EXCESSIVE SWEATING OR HYPERHIDROSIS

Excessive sweating: what is hyperhidrosis?
Hyperhidrosis is a disorder characterised by excessive sweating; it affects:

the palms of the hands
the soles of the feet (plantar hyperidosis)
the underarms

other areas of the body

Sweating is used to keep the body temperature normal when subjected to heat or exercise. When you sweat too much, excessive perspiration, and not in circumstances such as those described, this is hyperhidrosis.

Those with wet hands feel uncomfortable from excessive sweating, while those with perspiring underarms and feet struggle with the unpleasant smell that the bacterial degradation of sweat provokes by soaked cellular debris.

Hyperhidrosis can also cause some skin diseases such as athlete's foot and contact dermatitis.

The skin changes colour and in the more severe forms of hyperhidrosis of the soles of the feet, cracks, fissures, and flaking of the skin may appear.

There are 3 basic forms of hyperhidrosis:

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

 There are 2 types of hyperhidrosis:

• Primary hyperhidrosis: the cause is unknown and excessive sweating is localised in the armpits, hands, face, and feet. Primary hyperhidrosis begins during childhood or early adolescence, gets worse during puberty, and lasts throughout your life.
• Secondary hyperhidrosis, which is less common than primary hyperhidrosis, occurs with excessive sweating that is caused by a disease and usually occurs throughout the body. The diseases that can cause secondary hyperhidrosis include: hyperthyroidism, menopause, obesity, psychiatric disorders, Hodgkin's disease, tuberculosis, various types of cancer and diabetes. Secondary hyperhidrosis can also be caused by medication, fever and alcoholism. Hyperhidrosis affects both sexes in the same way and can occur in any age group.

Excessive sweating: diagnosis

Hyperhidrosis is diagnosed by physical examination. In many cases the doctor can directly observe excessive sweating.
The doctor may also require you to undergo a specific test (the Minor test).

Excessive sweating: treatments

• Topical agents applied to the skin in the affected area are the first treatment for hyperhidrosis. An aluminum chloride solution is the most commonly used and effective topical application; it is applied on dry skin.
• Systemic medications can be taken orally and include anticholinergics, sedatives or tranquillisers, and calcium channel blockers. These oral medications have side effects, such as dry mouth and eyes, blurred vision, and constipation, and may not be appropriate for children. Because of side effects, oral medications cannot be recommended as a long-term solution.

Treatments such as antiperspirants and iontophoresis have been improved and are more effective than in the past.

• Iontophoresis is the application of an electric current through the skin and can be used for excessive plantar and palm sweating but requires a daily treatment of about 30 minutes, often several times a day.

Excessive sweating: more recent treatments include botulinum toxin and laser therapy.

• Botulinum toxin. Botulinum toxin is a natural purified protein with the ability to temporarily block the secretion of the chemical that is responsible for the release of sweat from the sweat glands. By blocking, or interrupting the action of this chemical messenger, botulinum toxin prevents sweating in the area where it is injected. For the treatment of excessive sweating on the underarms, hands, feet, head and face (craniofacial), and other relatively small areas of the body (such as under the breast) botulinum toxin may be recommended. The results begin to become apparent after about 2–4 days and usually after 2 weeks the maximum effectiveness of the treatment is reached. Results can last from a minimum of 4 months to a maximum of 14 months. The temporary cessation of the functioning of these sweat glands has little to do with thermoregulation. The treatment can be performed on an outpatient basis and takes little time (very experienced medical professionals can inject both armpits in less than 10 minutes), and do not require any restrictions for work or other leisure activities (apart from refraining from intensive exercise or using a sauna on the day of treatment). During the procedure, a very thin needle is used to inject small amounts of botulinum toxin just below the skin intermittently throughout the area affected by excessive sweating. To relieve pain, doctors can use an anaesthetic, ice or painkillers. Follow-up visits will be scheduled every 1 or 2 weeks. The check-up is very useful because it allows the doctor to verify the success of the treatment. The cost of botulinum toxin treatments for hyperhidrosis varies depending on the size of the body area and the number of injections to be given.

In addition, healthcare professionals and their patients are experimenting with combinations of treatments.

Excessive sweating: surgery. Liposuction for excessive underarm sweating is being perfected, but less invasive treatments should be considered before intervening with liposuction or surgery.

• ETS surgery, (endoscopic thoracic sympathectomy) accesses the sympathetic nervous system and is reserved only for certain severe cases of palmar hyperhidrosis, which have not responded to all other treatment options or combinations of treatments. Before considering ETS treatment, doctors and their patients should consider the real risks of permanent damage and serious side effects. Surgical procedures involve the removal of portions of the nerves responsible for excessive sweating and the removal of sweat glands during an open or minimally invasive surgical procedure. For more severe forms, a surgeon may be required, who can remove a portion of the nerve that controls hand sweating. The procedure, however, causes compensatory sweating reactions in other parts of the body. Alternatively, the underarm sweat glands can be surgically removed, but this may require skin grafts.
• Liposuction can be used to remove the sweat glands in the underarm area.

Excessive sweating: prevention

Treatments help to prevent excessive sweating, but not to eliminate it. Hyperhidrosis can also be managed through simple daily hygiene practices such as:

• Taking a bath or shower every day to reduce bacteria
• Washing and changing clothes often
• Changing socks or tights at least 2 times a day
• Changing shoes
• Wearing absorbent socks
• Natural fabrics
• Antiperspirants
• Foot powder
• Going barefoot often

Excessive sweating: food

Some foods can stimulate sweating and should therefore be avoided. These include:

• Caffeine
• Alcohol
• Spicy foods
• Hot drinks
• Garlic
• Onions

Excessive sweating is not dangerous to health, but it can seriously affect your quality of life.