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Hyperhidrosis | Excessive Sweating Symptoms

Defining Hyperhidrosis (misspelled hyperhydrosis) - 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.

Classification - Causes of hyperhidrosis can be primary or secondary

Regions of the body - scalp, facial (face), palmar (hands), axillary (armpits), truncal (trunk), plantar (feet)

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
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.

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.

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.

Less frequent. Can be associated with hyperhidrosis of other areas of the body.

Excessive sweating of the feet. Can be associated with hyperhidrosis of other areas of the body.

Characteristics Either sudden onset or continuous sweating. Sweating usually brought on by no apparent reason. Usually not aggravated by exercise. Emotional stress, high ambient temperatures, and/or gustatory stimuli are the most important aggravating factors. Hyperhidrosis usually improves during the cold/cool months and worsens during hot/warm months. Sweating usually stops during sleep. Hereditary (25% of individuals with hyperhidrosis tend to have a family member with symptoms as well).

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Treatment - 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 (Drysol), Iontophoresis. Medications (anti-cholinergics), Surgery.

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.

Iontophoresis - Tried, if antiperspirants not effective. Used to treat palmar, axillary, and plantar hyperhidrosis.
Low intensity electric current (15-18 mA) applied to the palms and/or soles immersed in an electrolyte solution.
Has to be repeated regularly, initially in 20 minute sessions several times/week, gradually stretching out the interval between treatments to 1-2 weeks. The results vary: many patients (70%), suffering from light to moderate hyperhidrosis, are happy with the method, some may consider it too time-consuming or inefficient and comparably expensive. It is difficult to apply in axillary, and impossible to use in diffuse hyperhidrosis of the face or the trunk/thigh region. Side effects include: burning, electric shock, discomfort, tingling, skin irritation (erythema and vesicle formation). Sweating returns after cessation.

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. Using a Micro Single Incision endoscopic technique, easy access to this area requires only a single 1/12th inch incision per side. In the past, a rib was removed or a large painful incision was required between two ribs to provide access to this area. Some surgeons today make three to four small incisions when performing endoscopic thoracic sympathectomy. Dr. Nielson has applied state-of-the-art technology to his endoscopic technique and he only makes a 1/12th inch incision per side.

Excessive sweating of the whole body and/or trunk cannot be treated surgically.

Botulinus toxin (Botox injections) - Produced by a bacteria known as Clostridium botulinum, this toxin is one of the most lethal poisons known. This toxin interfers with the neurotransmitter acethylcholine at the synapses (nerve junction points). Progressive paralysis of all muscles in the body develops. Botulinus toxin given in extremely low doses has been used to treat localized muscle hyperactivity such as lid spasms and torticollis. Side effects include: dry mouth, bladder paralysis, bowel inactivity, and others. Repeat injections are frequently required every 1 to 6 months.

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 - Limited effect in the majority of patients. 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.

Alternative Treatment Methods - Alternative Medicine, Homoeopathy, Massage, Acupuncture, Phytotherapeutic (Herbal) drugs. These methods are hard to document improvement.

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

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