Hyperhidrosis Totally Explained

Everything about Hyperhidrosis totally explained

Primary hyperhidrosis is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature.

Signs and symptoms

Hyperhidrosis can either be generalized or localized to specific parts of the body. Hands, feet, axillae, and the groin area are among the most active regions of perspiration due to the relatively high concentration of sweat glands; however, any part of the body may be affected. Primary hyperhidrosis is found to start during adolescence or even before, and interestingly, seems to be inherited as an autosomal dominant genetic trait.
Primary hyperhidrosis must be distinguished from secondary hyperhidrosis, which can start at any point in life. For some, it can seem to come on unexpectedly. The latter form may be due to a disorder of the thyroid or pituitary gland, diabetes mellitus, tumors, gout, menopause, certain drugs, or mercury poisoning. Such secondary forms may have more serious consequences than just hyperhidrosis, making medical consultation advisable.

Affected areas

Palmar: Excessive sweating of the hands.
Axillary: Excessive sweating of the armpits.
Plantar: Excessive sweating of the feet.
Facial: Excessive sweating of the face. (for example not emotional or thermal related blushing)
Cranial: Excessive sweating of the head, especially noted around the hairline.
General: Overall excessive sweating.

Cause

It isn't known what causes primary hyperhidrosis. One theory is that hyperhidrosis results from an overactive sympathetic nervous system, but this hyperactivity may in turn be caused by abnormal brain function.
Some patients afflicted with the condition experience a certain degree of reduction in their quality of life, depending on how severe their condition is. Sufferers feel at a loss of control because perspiration takes place independent of temperature and emotional state.
However, anxiety can exacerbate the situation for many sufferers. A common complaint of patients is that they get nervous because they sweat, then sweat more because they're nervous. Other factors can play a role; certain foods & drinks, nicotine, caffeine, and smells can trigger a response (see also diaphoresis).

Treatment

Hyperhidrosis can usually be very effectively controlled, but there's no known permanent cure because little is known about the cause behind excessive sweating.

Medications

Aluminium chloride (hexahydrate) solution: While aluminium chloride is used in regular antiperspirants, hyperhidrosis sufferers need a much higher concentration to effectively treat the symptoms of the condition. A 15% aluminium chloride solution or higher usually takes about a week of nightly use to stop the sweating, with one or two nightly applications per week to maintain the results. An aluminium chloride solution can be very effective; some people, however, can't tolerate the irritation that it can cause but these constitute a minority of all patients. Also, the solution is usually not effective for palmar (hand) and plantar (foot) hyperhidrosis - for which iontophoresis (see below) may yield better results in some circumstances. For the severe cases of palmar and plantar hyperhidrosis there's a low level of success using conservative measures such as Aluminium chloride antiperspirants.

Botulinum toxin type A (including Botox ): Injections of the botulinum toxin are used to disable the sweat glands. The effects can last from 4-9 months depending on the site of injections. With proper anesthesia the hand and foot injections are almost painless. The procedure when used for underarm sweating has been approved by the U.S. Food and Drug Administration (FDA), and now some insurance companies pay partially for the treatments.

Oral medication: There are several oral drugs available to treat the condition with varying degrees of success.

A class of anticholinergic drugs are available that have shown to reduce hyperhidrosis. Ditropan (generic name: oxybutynin) is one that has been the most promising. For most people, however, the drowsiness, visual symptoms and dry-mouth (as well as all other mucus membranes) associated with the drug can't be tolerated. A time release version of the drug is also available, called Ditropan XL , with purportedly reduced effectiveness. Robinul (generic name: glycopyrrolate) is another drug used on an off-label basis. The drug seems to be almost as effective as oxybutynin, with similar side-effects such as a dry mouth or dry throat often leading to pain in these areas. Other less effective anticholinergic agents that have been tried include propantheline bromide (Probanthine ) and benztropine (Cogentin ).
A different class of drugs known as beta-blockers has also been tried, but doesn't seem to be nearly as effective.
Antidepressants and anxiolytics (anti-anxiety medications) are more archaic, related to the false former belief that Primary Hyperhidrosis was related to an anxious personality style.

Surgical procedures

Surgery (Endoscopic thoracic sympathectomy or ETS): Select sympathetic nerves or nerve ganglia in the chest are either excised (cut out) cut or burned, or clamped (theoretically allowing for the reversal of the procedure). The procedure causes relief of excessive hand sweating in about 85-95%. Major drawbacks related to compensatory sweating are seen in 20-80%. In a series in India, the incidence was found to be 62%.Other side effects include Horner's Syndrome (about 1%), Gustatory Sweating (less than 25%) and on occasion very dry hands (sandpaper hands). Most people find the sweating of Compensatory Sweating to be tolerable while 1-4% find it worse than the initial condition. Some occasional patients have also been shown to experience a cardiac sympathetic denervation, which results in a 10% lowered heartbeat during both rest and exercise. ETS was thought to be helpful in treating axillary hyperhidrosis, facial blushing and facial sweating. Yet, palmar hyperhidrosis patients have the best results and some surgeons only offer ETS for this group. Statistics have shown that when treated for facial blushing and/or excessive facial sweating, the failure rate of ETS for those two clinical presentations is higher and patients are more prone to side effects.

Surgery (Lumbar Sympathectomy): Lumbar Sympathectomy is a relatively new procedure aimed at those patients for which endoscopic thoracic sympathectomy didn't relieve their excessive feet (plantar) sweating. With this procedure the sympathetic chain in the lumbar region is being clipped or divided in order to relieve the severe or excessive feet sweating. The success rate is about 90% and the operation should be carried out only if patients tried other conservative measures.

Surgery (Sweat gland suction): A new and novel technique adapted and modified from liposuction. Approximately 30% of the sweat glands are removed with a proportionate reduction in sweat. This procedure is performed regionally, and not adopted throughout the country.

Iontophoresis: This method was originally described in the 1950s, and its exact mode of action remains elusive to date. The affected area is placed in a device that has two pails of water with a conductor in each one. The hand or foot acts like a conductor between the positively- and negatively-charged pails. As the low current passes through the area, the minerals in the water clog the sweat glands, limiting the amount of sweat released. Common brands of tap water iontophoresis devices are the Drionic, Idrostar and MD-1A (RA Fischer). Some people have seen great results while others see no effect. However, since the device can be painful to some (it is important to note that pain is usually limited to small wounds and that over time the body adjusts to the procedure) and a great deal of time is required, no cessation of sweating in some people may be the result of not using the device as required. The device is usually used for the hands and feet, but there has been a device created for the axillae (armpit) area and for the stump region of amputees.

Percutaneous Sympathectomy: a minimally invasive procedure in which the nerve is blocked by an injection of phenol.

Other

Weight loss: Hyperhidrosis can be aggravated by obesity, so weight-loss can help. However, most people with hyperhidrosis don't sweat excessively due to obesity.

Relaxation and meditation: Relaxation techniques have been tried with limited success.

Hypnosis: Hypnosis has been used with some success in improving the process of administering injections for the treatment of hyperhidrosis .

Talc/Baby Powder: One temporary treatment is talc or baby powder because the powder will absorb the sweat; however, after a while the powder may become a messy white coating on the place of application.

Prognosis and impact

Excessive sweating of the hands interferes with many routine activities, such as securely grasping objects. Some hyperhidrosis sufferers avoid situations where that'll come into physical contact with others, such as greeting a person with a handshake. Hiding embarrassing sweat spots under the armpits limits the sufferers arm movements and pose. In severe cases, shirts must be changed several times during the day. Additionally, anxiety caused by self-consciousness to the sweating may aggravate the sweating.
Some careers present challenges for hyperhidrosis sufferers. For example, careers which require the deft use of a knife may not be safely performed by people with excessive sweating of the hands. Employees, such as sales staff, who interact with many new people can be negatively affected by social rejection. The risk of dehydration can limit the ability of some sufferers to function in extremely hot conditions. Even the playing of musical instruments can be uncomfortable or become more difficult to play because of sweaty hands. As such, many hyperhidrosis patients have a limited career pool.

Epidemiology

Primary hyperhidrosis is estimated at around 3-4% of the population, afflicting men and women equally. It commonly has its onset in adolescence. Japanese are more affected as a group. About 3-40% have another family member afflicted, demonstrating a genetic transmission.

Further Information

Get more info on 'Hyperhidrosis'.

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