Why does nervousness make me sweat so much?

Q. I sweat profusely when I get nervous. This is especially true when I am about to meet new people. In particular, I get a lot of sweat on my forehead. It's very embarrassing. Any suggestions?

A. Sweat glands have an important job: they help you maintain your body temperature, particularly in hot weather or when you exercise. Physicians use the word hyperhidrosis to refer to sweating that goes beyond what you need.

Focal hyperhidrosis is the term used when excess sweating occurs over one part of the body, such as under the arms, on the palms of the hands, on the soles of the feet, or — as in your case — on the forehead. These are all areas that have a high concentration of sweat glands.

As you are aware, this problem can be socially embarrassing and, in some cases, can interfere with a person's ability to perform at work.

Millions of years ago, humans evolved a protective mechanism for avoiding or dealing with danger — it's called the fight-or-flight response. Sweat glands are activated as part of this response. When you're nervous, you may also feel your muscles tense, along with a quickening of your heart rate or your breathing.

Dermatologists tend not to think of hyperhidrosis as an emotional disorder. Rather, they think the glands responsible for sweat production are particularly sensitive to emotional stimuli. They try to manage the sweating rather than the emotions that may be triggering it.

So, if you haven't done so already, consult a dermatologist. The doctor will check out whether there is a medical cause for hyperhidrosis that can be treated. For example, sweating can increase in people with hormone disorders, neurological illnesses, and cancer. Some medications can cause hyperhidrosis, too.

Assuming you don't have any of those problems, your doctor may recommend applying a topical solution to your forehead. Although there are a few different options, the most common contain aluminum chloride, which is the same chemical used in many over-the-counter antiperspirants.

If a topical solution doesn't work, your doctor may offer you botulinum toxin (Botox) injections. This substance, which is used as a cosmetic aid (for example, to smooth facial wrinkles), can also reduce sweating by inhibiting the nerves that trigger the sweat glands.

Your anxiety in meeting new people may be exaggerated by your worry about sweating. If you get the sweating under control, your confidence may increase and you may feel less anxious going into social settings.

On the other hand, your anxiety about social situations may persist even if the sweating stops. In that case, I suggest you consult a mental health professional to deal with the anxiety directly. Many types of psychotherapy can help you understand and cope with the sources of your anxiety about meeting new people.

Anxiety medications can also help. If the anxiety crops up only in the context of a performance (that is, giving a speech or presentation), a doctor may recommend a beta blocker. These are drugs that block the sympathetic nervous system and can thus reduce sweating. For more general forms of social anxiety, an SSRI (selective serotonin reuptake inhibitor) may help. Examples are sertraline (Zoloft), paroxetine (Paxil), or fluoxetine (Prozac). When these drugs are effective, they solve more than just the sweating problem. In the best case, you feel less anxious — and in turn you should sweat less.

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