Hyperhidrosis, also known as excessive sweating, is not a commonly recognized disease, in fact only a small percentage of people having this problem are seeking medical help, but this problem affects millions of people around the globe. This problem is a very serious medical condition where excessive sweating occurs on particular body parts with high concentration of sweat glands like the feet, palms, groin area and especially the underarms.

Sweating is necessary to control body temperature during times of exercise and warm/hot surroundings. Sweating is regulated by the sympathetic nervous system. In 0.6 to 1.0% of the population, this system is revved-up and works at a very high level causing sweating to occur at inappropriate times in specific areas of the body. This condition is known as hyperhidrosis.

Hyperhidrosis also promotes the development ofskin infections and unpleasant body odors.

While sweating is normal and it is true everyone sweats, those suffering with Hyperhidrosis sweat at a much higher rate than the average person.

Typically the average person sweats in situations such as warm temperatures, exercising, and emotional types of situations such as being nervous, angry, embarrassed, or scared). However people with Hyperhidrosis sweat in all types of situations and much more in these specific circumstances.

hyperhidrosis

Primary or idiopathic hyperhidrosis

Hyperhidrosis without a known cause. A more frequent condition than secondary hyperhidrosis. Localized commonly in the hands, armpits, scalp, face, and/or feet. Starts during childhood or early adolesence, worsens during puberty, and then persists for the rest of one’s life. Nervousness and psychiatric disorders are rarely the cause. The excessive sweating is very embarrassing and social, professional, and intimate relationships are often seriously affected.

Secondary hyperhidrosis

Caused by an underlying condition. Usually causes excess sweating of the entire body, however. Some of these conditions are; endocrine disorders such as hyperthyroidism, endocrine treatment for malignant disease, menopause, obesity, psychiatric disorders, systemic malignant disease.

Manifestations of Primary Hyperhidrosis

  • Scalp/Facial Hyperhidrosis and Flushing: Excessive sweating of the scalp and face. Commonly associated with moderate to severe facial blushing as well. This condition often causes the individual to become self-conscious and to develop a low self esteem.
  • Palmar Hyperhidrosis: Far and above the area of the body causing the most distressing condition. The hands are used socially and professionally more than any other part of the body. Excessively wet/moist hands may even limit the choice of one’s profession. Avoiding social contact is common for individuals with severe hyperhidrosis palmaris. Patients notice not only that their hands feel very moist/wet all the time, but also feel cool/cold. Some individuals have a bluish/purple discoloration of their hands as well.
  • Axillary Hyperhidrosis: Hyperhidrosis of the armpits causes large wet marks and staining on the clothes. A strong body odor develops quickly which can cause very negative emotional/psychological repercussions. Slightly more common in females than males. The highest incidence occurs with people of Asian and Jewish ancestry, but can affect all races.
  • Truncal and/or Thigh Hyperhidrosis: Less frequent. Can be associated with hyperhidrosis of other areas of the body.
  • Plantar Hyperhidrosis: Excessive sweating of the feet. Can be associated with hyperhidrosis of other areas of the body.

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Treatments

Secondary hyperhidrosis is treated by first addressing the underlying disorder. If a patient is on hormonal therapy then administration of an anti estrogen (ciproterone acetate) can give relief to sweat attacks. Primary hyperhidrosis patients and secondary hyperhidrosis patients experiencing moderate to severe sweating not relieved otherwise may benefit from the following treatment modalities

Antiperspirants - The first therapeutic measure recommended. Aluminum Chloride Hexahydrate (20-25%) in 70-90% alcohol applied in the evening 2-3 times per week. Less effective over time (within months). High incidence of skin irritation. 10% Glutaraldehyde. Good clinical result in 72 hours. Brown discoloration of the skin occurs. Effective in individuals with light to moderate hyperhidrosis, but not always. Must be repeated regularly for life.

Medications - No specific medication to treat hyperhidrosis. Sedative (psychotropic) and/or anti-cholinergic drugs commonly used. Many side-effects. Dry mouth “cotton tongue”. Accomodation difficulties of the eyes (hard to focus eyes). Many others. Not generally recommended for treating hyperhidrosis. Low dose anti-cholinergic agents may decrease excess sweating without causing incapacitating side-effects in those few individuals who suffer only from profuse truncal sweating. A dosage necessary to normalize the amount of sweating is rarely tolerated.

Surgery - Endoscopic Sympathectomy, Treatment of Choice for Severe Hyperhidrosis. Interruption of nerve impulses to sweat glands of the palms, face, axillae (armpits) by cutting or electrocautery is called “Thoracic Sympathectomy”. The ganglia (nerve junctions) which lead to the sweat glands of the palms, axillae, scalp and face are accessible through the chest (thoracic cavity) because they travel along the side of the spine of the back.

Sources: Hyperhidrosis, Associated Content

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