Life in Charleston is inherently sweaty—springtime highs can reach the mid-80s and 90-degree days are the summertime norm. To better understand the purpose behind perspiration, we asked Roper St. Francis Healthcare primary care physician Dr. Valerie Scott and dermatologist Dr. Todd Schlesinger to turn up the heat on this critically important function.
The perspiration situation
Sweating is an evaporative cooling process that works much like our refrigerators and air conditioners—when moisture rises to the surface and comes into contact with the air, we experience immediate relief (even if you don’t feel it mid-workout). There’s not much to sweat—it’s simply water from our bloodstream that’s released through pores in our skin. Sweat also contains salt and sugar, along with traces of ammonia and urea generated when cells break down proteins.
Several million sweat glands under the skin help draw water out of our bodies. The majority of these are eccrine sweat glands, which release sweat directly to the skin’s surface. Found everywhere from your feet to your face, they’re the main glands responsible for regulating body temperature. Sweat from eccrine glands is primarily water and doesn’t have a smell.
The rest are apocrine glands, which release sweat into hair follicles and are found on the armpits, groin and scalp. Sweat from apocrine glands contains proteins and lipids, which make it oily and help keep hair smooth and glistening. These glands kick on at puberty, about the time we start to generate funky smells, but it’s not the sweat that actually stinks—body odor comes from bacteria that live on our skin and feed on sweat.
Breaking a sweat
Hopefully, sweat sessions are a regular part of your fitness routine, but more sweat doesn’t automatically mean better health. “Being soaked after a workout may prove you’ve worked hard, but sweat quantity doesn’t correlate to weight loss or a cardiovascular boost,” says Dr. Scott. There’s no reason to try to sweat more when you work out, because you’re just shedding water. An extra jacket on a run (or hustling through sprints in plastic trash bags) doesn’t drop extra pounds—you’ll simply lose more water and risk dehydration. “The benefit is in the exercise, not in the sweating.”
The same is true of saunas. While sitting in a hot room feels good, opens up your pores and can help you relax, the practice won’t help you shed weight or significant toxins. “Our bodies do metabolize toxins through sweat, but it’s far from efficient,” explains Dr. Scott. The liver and kidneys are the body’s first line of defense for shedding chemicals and metals, with sweat kicking in as a last resort.
Sweat equity
A person’s “normal” amount of sweat is determined by body mass. Men typically sweat more than women, because they tend to have more muscle and greater body mass, leading to a higher internal temperature. But all bodies are built differently and that includes cooling systems.
Some people begin to sweat so much during puberty that it impairs social development. For others, this over-sweating condition, known as hyperhidrosis, may begin later. Excess sweat is also often seen in menopausal women and people who are overweight. “The biggest concern with hyperhidrosis is the social aspect,” says Dr. Scott. Although sweat can be collected and weighed for a formal diagnosis of hyperhidrosis, “too much” sweat is typically subjective—if perspiration is hindering your life, talk to your doctor.
Although far less common, some people have the opposite problem: anhidrosis. Certain health conditions can damage sweat glands, as can burns and extreme dehydration. Alcoholism and opioid abuse may also lead to a diminished ability to sweat. Without the ability to regulate internal temperature, people with anhidrosis are more likely to suffer heatstroke and must be vigilant about staying cool when it’s hot outside.
Sweating the details
“Sweat is the body’s temperature regulatory mechanism,” explains Dr. Schlesinger. Because of that, medical measures to control sweat are approached with care. Two common treatments are the prescription deodorant Drysol and Qbrexza underarm wipes to block sweat signals. Some patients require an oral medication like Robinul, a peptic ulcer treatment that reduces sweat and saliva levels. These patients have to be diligent to avoid heatstroke, since they lose some ability to self-regulate temperature.
In severe cases, including overly sweaty hands, Botox injections work to block the nerve signals causing sweat. Newer treatments such as microwave rays and tiny clips on nerves are also being used. As a last resort, doctors may surgically remove apocrine sweat glands, especially in cases where inflammatory disease, nodules or cysts accompany the hyperhidrosis.
“When you live in South Carolina, perspiration is just a part of life,” says Dr. Scott. “Sweat is normal, and it’s a good thing.” So unless your body isn’t cooling as it should or excessive perspiration is hindering your social or work life, don’t sweat it.
SIDEBAR: Medical experts for this article include Dr. Valerie Scott, who practices family medicine at Roper St. Francis Physician Partners Primary Care, and Dr. Todd Schlesinger, a physician with Epiphany Dermatology and Director of the Clinical Research Center of the Carolinas.
Editor’s Note: This blog is an excerpt from the article “Playing It Cool,” originally authored by Stratton Lawrence. This piece was featured in the Spring 2022 issue of House Calls.