What are the important aspects of medical history that need to be ascertained?
Mild sweating may not be dangerous. However, drenching sweats that require a change of bedclothes and sheets may be a challenging diagnosis.
Can neurological problems cause sweating?
Spinal cord injuries, stroke, and some other neurological disorders may cause excessive sweating.
What about associated fever?
Temperature should be measured twice a day to ascertain the presence of fever that may precede sweating. When fever is associated with night sweats, infections or malignancy are the likely possibilities. Tuberculosis is an important cause of night sweats in India. Routine evaluation that includes blood tests, Chest X-rays, ultrasonography or scans may be required. Risk factors for HIV infections should be assessed. Unintentional weight loss, oral thrush and enlargement of lymph nodes may give a clue.
What about other infections causing night sweats?
Malaria, typhoid, and scrub typhus may be considered. Joint pains, backache, and recent dental treatment may cause infection in the heart valves if the valves are not originally normal. These are associated with excess sweating.
What about medications causing excessive sweating?
Sweating may occur several weeks after initiation of anti-depression therapy Pilocarpine, bethanechol, and exposure to pesticides containing organophosphate may cause excessive sweating. Anti-diabetic medications that cause lowered blood glucose can cause sweating, Insulin-secreting tumours may cause hypoglycaemia and excessive sweating.
What about sweating and lymphoma?
This is the most common malignancy associated with night sweats. Hodgkin’s lymphoma is associated with night sweats, fatigue, itching, and pain at the site of lymphoma after alcohol consumption. Prostate cancer, and kidney cancer, can cause excessive sweating.
What about treatment for excess sweating?
Treatment depends upon the severity and underlying causes. Over-the-counter options with aluminium chloride may be effective. Drugs that block chemical signals to the sweat glands may be effective. These are Oxybutynin or glycopyrrolate. Excess sweating due to anxiety or stress can be treated by beta-blockers or anti-anxiety medications. Botulinum injections are used for excess underarm sweats. Iontophoresis, microwave therapy, and laser therapy are effective for underarm sweating, avoiding caffeine, and spicy food, and frequent bathing is effective.