Dear Dr. Roach: Anytime I work — outside or in the house, in any season — my head sweats the whole time. A lot of sweat comes off my head. I have to cool off inside under a fan every half hour, even if the air conditioning is on. I put ice on my head, and I don’t sweat anywhere else.
If I am sitting in the house and not working, I am freezing. I will put on a jacket and cover up with a blanket. I am cold anytime the house is less than 23 degrees. I am 75 years old, and this has been going on for years. Have you ever heard of anything like this?
Anon.
With a high degree of certainty, I can say you have primary focal hyperhidrosis. Doctors love making diagnoses and patients are often relieved to know there is a condition causing their symptoms, but the name just means you have primary (not related to any other condition), focal (a focus in one part of the body — for you, it’s your head, but most people notice face, scalp or both), hyper- (too much), hidrosis (sweating). Primary focal hyperhidrosis appears as an excess amount of sweating in relation to normal emotional stress.
If the diagnosis is correct, I would predict that you have no problems sweating while sleeping, since the emotional stimulus to sweating is absent. Sweating at night would make me consider menopausal hot flashes. The focal location of your head makes me think primary focal hyperhidrosis is much more likely.
The fact that you are cold all the time could be due to the fact that the sweating is cooling you excessively. However, some people just run cool all the time, especially older people. Further, it could be that you have a medical condition causing you to feel cool. Low thyroid hormone level is classic for that.
I’m sorry you haven’t found a medical provider who has been able to diagnose this condition. But if you ask your primary physician about it, they will likely prescribe topical 20% aluminum chloride hexahydrate or 2% glycopyrrolate for treatment. An expert would be needed to consider a second treatment if these are too irritating or ineffective.
Dear Dr. Roach: I am a 75-year-old male and was diagnosed many years ago with thalassemia. My A1C has been slightly high. Since sugar is carried on hemoglobin and my hemoglobin is disfigured with thalassemia, does it affect my A1C?
J.M.
The thalassemias are a group of disorders with abnormal hemoglobin molecules. Normally there are four chains in a hemoglobin molecule: two alpha and two beta. The clinical variation among the different types is striking, from no symptoms to fatal before birth. It’s estimated that 5% of the world’s population is affected by thalassemia. This causes blood cells to be smaller than usual, and some of the blood cells to have a short lifespan.
The A1C is a measurement of how much sugar is attached to the hemoglobin molecule. In people with normal hemoglobin levels, it’s an excellent measurement of how blood sugar has been over the lifetime of a red blood cell. Since you have different hemoglobin molecules, the normal A1C range is not valid for you. To make the diagnosis of diabetes, a glucose tolerance test would be best. Measuring many blood sugars and taking the average is the most reliable way of following blood sugar levels in a person with known diabetes. In that case, it’s important to get measurements after eating as well as when fasting.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu
