Hyperhidrosis

1 What is Hyperhidrosis?

Hyperhidrosis is defined as sweating in excess of that required for the normal thermoregulatory maintenance in the body. Commonest sites affected by hyperhidrosis are: soles, palms and axillae. It may be a primary disorder or secondary to a number of pathological conditions.

There are three types:

  1. Emotionally induced
  2. Localized
  3. Generalised

It is a cause of psychological trauma for the patient and affects personal, social and professional life.

2 Symptoms

A number of signs and symptoms, which can indicate that the person is suffering from hyperhidrosis are:

  • Wet and moist palms and soles
  • Visible sweating that even drenches the clothes
  • Discoloration of the affected area
  • Maceration of the skin
  • Foot odour
  • Cracking and scaling of the skin

Hyperhidrosis can be localized or generalized.

  • Localised hyperhidrosis affects armpits, palms, soles, face or other sites
  • Generalised hyperhidrosis affects most or all of the body

It can be primary or secondary.

Primary hyperhidrosis

  • Starts in childhood or adolescence
  • May persist lifelong or improve with age
  • There may be a family history
  • Tends to involve armpits, palms and or soles symmetrically
  • Sweating usually reduces at night and disappears during sleep

Secondary hyperhidrosis

  • Less common than primary hyperhidrosis
  • More likely to be unilateral and asymmetrical or generalized
  • Can occur at night or during sleep
  • Due to endocrine or neurological conditions

3 Causes

Primary hyperhidrosis is caused bu over-activity of the hypothalamic thermoregulatory centre in the brain. It is transmitted via the sympathetic nervous system to the eccrine sweat gland.

Triggers to attacks of sweating may include:

Causes of secondary localised hyperhidrosis include:

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

Causes of secondary generalised hyperhidrosis include:

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

4 Making a Diagnosis

During your appointment, your doctor will ask about your medical history and conduct a physical exam in order to make a diagnosis of hyperhidrosis.

Important laboratory studies in the hyperhidrosis workup may include the following:

Chest radiography may be used to rule out tuberculosis or a neoplastic cause of the hyperhidrosis.

5 Treatment

The goal of treatment for hyperhidrosis is to control your heavy sweating.

General measures:

  • Wear loose-fitting, stain-resistant, sweat-proof garments.
  • Change clothing and footwear when damp.
  • Socks containing silver or copper reduce infection and odour.
  • Use absorbent insoles in shoes and replace them frequently.
  • Use a non-soap cleanser.
  • Apply talcum powder or corn starch powder after bathing.
    • Try dusting powder containing anticholinergic drug, diphemanil 2%.
  • Avoid caffeinated food and drink.
  • Discontinue any drug that may be causing hyperhidrosis.
  • Apply antiperspirant.

Topical antiperspirants

  • Antiperspirants contain 10–25% aluminium salts to reduce sweating.
  • Experimentally, topical anticholinergics such as glycopyrrolate have been successful in reducing sweating.
  • Deodorants are fragrances or antiseptics to disguise unpleasant smells.
  • Available as cream, aerosol spray, stick, roll-on, wipe or paint.
  • Applied when skin is dry, after a cool shower or just before sleep.
  • Wash off in the morning.
  • Use from once or twice weekly to daily, if necessary.
  • If irritating, apply hydrocortisone cream.

Iontophoresis:

  • For hyperhidrosis of palms, soles and armpits.
  • Mains and battery-powered units are available.
  • Affected area is immersed in water, or with greater effect, glycopyrronium solution.
  • Gentle electrical current is passed across the skin surface for 10–20 minutes.
  • Repeated daily for several weeks then less frequently as required.
  • May cause discomfort, irritation or irritant contact dermatitis.
  • Requires long-term commitment to treatment.
  • Not always effective.

Oral medications

Oral anticholinergic drugs:

  • Propantheline 15–30 mg up to three times daily, oxybutynin 2.5–7.5 mg daily, benztropine, glycopyrrolate (unapproved).
  • Can cause dry mouth, and less often blurred vision, constipation, dizziness, palpitations and other side effects.
  • Should not be taken by those with glaucoma or urinary retention.
  • Caution in elderly patients: increased risk of side effects is reported, including dementia.
  • May interact with other medications.

Beta blockers:

  • Block the physical effects of anxiety.
  • Unsuitable for people with asthma or peripheral vascular disease.

Calcium channel blockers, nonsteroidal anti-inflammatory drugs and anxiolytics may also be useful for some patients.

Botulinum toxin injections

  • Botulinum toxin injections are approved for hyperhidrosis affecting the armpits.
  • Reduce or stop sweating for three to six months.
  • Used off-license for localized hyperhidrosis in other sites.

Surgical removal of axillary sweat glands: Overactive sweat glands in the armpits may be removed by several methods, usually under local anaesthetic.

  • Tumescent liposuction
  • Subcutaneous curettage (scraping them out)
  • Microwave thermolysis Subdermal Nd:YAG laser

Surgery to cut out the sweat gland-bearing skin of the armpits: If a large area needs to be removed, it may be repaired using a skin graft.

Sympathectomy: Division of the spinal sympathetic nerves by chemical or surgical endoscopic thoracic sympathectomy (ETS) may reduce sweating of face (T2 ganglion) or armpit and hand (T3 or T4 ganglion), but is reserved for the most severely affected individuals due to potential risks and complications.

Hyperhidrosis may recur in up to 15% of cases often accompanied by undesirable skin warmth and dryness. New-onset hyperhidrosis of other sites in 50–90% of patients, severe in 2%. It is reported to be less frequent after T4 ganglion sympathectomy compared with T2.

Serious complications include Horner syndrome, pneumothorax (in up to 10%), pneumonia and persistent pain (in fewer than 2%). Lumbar sympathectomy is not recommended for hyperhidrosis affecting the feet as it can interfere with sexual function.

6 Prevention

Preventive measures for hyperhidrosis include:

  • Drink a lot of water.
  • Don’t stress.
  • Bring down your caffeine intake.
  • Avoid using harsh deodorant or soap.
  • Avoid taking hot baths.
  • Shun hot drinks.
  • Stave off from alcohol, drugs and cigarettes.
  • Avoid eating sugary, spicy and chemically-processed foodstuff.
  • Shave the underarms and groin areas to prevent excessive sweating.
  • Wear clothes made of natural fibers, like cotton. Avoid synthetic fabrics, like nylons and polyesters.
  • Wear loose fitting clothes.
  • Reduce that extra flab.
  • Try to keep the temperature of your body cool.

7 Alternative and Homeopathic Remedies

A few alternative and homeopathic remedies exist for hyperhidrosis.

Home Remedies for Excessive Sweating include:

  1. Natural Vinegar - Intake of two teaspoons of natural vinegar and one teaspoon of apple cider vinegar thrice in a day is an excellent remedy to cure the excessive sweating. Take this mixture on an empty stomach, half an hour after or before the meal.
  2. Tomato Juice - Every day, drink a glass of fresh tomato juice made at home to get rid of the problem of excessive sweating.
  3. Herbal Tea - Sage tea has proven to be a great remedy to cure the troubles of excessive sweating. Brew some sage herbs in warm water and let them cool. Drink this every day as sage is rich in magnesium and Vitamin B, which reduces the activities of sweat glands. This remedy is especially meant for stopping excessive sweating in the underarms.Green tea is equally effective if you do not get sage herbs easily.
  4. Potato - This is the easiest remedy to get rid of too much sweating. Simply cut slices of potato and rub them under your arms and the areas, which sweat more.
  5. Witch Hazel - This herb is a great astringent and antiperspirant, which gently dries up the sweating area. Tea made up of this natural herb can also be used.
  6. Cornstarch and Baking Soda - To get rid of excessive underarm sweating, apply a mix of cornstarch and baking soda under the arms after thoroughly cleaning them. Let it stay for half an hour and wash it off later. You can also add any essential oil as a deodorant into the mixture.
  7. Wheatgrass Juice - A glass of wheatgrass juice a day is an effective remedy for treating the problem of excessive sweating. Wheatgrass juice neutralizes the acids in the body and is a rich source of vitamin B6, protein, vitamin C, folic acid, and vitamin B12.
  8. Tannic Acid - Tea is the prominent source of tannic acid. Steep some tea bags in the boiling water. When the water cools down, immerse your palms in it. This is a superb remedy if you face a lot of perspiration in your palms.
  9. Coconut Oil - Infuse about 10gms of camphor in a bowl of coconut oil and apply it on the sweat prone areas to treat the trouble naturally.
  10. Tea Tree Oil - Thin layers of tea tree oil can be applied to the high perspiring areas. Tea tree oil has natural astringents, which will give you the desired results within a few days of using it.
  11. Grapes - Eating grapes every day can soothe out the problem of extreme sweating. It has natural antioxidants and it balances the temperature of the body.
  12. Salt - Mix a tablespoon of salt with lime juice and massage your hands with this mix. It will decelerate the activities of sweat glands and will cure excessive sweating.

Homeopathic Medications for Excessive Sweating:

Apart from home treatments, homeopathic remedies are equally beneficial in getting rid of excessive sweating.

  • Silicea: Silicea is generally used for clammy and sweaty feet.
  • Acidum hydrofluoricum : This homeopathic remedy is used for curing excessive sweating in the palms and is meant for those, who have a sour odour sweat.
  • Calcarea : Calcarea treats those patients, who suffer from excessive sweating due to obesity.
  • Botulinum: This homeopathic remedy cures excessive underarm sweating.

8 Lifestyle and Coping

A range of lifestyle measures can be taken to minimize the impact of hyperhidrosis on daily living and help individuals cope with their condition. Appropriate measures vary depending on the anatomical sites affected.

  • Maintaining good hygiene - Maintaining good hygiene is important for individuals affected by hyperhidrosis. They should bathe daily and pay special attention to drying affected areas of skin (particularly the feet) to reduce bacterial concentrations. Affected feet should be aired regularly.
  • Absorbent pads - Individuals with axillary hyperhidrosis may benefit from using absorbent pads to prevent sweat from soaking through clothing.
  • Changing clothing - Axillary hyperhidrosis can result in sweat-soaked clothing and individuals who experience this may need to carry extra clothing to allow them to change as needed.
  • Selecting appropriate clothing and footwear - Individuals with hyperhidrosis affecting the armpits may benefits from wearing clothing made from breathable materials such as silk and cotton, and avoiding man-made fibers and tight or restrictive clothing.Wearing black or white clothes may help reduce the visibility of sweat stains. Those with affected feet should wear thick socks made from cotton or wool, and rotate their socks and shoes. Shoes made from leather, mesh or canvas is most appropriate and those made from synthetic materials should be avoided by individuals with plantar hyperhidrosis.
  • Wearing gloves - Wearing gloves may make it easier for those with palmar hyperhidrosis to complete some tasks.
  • Relaxation - In some cases, hyperhidrosis occurs in response to emotional stimuli. Practising relaxation techniques may assist individuals to cope with emotional stimuli that trigger sweating.
  • Rehydration - Excessive sweating may lead to dehydration if fluids are not replaced. Ensuring proper hydration is maintained is therefore an important component of managing the condition.

9 Risks and Complications

Complications of hyperhidrosis can be embarrassing, and might include changing clothes multiple times a day.

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)
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