Underarms, sweating, odor, and hyperhidrosis.

     Not a very glamorous topic, but one that bothers quite a few of our patients and about which I get lots of questions.
     First, I get a lot of questions about when to start deodorant with kids. There are many 7 and 8 year old girls and 8 to 10 year old boys that (years before puberty starts) will need deodorant because they develop underarm body odor. If your child is grumbling around about using deodorant remind them that every one gets to a point where, as they grow up, they need to use it. It is fine to use any deodorant at a young age (it does not have to be a "teen deodorant"). As with any deodorant, if it causes irritation, try a different brand (see below). The average child starts using deodorant when they are a little older than the ages above, but if your child needs it at a younger age, encourage them to do so.
     When to start an antiperspirant, you ask? If it is an odor issue and not an issue with excess sweating, it is fine to use just the deodorant. If your child sweats through shirts (even a little bit), make sure it is a product with both a deodorant and antiperspirant.
     Some teens and adults are so sensitive to different antiperspirants and deodorants, that they need a fragrance-free deodorant and antiperspirant designed for sensitive skin. Common ingredients that cause reactions include the fragrance, propylene glycol, essential oils, parabens, vitamin E, and lanolin. Dr. Matthew Zirwas, M.D., a dermatologist at the Ohio State University, did a study on antiperspirant and deodorant allergy. He reported that the leading products with low likelihood of causing local allergic reactions include the following:
Almay Hypo-Allergenic Fragrance Free Roll On (antiperspirant and deodorant)
Certain Dri (antiperspirant)
Crystal Roll-On Body Deodorant for Sensitive Skin (deodorant)
Crystal Stick Body Deodorant for Sensitive Skin (deodorant)
Mitchum Roll-On Deodorant (antiperspirant and deodorant)
Secret Soft Solid Platinum Deodorant Unscented (deodorant)
If your child is having an issue with rashes, irritation, or itching with antiperspirant and deodorant use, consider one of these products. They are available in stores and on-line. If the itching is an issue or a rash is forming, it is fine to use over the counter 0.5 or 1% hydrocortisone cream once or twice a day for a few days to calm the itching and rash down.
     What is hyperhidrosis? It means excessive sweating. Some folks sweat excessively compared to others. Sometimes, it is multiple areas. Other times it is just it one place or two, such as hands, feet, head, or underarms. Although there are some medications (stimulants for ADHD) and conditions (hyperthyroidism) that can cause increased sweating, the vast majority of kids and adults with hyperhidrosis do not have a specific medical reason for the issue. I remind teens that caffeine can cause excessive sweating. If someone has excessive sweating and drinks caffeine, they should try cutting back or stopping their caffeine intake to see if that helps reduce the sweating. Genetics can play a part -- many times this runs in families (not something you would wish to pass on, however).
     If your child struggles with excessive sweating at their feet, try doing more breathable socks and shoes (less leather shoes and more athletic shoes or sandals; Drymax or CoolMax socks). For sweaty feet that need something more, consider using an underarm antiperspirant on the feet every morning.
If usual antiperspirants do not work, consider a "Clinical Strength" antiperspirant such as Gillette (for guys) and Secret (for girls). If that does not help decrease the sweating, try the over the counter Certain Dri Antierspirant Roll-On on the feet at bedtime. Then use the Clinical Strength antiperspirant on the feet in the morning. One more step would be to continue the Certain Dri Antiperspirant Roll-On at bedtime and do Certain Dri A.M. in the morning.
     If your child struggles with excessive sweating at the underarms, start with a "Clinical Strength" antiperspirant. If that is not helping, add the Certain Dri AntiPerspirant Roll-On at bedtime. One more step would be to try the Certain Dri A.M. in the morning. If those are not helping, we can discuss at a check-up or appointment other options, including trying prescription medications including Xerac AC or DrySol. If we are not having good success with these options, the next step is to see the dermatologist -- they are the hyperhidrosis specialist.
     What to do for sweaty hands? Try the Certain Dri AntiPerspirant Roll-On each evening, applying to the palms of your hands. If that helps, continue the Certain Dri. If that does not help, we can discuss at a check-up or other appointment other options. These include the Xerac AC and DrySol. See below.

Use of prescription Xerac AC or DrySol solution:
These medications are used to reduce the sweating from an area. They are applied to the area before bedtime and allowed to stay over night. They can cause irritation or redness at the site. Ironically, it can help to reduce the sweating if it has caused some irritation. If the irritation or redness is too much, wipe it off early with a warm, wet washcloth. For irritation afterwards, apply some Aquaphor Healing Ointment or over-the-counter 1% hydrocortisone cream. It may take 1-2 weeks of using it every night to notice a difference with how much that area sweats. If it is helping, we recommend using it for 2-3 weeks total then see if simply continuing the morning antiperspirant is working. Even if you have a good 3-6 weeks of less sweating even after stopping the medication, the sweating will likely return. At that point, you may need to do it just 3-7 nights in a row to reduce the sweating for a number of weeks. If working, continue in this way. If not helping, let our office know during a visit or call during routine office hours.