Hyperhidrosis

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WHAT IS Hyperhidrosis?

Axillary Hyperhidrosis, or excessive sweating in the armpits can cause embarrassing wet marks on shirts. Plantar Hyperhidrosis refers to excessive sweating of the feet and is a known cause of foot odour. Less commonly, patient may have excessive sweating of the trunk or thighs

Sweating is a natural body function needed for the regulation of body-temperature. There are five million sweat glands throughout the body and about 2/3 of these gland are located in the hands. The secretion of sweat is controlled by the sympathetic or (vegetative) nervous system. In some people (1% of the population), the nerves are over-stimulated and sweat is produced far greater than needed to keep a constant temperature. This condition is referred to as Hyperhidrosis. Excessive sweating may be episodic or continuous. Profuse sweating may be caused by warm weather, emotional stress, or occur without any reason. Hyperhidrosis may be part of an underlying medical condition (secondary Hyperhidrosis) or may be of unknown cause (primary Hyperhidrosis). In general, secondary Hyperhidrosis involves the entire body. Diseases or medical conditions causing secondary Hyperhidrosis include hyperthyroidism, endocrine treatment for malignant diseases, psychiatric disorders, obesity and menopause. Primary Hyperhidrosis, or sweating without known cause is also termed idiopathic or essential Hyperhidrosis. This is a much more common condition than secondary Hyperhidrosis and may occur in one or several location s of the body. The hands, feet and armpits are the most common locations. The condition usually starts during adolescence and is lifelong. Nervousness and anxiety can precipitate excessive sweating.

SYMPTOMS OF PRIMARY Hyperhidrosis

Facial sweat may be so profuse that it causes the person to be insecure or anxious. The person may appear overly nervous when this is not the case. Patients may also experience excessive facial blushing. Sweaty hands is usually the most distressing manifestation of primary Hyperhidrosis. The amount of hand sweating varies from moisture to dripping. Many patients report that their hands also feel cold. Because our hands are exposed in social and professional settings, many patients with Hyperhidrosis are self conscious and may avoid social contact. They may be reluctant to shake hands, handle paperwork, etc . Patients have even been embarrassed to hold the han ds of those they love.

Axillary Hyperhidrosis, or excessive sweating in the armpits can cause embarrassing wet marks on shirts. Plantar Hyperhidrosis refers to excessive sweating of the feet and is a known cause of foot odour. Less commonly, patient may have excessive sweating of the trunk or thighs.

TREATMENT OF Hyperhidrosis

In secondary Hyperhidrosis, the underlying medical condition should be treate d first. For example, patients with hyperthyroidism should have treatment directed at their endocrine disease. Those patients with psychiatric diseases such as anxiety disorders should seek pyschiatric care. Treatment options for primary Hyperhidrosis include antiperspirants, iontophoresis, drugs and botulinum toxin injections and surgery.

ANTIPERSPIRANTS

It is the simplest treatment and is usually recommended first. The most effective agent is aluminium chloride. This treatment works for patients with light to moderate Hyperhidrosis.

BOTULINUS TOXIN INJECTION

Botulinum toxin is a poison that interferes with nerve conduction. This toxin is produced by the bacteria Chlostridium Botolinum and works by interfering with the effect of the neuro-transmitter substance acethylcholine at the nerve synapses. In low doses, the toxin may be injected in the face or neck to paralyse local muscles to prevent wrinkles or treat muscular spasms. It may also be used to treat Hyperhidrosis by paralysing the sympathetic nerves that cause sweating by injecting the toxin in the axilla or hands. It works well for axillary and palmar Hyperhidrosis. The treatment has a good success rate and can be done as a outpatient

IONTOPHORESIS

Iontophoresis is a second line treatment if antiperspirants fail. This treatment consists of applying low intensity electric current to the hands or feet immersed in an electrolyte solution. The procedure has to be repeated regularly several times/week. The results vary, but many patients believe it is too time consuming and expensive. It is difficult or impossible to treat axillary or facial Hyperhidrosis with this method.

DRUGS

Various drugs may affect sweating, but in general are not recommended for the treatment of Hyperhidrosis because of side affects including dry mouth, blurred vision and sedation.

THORCASCOPIC SYMPATHECTOMY

Endoscopic thoracic sympathectomy cures Hyperhidrosis. Surgery is performed by inserting a miniature camera and i instruments into the chest through small stab wounds similar to that used for knee arthroscopy. The vascular surgeon cuts or clip the sympathetic nerves of the  ganglion with magnification and illumination provided by the camera. The surgery lasts an hour. The procedure is performed on an out-patient basis and most patients return to work and regular physical activity within one week. The endoscopic technique is very safe and is curative in 98% of patients. The procedure is performed bilateraly in the same session.