Hyperhidrosis

Author: Dr. Oreste Di Mattei Di Matteo

Date: 21/11/2019

Hyperhidrosis is a problem that affects many men and women, and certainly deserves great attention.
Hyperhidrosis should not be underestimated at all, as:

  • it can be a possible source of discomfort, making normal social relationships more difficult
  • it can be an indicator of serious health problems, which therefore need to be dealt with promptly.

What are the areas most affected by hyperhidrosis?
Hyperhidrosis
 is a disorder characterised by excessive sweating that mainly affects:

  • palms of the hands
  • soles of the feet
  • underarms
  • other areas of the body (torso, head, face, under the breasts, etc.)

Hyperhidrosis: why do we sweat?
Sweating serves to regulate body temperature, in circumstances such as:

  • heat
  • physical exercise
  • stress
  • particular emotional state

When you sweat too much, when sweating is excessive, without a specific cause, this is hyperhidrosis.

How does hyperhidrosis occur?
There are 3 basic forms of hyperhidrosis:

  • Psychogenic, generally affecting the palms of the hands, the soles of the feet and the underarms
  • Localised, typically affecting the palms of the hands, underarms, groin, face, and the area under the breasts
  • Generalised, which can affect the whole body

Types of Hyperhidrosis
There are 2 types of hyperhidrosis:

  • Primary hyperhidrosis: the cause is unknown and excessive sweating is localised (underarms, hands, face, and feet). Primary hyperhidrosis lasts for life.
  • Secondary hyperhidrosis is caused by a pathology (hyperthyroidism, menopause, obesity, psychiatric disorders, Hodgkin's disease, tuberculosis, various types of cancer and diabetes), drugsfever and alcoholism and usually excessive sweating affects the entire body.

Hyperhidrosis: symptoms
The symptoms of hyperhidrosis vary depending on the area affected:

  • Hands. Palmar hyperhidrosis affects the palms of the hands, which are excessively moist, wet and cold
  • Underarms. Axillary hyperhidrosis, the underarms are affected with excessive sweating leaving sweat marks on the clothes
  • Head. Cranofacial hyperhidrosis, perspiration, produced by excessive sweating, from the top of the head to the face
  • Face. Facial hyperhidrosis, excessive sweating affecting the face and is accompanied by redness
  • Feet. Plantar hyperhidrosis, in this case it is the feet that sweat excessively
  • Torso. Hyperhidrosis of the torso is where the torso sweats excessively

Hyperhidrosis: diagnosis
By listening to the patient's medical history, the doctor will make the correct diagnosis of hyperhidrosis.
Before recommending treatments, pathologies that present hyperhidrosis as a symptom should be excluded.
Your doctor may ask you to perform additional tests to determine the amount of sweat and to determine which parts of the body are affected by hyperhidrosis.

Hyperhidrosis is diagnosed by:

  • a physical examination, direct observation
  • a specific test (the Minor Test)

Treatments to combat hyperhidrosis
Topical agents
: these are the first treatment for hyperhidrosis. Products based on aluminum chloride are the preferred choice.

Systemic drugs
 (anticholinergics, sedatives or tranquilising medication, and calcium channel blockers) used only for short periods and under strict medical supervision.

Iontophoresis Iontophoresis can be used for excessive sweating of the feet and palms but requires a daily treatment of about 30 minutes, often several times a day.

Botulinum toxin. Botulinum toxin prevents sweating in the area where it is injected (underarms, hands, feet, head, face (craniofacial), and under the breasts). The results can last up to 14 months.

The methods of underarm surgery with a surgical approach for axillary hyperhidrosis include:

  • Excision. This is the removal of the sweat glands. Thoracic endoscopic sympathectomy (ETS) presents significant risks, such as compensatory sweating (an irreversible form of excessive sweating across large areas of the body) and is used only in extreme cases.  
  • Liposuction.The sweat glands can be sucked out
  • Laser therapy.  The tissue where the sweat glands are located is liquefied
  • Combinations of treatments. More than one surgical technique can be used together (liposuction and laser therapy).

How do you live with hyperhidrosis?
Treatment is useful to improve the quality of life of those affected by this disorder.
Hyperhidrosis can cause:

  • physical impairments
  • social exclusion
  • psychological problems (decrease in self-esteem, etc.).

When sweating is excessive and without control, it can be:

  • embarrassing
  • anxiety inducing
  • crippling

It can limit:

  • many aspects of an individual's life
  • career choices
  • activities in general
  • relationships
  • emotional well-being
  • self-image

In addition to psychological problems, dermatological problemsmay also arise:

  • painful or irritating diseases
  • excessive bacterial proliferation
  • fungi or mycosis
  • infections
  • skin maceration.

Hyperhidrosis: prevention
Treatments can reduce and prevent excessive sweating, but do not eliminate it.
There are certain things that can help control the discomfort of hyperhidrosis, among the most common are:

  • Taking baths
  • Changing clothes often
  • Changing shoes
  • Wearing absorbent socks
  • Using natural fabrics
  • Applying antiperspirants
  • Using foot powders
  • Walking barefoot  

Hyperhidrosis, if it is not a symptom of a serious disease, is not dangerous in terms of health, but could have a very strong impact on the quality of life and lifestyle of the individual.

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