Prince Andrew allegedly suffered from anhidrosis

    Prince Andrew’s alleged sweating problem is rarely linked to trauma

    18 November 2019

    This weekend’s Newsnight interview between Prince Andrew and Emily Maitlis has generated much coverage around the world, with several parts of it being heavily analysed by commentators. One contentious area is the claim by the Prince that he had a temporary inability to sweat as a consequence of the adrenaline rushes he experienced fighting as a helicopter pilot in the Falklands conflict.

    Medical experts have raised eyebrows on whether this could in fact happen – and only the Prince and his personal physician know the facts on this – but this medical condition (called anhidrosis)  is probably more common than we realise. However, no one knows exactly how many people are affected by anhidrosis because people with mild cases of the condition may not even be aware that they have it, or, if they are, may never mention it to their doctor.

    There are a number of possible causes (and post-traumatic stress is not usually mentioned) including inherited conditions, skin damage, drugs and conditions causing nerve damage such as diabetes. It can be possible to not sweat at all, or only in certain parts of the body and although treatment is rarely necessary if patchy sweating occurs, if full-body anhidrosis occurs there is a risk of heat-related conditions developing such as heat exhaustion or heatstroke.

    More common is hyperhidrosis, or excessive sweating, believed to affect around 3 per cent of the population and which usually first develops under the age of 25. Although it is not a serious or life-threatening health problem, it can cause significant upset and embarrassment to people suffering with it, and men and women are equally affected by it. Although there is no strict definition as to what constitutes hyperhidrosis, as a general point if you have sweating to a level that is interfering with your normal daily activities then you have hyperhidrosis. There are three main categories of the condition – generalised, primary and secondary focal. Generalised hyperhidrosis affects the entire body whereas primary affects the armpits, palms of the hands, soles of the feet and the scalp and usually starts during childhood or adolescence. Secondary focal hyperhidrosis is less common and affects certain parts of the body and is less common.

    Treatment of hyperhidrosis depends on the cause and any underlying medical condition needs to be treated as this is often enough to stop the problem. If treatment is required then doctors usually start with the least invasive treatments such as strong anti-perspirants. The usual one is aluminium chloride hexahydrate  solution applied to the armpits, feet, hands or face (avoiding the eyes) at bedtime and then washed off in the morning. This is initially applied every day until the condition improves and then gradually reduced to once or twice a week and can be used safely in the long-term if necessary. If this does not work then specialist referral may be required.

    Specialist treatments available include iontophoresis – where affected areas such as the palms or soles of the feet are immersed in warm water and weak electrical currents passed across the area – and intradermal injections of botulinum toxin which can be very effective but require repeated courses of treatment.

    Surgery is usually only considered if other treatments have failed and involves either resecting the sweat glands (under local anaesthetic) or having a sympathectomy, where the sympathetic nerves over the neck of the ribs are cut under general anaesthetic. However, this is usually considered as a last resort because of possible complications that may occur and if the armpits are affected then the newer treatment laser sweat ablation (LSA) may be considered as an alternative.

    Prince Andrew states that his anhidrosis has now resolved and he no longer suffers from this problem. Be that as it may, the prevailing medical view remains not only that trauma is not a recognised trigger for this condition but also that adrenaline surges lead to more sweating rather than less. The intense scrutiny he is now under on the back of his comments may now be making him rather more sweaty under the collar than he would wish to be.