Hyperhidrosis

February 2, 2017

Hyperhidrosis is a disorder that defines individuals who sweat more than the body would normally need to maintain optimal temperature.

Hyperhidrosis affects work productivity, confidence, social comfort, emotional well being and wardrobe choices. Studies show that hyperhidrosis impacts quality of life similar to or even greater than other well-known dermatological conditions, such as severe acne or psoriasis. It has also been shown that only 38% of hyperhidrosis sufferers talk to a health care professional about their condition. People rarely seek help because many are unaware that excessive sweating is a treatable medical disorder.

Hyperhidrosis, or excessive sweating, is a relatively rare, non-life-threatening medical condition that occurs in the –

Hands (palmar hyperhidrosis);
Armpits (axillary hyperhidrosis); or
Feet (plantar hyperhidrosis)

Regardless of where it occurs, hyperhidrosis affects a person’s quality of life.

Hyperhidrosis is not a temporary condition. Many people who suffer from it have suffered for many years, often from childhood or sometimes from adolescence. Hot or cold, the sweating is constant, and the impact of hyperhidrosis can be severe. Wetness and staining of clothes, clammy hands and sodden smelly shoes, inability to grip objects such as pens, cold and wet handshake, damage to keyboards and difficulty dealing with paper and metals, can make a miserable existence. People may constantly worry about changing clothes, freshening up, using absorbent pads or sticking with loose black or white clothes, and may avoid making friends or interacting with people at work. Patients report that they are even embarrassed to hold the hands of those they love. Loneliness, depression and decreased confidence can result.

Excessive sweating can also cause irritating or painful skin conditions.

Types

There are 2 categories of hyperhidrosis – primary and secondary.

Primary hyperhidrosis – In primary hyperhidrosis, the most common type, the cause of the excessive sweating is not known. It often starts in childhood or adolescence and tends to affect the palms, soles, armpits and sometimes the face and scalp. Rarely, primary hyperhidrosis may affect the whole body.
Secondary hyperhidrosis – Secondary hyperhidrosis occurs when the excessive sweating is due to an underlying medical condition. It may affect the whole body.

Causes

Primary hyperhidrosis appears to be due to overactivity of the hypothalamic thermoregulatory centre in the brain, and is transmitted via the sympathetic nervous system to the eccrine sweat gland.

Triggers to attacks of sweating may include –

Hot weather
Exercise
Fever
Anxiety
Spicy food

Causes of secondary localised hyperhidrosis include –

Stroke
Spinal nerve damage
Peripheral nerve damage
Surgical sympathectomy
Neuropathy
Brain tumour
Chronic anxiety disorder

Causes of secondary generalised hyperhidrosis include –

Obesity
Diabetes
Menopause
Overactive thyroid
Cardiovascular disorders
Respiratory failure
Other endocrine tumours, eg phaeochromocytoma
Parkinson disease
Hodgkin disease
Drugs – caffeine, corticosteroids, cholinesterase inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitors, nicotinamide and opioids

Symptoms

Most people sweat when they exercise or exert themselves, are in a hot environment, or are nervous, anxious or under stress. The excessive sweating experienced with hyperhidrosis far exceeds such normal sweating.

Hyperhidrosis is embarrassing and interferes with many daily activities.

Axillary hyperhidrosis –

Clothing becomes damp, stained and must be changed several times a day
Wet skin folds are prone to chafing, irritant dermatitis and infection

Palmar hyperhidrosis –

Slippery hands lead to avoidance of hand shaking
Marks left on paper and fabrics
Difficulty in writing neatly
Malfunction of electronic equipment such as keypads and trackpads
Prone to blistering type of hand dermatitis (pompholyx)

Plantar hyperhidrosis –

Affects soles of the feet
Unpleasant smell
Ruined footwear
Prone to blistering type of dermatitis (pompholyx)
Prone to secondary infection (tinea pedis, pitted keratolysis)

Complications

Complications of hyperhidrosis include –

Infections – People who sweat profusely are more prone to skin infections.
Social and emotional effects – Having clammy or dripping hands and perspiration-soaked clothes can be embarrassing.

Treatment

Antiperspirants – Excessive sweating may be controlled with strong anti-perspirants, which plug the sweat ducts. Products containing 10% to 20% aluminum chloride hexahydrate are the first line of treatment for underarm sweating. Some patients may be be prescribed a product containing a higher dose of aluminum chloride, which is applied nightly onto the affected areas. Antiperspirants can cause skin irritation, and large doses of aluminum chloride can damage clothing.

Medication – Medicines may prevent stimulation of sweat glands. These are prescribed for certain types pf hyperhidrosis such as excessive sweating of the face. Medicines have side effects and are not right for everyone.

Iontophoresis – This procedure uses electricity to temporarily turn off the sweat gland. It is most effective for sweating of the hands and feet. The hands or feet are placed into water, and then a gentle current of electricity is passed through it. The electricity is gradually increased until the patient feels a light tingling sensation. The therapy lasts about 10 to 20 minutes and requires several sessions. Side effects include skin cracking and blisters, although rare.

Botox – Botulinum toxin type A (Botox) is used to treat severe underarm sweating. This condition is called primary axillary hyperhidrosis. Botulinum toxin injected into the underarm temporarily block the nerves that stimulate sweating. Side effects include injection-site pain and flu-like symptoms. Botox used for sweating of the palms can cause mild, but temporary weakness and intense pain.

Endoscopic thoracic sympathectomy (ETS) – In severe cases, a minimally-invasive surgical procedure called sympathectomy may be recommended when other treatments do not work. The procedure turns off the signal that tells the body to sweat excessively. It is usually done on patients whose palms sweat much more heavily than normal. It may also be used to treat extreme sweating of the face. ETS does not work as well for those with excessive armpit sweating.

Underarmsurgery – This is surgery to remove the sweat glands in the armpits. Methods used include laser, curettage (scraping), excision (cutting), or liposuction. These procedures are done using local anesthesia.

Hypnosis – Individuals who have tried hypnosis for palmar hyperhidrosis have reported little improvement.

Lasertherapy – Some desperate patients have tried this technique. This technique involves direct irradiation of the palms which results in 3rd degree burns of the hands without any improvement in sweating.

Radiotherapy – High-dose radiation to treat axillary hyperhidrosis. Serious dermatitis and skin retraction develops.

Psychotherapy – Psychological problems commonly develop as a consequence of hyperhidrosis, not the other way around. Psychiatric or psychopharmacologic therapy may help an individual to cope with hyperhidrosis condition, but certainly won’t treat the disorder.

Complementary Treatment

Axillary Sweat Gland Removal – Z-plasty excision of the axillary sweat glands. Hypertrophic and/or constrictive scars may sometimes form restricting shoulder motion.

Acupuncture regulates organ functioning and promotes harmony between the internal and external body so as to arrest excessive sweating.

Supplements

Magnesium – Sweating is also caused due to the deficiency of magnesium in the body. However excessive sweating can also lead to magnesium deficiency in the body.

Gamma-aminobutyric or GABA is an amino acid produced naturally in the brain. Decreased levels of GABA in the body are correlated with anxiety, which is a main trigger of hyperhidrosis.

B-complex vitamins serve a crucial function in the maintenance and regulation of the nervous system. A deficiency in B vitamins will inhibit the body ability to handle stress, the main trigger of primary hyperhidrosis. B vitamins are also important to help stabilize the body’s lactate levels, which are responsible for preventing anxiety attack, another key trigger of sweating.

Calcium is secreted from your body when people sweat; therefore patients with hyperhidrosis are at an increased risk of calcium deficiency.

Vitamin C is an essential nutrient in helping your body cope with stress, which will have the secondary effect of helping reduce the sweating. Vitamin C also plays an important role as an antioxidant which counteracts hyperthyroidism, one of the leading causes of secondary hyperhidrosis.

Vitamin E and Selenium are both powerful antioxidants as well. They work together to protect cells from oxidative damage caused by hyperthyroid ism, which causes excessive sweating due to an overactive thyroid gland. Selenium strengthens the capillary walls and decreases their dilation which will reduce perspiration. Vitamin E has been shown to be especially effective in reducing hot flashes and night sweats in women going through menopause.

Herbal Treatment

Witch Hazel – The bark and leaves of the witch hazel plant are extracted into a powerful astringent which can be applied in liquid form to the skin.

Burdock – this herb safely manages excessive sweating by eliminating excessive fluids through other means rather than the sweat pores. It redirects sweating fluids through the lymph nodes, kidneys and bowels instead.

Astragalus – This herb, native to northeast China, has mild diuretic properties and plays a role in balancing your sweat response.

Tea Tree Oil – this one is exceptionally effective for foot sweating.

Passion Flower reduces the symptoms of general anxiety disorder and over-activity in the brain which are two major contributing factors of hyperhidrosis. In addition, the antispasmodic action of passion flower relaxes spasms and tensions in muscles. This leads to calmer nerves and a reduction in perspiration. Passion flower also sooths the sympathetic nervous system and improves blood circulation.

Chamomile has been listed as an alternative treatment for hyperhidrosis by the International Hyperhidrosis Society and the American Institute for Hyperhidrosis. It is a calming herb that reduces stress and anxiety by soothing the nerves.

Reference –

http://www.medbroadcast.com/condition/getcondition/Hyperhidrosis

http://patient.info/health/excessive-sweating-hyperhidrosis

http://www.parsec.it/summit/hyper1e.htm

https://www.nice.org.uk/guidance/ipg487

http://my.clevelandclinic.org/services/heart/disorders/hyperhidrosis

http://www.dermnetnz.org/hair-nails-sweat/hyperhidrosis.html

http://www.hyperhidrosis.ca/

http://www.nhs.uk/Conditions/Hyperhidrosis/Pages/Treatment.aspx

http://www.mayoclinic.org/diseases-conditions/hyperhidrosis/basics/definition/con-20030728

http://www.sweathelp.org/hyperhidrosis-treatments/treatment-overview.html

http://www.webmd.com/skin-problems-and-treatments/hyperhidrosis2