Systemic Lupus Erythematosus (SLE) is a chronic autoimmune condition where the body’s immune system mistakenly attacks its own healthy tissues, leading to widespread inflammation and potential organ damage. Because SLE can affect nearly any system in the body, it produces a wide variety of symptoms. One common symptom patients report is excessive or unusual sweating, known as hyperhidrosis. Understanding the underlying causes, which range from the disease process itself to necessary medical treatments, is important.
Systemic Inflammation and Temperature Dysregulation
Excessive sweating can be a direct result of active lupus disease, often occurring during a flare. The body’s systemic inflammatory response, a hallmark of SLE, disrupts the normal mechanisms of temperature control. This disruption frequently manifests as low-grade fevers or significant night sweats, which are common signs of a flare.
The immune system’s activity can lead to increased production of molecules like nitric oxide (NO) during periods of high inflammation. High levels of nitric oxide cause the blood vessels in the skin to widen (vasodilation). This action brings more warm blood to the skin’s surface, which the body attempts to cool by producing sweat.
Lupus can also affect the autonomic nervous system (ANS), the involuntary control center for functions like heart rate and body temperature regulation. When inflammation targets the nerves of the ANS, it results in autonomic dysfunction. This dysfunction impairs the body’s ability to maintain a stable internal temperature, leading to periods of heat intolerance and spontaneous sweating episodes.
Medication-Related Causes of Hyperhidrosis
The most frequent reason for excessive sweating in lupus patients is often a side effect of pharmacological treatment. Corticosteroids, such as Prednisone, are widely used to suppress inflammation and the immune response in SLE. These powerful medications interfere with the body’s hormonal balance and temperature regulation, resulting in increased sweating and hot flashes.
Prednisone works by mimicking cortisol, a naturally occurring stress hormone. The resulting high levels can temporarily alter the body’s internal thermostat and metabolism. This overstimulation causes many people to experience intense sweating or flushing. The severity of this side effect is often related to the dosage, with higher doses more likely to induce noticeable hyperhidrosis.
Other medications used in lupus treatment, including some immunosuppressants and antimalarial drugs, can also contribute to this symptom. Furthermore, by suppressing the immune system, many lupus medications increase the risk of developing an infection. A fever accompanied by sweats is a classic sign that the body is fighting off a secondary pathogen.
Differentiating Symptoms and Management Strategies
Reporting any change in sweating patterns to a physician is important, as excessive sweating can signal a lupus flare or a more serious underlying issue. Doctors must first differentiate if the sweating is due to active disease, a medication side effect, or another co-existing condition. Since lupus patients are at a higher risk of infection, a thorough evaluation is required to rule out a bacterial or viral illness presenting with fever and sweats.
The physician may also test for other conditions that cause hyperhidrosis, such as hyperthyroidism or diabetes, which are common in the autoimmune population. Distinguishing between disease-related and drug-related sweating involves reviewing the patient’s current medication dosages and disease activity markers. If the sweating correlates with a recent increase in Prednisone dose, a medication adjustment may be considered.
For managing the symptom, several practical and medical strategies are available. First-line treatments often involve highly effective, aluminum chloride-based topical antiperspirants, which temporarily block the sweat ducts. Patients are also advised to wear loose-fitting, breathable clothing and maintain a cool environment, particularly while sleeping.
When topical treatments are not sufficient, other medical options can be explored. These include iontophoresis, a procedure using a mild electrical current applied through water to reduce sweating, primarily on the hands and feet. For localized, severe sweating, botulinum toxin injections can temporarily block the nerve signals to the sweat glands. Oral medications, such as anticholinergics, may also be prescribed to reduce overall sweat production, although these are reserved for more severe cases due to potential systemic side effects.