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HYPERHIDROSIS
DEFINITION
Hyperhidrosis is the secretion of sweat in amounts greater
than needed for regulation of body temperature.
hyperhidrosis can be defined
as excessive sweating of the palms, soles of the feet, axillae, and face. It
can be both a distressing and a genuinely disabling condition.
Hyperhidrosis
(excessive, uncontrollable sweating) can be embarrassing and
significantly impacting social and professional performance and quality of
life.
Diagnosis
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Focal,
visible, excessive sweating of at least six months duration without
apparent cause
plus at least two of the following characteristics:
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Bilateral and
relatively symmetric
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Impairs daily
activities
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At least one
episode per week
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Onset before
age 25
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Family history
of idiopathic hyperhidrosis
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Focal sweating
stops during sleep
Patients with hyperhidrosis generally develop symptoms in childhood or
adolescence that persist throughout adult life. Patients have focal symptoms
most often localized to their palms, soles, and sometimes axillae .
hyperhidrosis is made worse by heat or emotional stimuli, it is not considered a
psychological disorder.
Patients with
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Axillary hyperhidrosis
report skin maceration and staining of clothes
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Palmar hyperhidrosis
often leads to a fear of shaking hands and soiling of papers, and
patients may have difficulty with work or recreational tasks that require a
dry grip. Patients report that hyperhidrosis often results in social problems
on both a private and professional level.
INCIDENCE
Because hyperhidrosis is thought to be underreported, the
exact incidence is not known. It is believed that hyperhidrosis affects 0.6 to
1.0 percent of the population . A survey of 150,000 United States (US)
households, which was sponsored by a manufacturer of a treatment for
hyperhidrosis, estimated a prevalence of 2.8 percent
WHY DO WE
SWEAT?
The primary purpose of sweating is to assist in
maintaining temperature, skin hydration, and fluid and electrolyte balance.
Sweat is produced by the body's sweat glands:
there are up to 4 million sweat glands, of which about 3 million are eccrine
sweat glands and the remainder are apocrine glands. Eccrine sweat glands are
innervated by the sympathetic nervous system.
Their primary function is the secretion of sweat - an odourless, clear fluid
that regulates body temperature —
the rate of which is affected by emotional and gustatory stimuli. Eccrine sweat
glands, which are responsible for focal
hyperhidrosis, are distributed over nearly the entire body surface, although
their density is highest in the soles of the feet and the forehead, followed by
the palms and cheeks.
Thermal sweating can occur throughout the day, but emotional sweating
(palms, soles, and to some degree axillae) stops while sleeping
TREATMENT —
hyperhidrosis can lead to significant social and employment distress. many
effective therapies exist,
Topical therapy — Most
commercially available over-the-counter antiperspirants contain a low-dose metal
salt (usually aluminium) that physically obstructs the opening of sweat gland
ducts. These over-the-counter products are only successful in treating patients
with very mild symptoms.
Medications — Systemic
medical regimens may be employed in the treatment of hyperhidrosis, but they are
rarely successful in severe cases. Although controlled trials are lacking,
anticholinergic agents are sometimes used . However, the role of these
medications is limited as the dosage required to reduce sweating is usually
complicated by the development of unpleasant side effects such as dry mouth,
blurred vision, or urinary retention
In patients with hyperhidrosis related to specific emotional events,
beta-blockers or benzodiazepines may be useful in reducing the emotional
stimulus that leads to the excessive sweating
Iontophoresis — Iontophoresis
is the introduction of ionized substances through intact skin by the application
of direct current. The exact mechanism of action is unclear, but it is thought
to block sweat glands.
Iontophoresis for hyperhidrosis is typically performed with tap water.
Iontophoresis is most often used for palmar or plantar hyperhidrosis. Iontophoresis appears to alleviate symptoms in
approximately
85 percent of patients with palmar or plantar hyperhidrosis
and is safe and simple to perform If tap water iontophoresis is
ineffective, some authors recommend adding anticholinergic agents to the
treatment trays
Botulinum toxin injections —
By blocking the release of acetylcholine, can
also temporarily reduce sweat production. Injections are used for armpit hyperhidrosis. This can give between
9 to 12 months relief from sweating.
Palms can be treated under local anaesthetic block with a good result expected
for
4 to 8 months
COST
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Discussed at consultation as
depends on severity
***Please note
Iontophoresis shows improvement in 85% of
patients
Injection therapy shows dramatic improvement
in over 95% of patients
Both therapies are not permanent and sweating
may return over time
however further treatment can be undertaken
Idiopathic
hyperhidrosis
Reference for
above Idiopathic Hyperhidrosis
by
C Christopher Smith, MD
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