DEAR DR. ROACH: I am an elderly woman who has never perspired and would like to know why. Heat makes me very sick. I love the outdoors, but can be out only a short while in the warmer weather. No one seems to have an answer for me. — P.M.

ANSWER: The name for the condition of no sweating at all is anhidrosis, and there are several causes. There are rare conditions people are born with. These are a possibility, since you have never perspired. However, nearly all of these rare diseases have other significant symptoms you don’t mention.

Damage to sweat glands can be seen in autoimmune diseases and diseases that can destroy sweat glands. None of these is likely, as they too have additional symptoms you would have identified during your life. Likewise, you don’t mention medications, which may have lack of sweating as a side effect.

I suspect you don’t have a diagnosable disease but rather that you are on the far end of the normal range for sweating (this would be called hypohidrosis). Just as there are people who get drenched with sweat in mildly warm weather, there are some who sweat very little.

Since sweating is a major way of keeping cool, you are at higher risk for heat injury, including heatstroke. Avoiding hot weather, as it sounds like you’ve done, is wise. Sun protection (e.g., wearing a wide-brimmed hat) is also wise, as is making sure you have enough fluids. Avoiding excess heat becomes even more important as you get older, since an older person has less ability to adapt to heat than a younger person.

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DEAR DR. ROACH: I have had excessive sweating for the past few years. I don’t mean underarms; I mean head and face. In warmer weather, my hair will be soaking wet in no time. My doctor thinks it’s related to the anxiety syndrome I have had since I was a small child, and prescribed nortriptyline 10 mg once daily. When I looked it up, I thought it might be a little dangerous for me. I am 79 years old.

I am very healthy otherwise. I hope you can help. It’s a horrible problem, and it ruins my summers. — J.H.

ANSWER: We use the Greek terminology to define this problem: primary focal hyperhidrosis, specifically craniofacial hyperhidrosis. “Primary” because it isn’t associated with any other known problem; “focal” because it is in one area; “craniofacial” meaning “head and face”; and “hyperhidrosis” just means “too much sweat.” The underlying cause is unknown, but your doctor might be right that anxiety is playing a role. However, it may run in families.

I disagree with nortriptyline in most people. Not only is it not a good treatment for anxiety, it may have excess sweating as a side effect, but the very low dose makes that unlikely. Doses for depression are often 300 mg.

The usual first treatment is topical antiperspirants to the affected areas. If over-the-counter treatments don’t work, then prescription strength (20 percent) aluminum chloride hexahydrate can be tried, although it can be irritating to the skin of the face in some people. Other treatments include a different topical treatment called glycopyrrolate, botulinum toxin (Botox) injection and oral medications like oxybutynin. In people in their 70s and 80s I try not to use the oral agents.

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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