpoint the nerves that regulate sweating in problem areas (hands, underarms or feet) and you seal them off.
The surgery worked like a dream for Cecily. But Dr. Brock was noticing that in many other patients, a drier body wasn’t the only outcome.
“What we noticed was that when we did the sympathectomy, or just before we did the sympathectomy, about 40 percent of our patients were on antidepressant or anti-anxiety disorder medication,” he says.
And after these patients received surgery: “Half of them came off their medication.”
So, he thought, maybe the medical community had been getting things backwards. Maybe with these patients, it wasn’t so much a case of “their anxiety causing their sweating,” but rather “their sweating was causing their anxiety.”
And that’s when Dr. Brock decided it was time to zero in on the complex issue of hyperhidrosis, by founding a center dedicated to fighting it. The Johns Hopkins Center for Sweat Disorders would be the first in the world to approach excessive sweating in a patient-centered, multidisciplinary way, with thoracic specialists, dermatologists, neurologists, and even plastic surgeons.
“But we quickly realized that psychology and psychiatrists were very important, and so that was sort of the first phone call,” he recounts.
And one of the first to receive that call was psychologist Carisa Perry-Parrish.
“Before I got involved in the sweat disorders center, I’d been doing behavioral medicine consultations with general pediatric dermatology,” she explains. “And even these kids that I was seeing, 3- and 4-year-olds, were already experiencing social rejection because of hand sweating!
“So I’m talking to their parents, and I’m like, ‘So, how is your 4-year-old doing?’ And they’re like, ‘Well, the other kids in her class don’t want to hold hands with her.’ Like, little kids skipping down the hall or playing Ring Around the Rosie!”
Since the Center for Sweat Disorders opened in 2013, all new patients have received a referral to the behavioral-medicine team. And while many report emotional distress right off the bat, Perry-Parrish says some claim their hyperhidrosis isn’t affecting their emotional well-being.
But when she and her team pose a question like: “Do you think it’s affecting what you have to do to get ready for work?” Perry-Parrish says the patient might respond: “’Well, yes. I have to make sure I can’t wear that color shirt because then all of my customers will see that I’m sweating."
"And when I’m shaking somebody’s hand I’m watching their face to see if they notice my hand is sweaty and noticing if they’re going to wipe their hand on their pants."
“And so they take it for granted how much they’re doing to cope with this medical condition that a lot of folks don’t know is actually an organic problem,” Perry-Parrish says.
But then there are patients like 17-year-old Silver Spring resident Avi Goldsmith, who was just diagnosed with hyperhidrosis and is considering getting a Thoracic Sympathectomy. Avi’s pretty frank about how hyperhidrosis has been affecting his life.
“One of the things a lot of kids do in my school is this thing called ‘dapping up,’” he says. “It’s like a modern handshake, not as formal. And when my hands are sweaty one of my greatest fears is that somebody’s going to do that.
“I’m getting nervous about somebody wanting to, you know, be friendly. And I feel like I’m different and weird,” he says.
An there’s that word again: “weird.” We heard it with Cecily Ober, too. But these days, her doctors say she’s an excellent example of a patient who is anything but “weird.” When Dr. Brock tests Cecily’s hands on the Vapo-Meter now, instead of registering in the 250 to 300 range, “now it’s around 40, 43. Which is very normal!” she says with a laugh.
And with that “normality” comes a confidence she’d never known. She’s more comfortable gesturing when she talks, and when she meets new people she eagerly extends her hand. In a way, when it comes to Cecily’s life now, she no longer sweats the small stuff.
Or the big.
Music: "Hyperhidrosis" by Loop from Left In the Sun