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Signs and symptoms
Hyperhidrosis can either be generalized or localized to specific parts of the body. Hands, feet, axillae, and the groin area are among the most active regions of perspiration due to the relatively high concentration of sweat glands; however, any part of the body may be affected. Primary hyperhidrosis is found to start during adolescence or even before, and interestingly, seems to be inherited as an autosomal dominant genetic trait.
Primary hyperhidrosis must be distinguished from secondary hyperhidrosis, which can start at any point in life. For some, it can seem to come on unexpectedly. The latter form may be due to a disorder of the thyroid or pituitary gland, diabetes mellitus, tumors, gout, menopause, certain drugs, or mercury poisoning. Such secondary forms may have more serious consequences than just hyperhidrosis, making medical consultation advisable.
Affected areas
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Palmar: Excessive sweating of the hands. |
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Axillary: Excessive sweating of the armpits. |
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Plantar: Excessive sweating of the feet. |
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Facial: Excessive sweating of the face. (i.e. not emotional or thermal related blushing) |
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General: Overall excessive sweating. |
Cause
It is not known what causes primary hyperhidrosis. One theory is that hyperhidrosis results from an overactive sympathetic nervous system, but this hyperactivity may in turn be caused by abnormal brain function
Some patients afflicted with the condition experience a certain degree of reduction in their quality of life, depending on how severe their condition is. Sufferers feel at a loss of control because perspiration takes place independent of temperature and emotional state.
However, anxiety can exacerbate the situation for many sufferers. A common complaint of patients is that they get nervous because they sweat, then sweat more because they are nervous. Other factors can play a role; certain foods & drinks, nicotine, caffeine, and smells can trigger a response (see also diaphoress).
Treatment
Hyperhidrosis can usually be very effectively controlled, but there is no known permanent cure because little is known about the cause behind excessive sweating.
Medications
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Aluminium chloride (hexahydrate) solution. |
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Botulinum toxin type A (including Botox] |
Surgical procedures
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Surgery VATS : Select sympathetic nerves or nerve ganglia in the chest are either cut or burned (completely destroying their ability to transmit impulses), or clamped (theoretically allowing for the reversal of the procedure). The procedure often causes anhidrosis from the mid-chest upwards, a disturbing condition. Major drawbacks to the procedure include thermo regulatory dysfunction (Goldstien, 2005), lowered fear and alertness[3] and the overwhelming incidence of compensatory hyperhidrosis. Some people find this sweating to be tolerable while others find the compensatory hyperhidrosis to be worse than the initial condition. It has also been established that there is a low (less than 1%) chance of Horner's syndrome. Other risks common to minimally-invasive chest surgery, though rare, do exist. Patients have also been shown to experience a cardiac sympathetic denervation, which results in a 10% lowered heartbeat during both rest and exercise. ETS was thought to be helpful in treating facial blushing and facial sweating. According to Dr. Reisfeld, the only indication for ETS at present is severe palmar hyperhidrosis (too much hand sweating). Statistics have shown that when treated for facial blushing and/or excessive facial sweating, the failure rate of ETS for those two clinical presentations is higher and patients are more prone to side effects. [4] |
References
- ^ Bhidayasiri R, Truong DD (2007). "Evidence for effectiveness of botulinum toxin for hyperhidrosis". doi:10.1007/s00702-007-0812-7. PMID 17885725.
- ^ Mijnhout GS, Kloosterman H, Simsek S, Strack van Schijndel RJ, Netelenbos JC (2006). "Oxybutynin: dry days for patients with hyperhidrosis". The Netherlands journal of medicine 64 (9): 326–8. PMID 17057269.
- ^ Pohjavaara P, Telaranta T, Väisänen E (2003). "The role of the sympathetic nervous system in anxiety: Is it possible to relieve anxiety with endoscopic sympathetic block?". Nordic journal of psychiatry 57 (1): 55-60. doi:10.1080/08039480310000266. PMID 12745792.
- ^ Reisfeld, Rafael. Sympathectomy for hyperhidrosis: should we place the clamps at T2-T3 or T3-T4 - Clinical Autonomic Research, December 2006, Volume 16, Number 6. (PDF). Retrieved on 2007-11-04.
- ^ Bieniek A, Białynicki-Birula R, Baran W, Kuniewska B, Okulewicz-Gojlik D, Szepietowski JC (2005). "Surgical treatment of axillary hyperhidrosis with liposuction equipment: risks and benefits". Acta dermatovenerologica Croatica : ADC / Hrvatsko dermatolosko drustvo 13 (4): 212–8. PMID 16356393.
- ^ Kreyden OP (2004). "Iontophoresis for palmoplantar hyperhidrosis". Journal of cosmetic dermatology 3 (4): 211–4. doi:10.1111/j.1473-2130.2004.00126.x. PMID 17166108.
- ^ Wang YC, Wei SH, Sun MH, Lin CW (2001). "A new mode of percutaneous upper thoracic phenol sympathicolysis: report of 50 cases". Neurosurgery 49 (3): 628–34; discussion 634–6. PMID 11523673.
- ^ Maillard H, Bara C, Célérier P (2007). "[Efficacy of hypnosis in the treatment of palmar hyperhidrosis with botulinum toxin type A.]" (in French). Annales de dermatologie et de vénéréologie 134 (8): 653–4. PMID 17925688.
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