Sweating is a necessary bodily function. It is vital in regulating the temperature. Most people sweat profusely only under physical stress or in response to high temperatures. But about three percent of Americans suffer from excessive sweating with minimal exertion and in normal temperatures.
What are the Symptoms of Hyperhidrosis
Obviously, profuse sweating is the primary symptom. The condition usually reveals itself at puberty or during the adolescent years. The areas most affect are armpits, groin, palms and soles. People with hyperhidrosis will have secondary effects of strong body or foot odor. The condition may be generalized or affect specific area. Typical over -the-counter antiperspirants are of little help.
Their output of perspiration interferes with the quality of their lives by contributing to body odor and producing wet splotches under their arms which can stain and ruin clothes. Even handshakes can be embarrassing when a sufferer of the condition cannot seem to dry his or her hands often enough.
Hyperhidrosis is sometimes associated with emotional stress, but some sufferers sweat too much most of the time. Usually people with hyperhidrosis are healthy, although underlying disease may rarely be a cause. The causes of typical hyperhidrosis are not known. Normally, however, the condition does not affect health.
Who Typically Suffers from Hyperhidrosis
All races and both sexes can suffer from hyperhidrosis, but it is much more common among Japanese – perhaps twenty times as common as among other ethnic groups. Basically, people of all ages report suffering from the condition, but most report having it as long as they can remember. Commonly, it is reported in association with puberty and can interfere with social relationships.
Causes of Hyperhidrosis
The causes of hyperhidrosis are not well understood. Excessive sweating or change in body odor may occasionally be associated with an underlying disease, but usually hyperhidrosis is not considered an indication of an illness. Chronic alcoholics often have sweaty palm and foot soles – palmoplantar hyperhidrosis. Caffeine can sometimes contribute to the intensity of sweating.
Treatments for Hyperhidrosis are Available
Victims of the condition usually try the usual array of antiperspirants, but it is important to read labels. Antiperspirants containing aluminum chloride may be more effective than other antiperspirants. If skin irritation results it may be treated over-the-counter hydrocortizone preparations. Irritation may disappear spontaneously as the body adapts to the antiperspirant. A pharmacist can offer advice on the most effective non-prescription preparation, which are sometimes hard to find due to the fact that they are somewhat more expensive and not common requested.
For more stubborn cases of hyperhidrosis as visit to a physician is recommended. The condition may require aggressive treatment such as botox injections or relatively simple surgery on nerves or sweat glands in the affected area. Doctors can also prescribe more effective antiperspirants.
Sweating is normal and healthy, but when it causes embarrassment or ruins clothing, hyperhidrosis may be the cause. Hyperhidrosis is not well understood, but is found in both sexes and all races. It may be managed with non-prescription preparations containing aluminum chloride. Pharmacists should be consulted. Physicians can usually provide more aggressive treatments for stubborn cases of hyperhydrosis.
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Alternative Treatments
Treatment of hyperhidrosis can be divided into topical, oral, surgical, and nonsurgical treatments (botulinum toxin). These therapeutic options differ with respect to their efficacy, duration of action, side effects, and cost of treatment. These treatment options and their specific indications will be discussed.
Topical Treatments
Topical treatments are limited to antiperspirants (Drysol®, Xerac®) containing aluminum chloride in concentrations ranging from 20% to 25%. The mechanism of action involves mechanical obstruction of the eccrine gland duct (Shelly & Jurley, 1975). The major limitation of aluminum chloride is localized burning, stinging, and irritation. The main indication for these products is as a first-line treatment for mild axillary hyperhidrosis.
Systemic Treatments
Oral anticholinergic agents such as glycopyrrolate or amitriptyline represent the main systemic medications for hyperhidrosis. They inhibit synaptic acetylcholine and therefore interfere with neuroglandular signaling (Connolly & de Berker, 2003). The main limitation of these drugs is the fact that the doses required to achieve a beneficial response in hyperhidrosis result in adverse effects such as dry mouth, blurred vision, constipation, and urinary retention. As a result their use is limited and not well established in primary focal hyperhidrosis.
Iontophoresis
Iontophoresis involves the passage of ions by means of an electrical current into the skin. This electrical charge appears to occlude the eccrine duct and interferes with eccrine gland secretion. The main indication for iontophoresis is in palmar or plantar hyperhidrosis, where the efficacy ranges from 80% to 90% (Sloan & Soltani, 1986). The main limitation of this therapeutic modality is that it is time consuming (requires 30 to 40 minutes per treatment site daily for at least 4 days of the week) and may cause skin irritation, dryness, or peeling. Sweating is well controlled after 6 to 10 treatments; however, long-term maintenance therapy is generally required at 1 to 4 week intervals. Iontophoresis is considered a second-line treatment for palmar or plantar hyperhidrosis, following aluminum chloride antiperspirants.
Surgical Treatments
Surgical treatment primarily involves thoracoscopic sympathectomy with success rates in the range of 80% to 90% for primary focal hyperhidrosis of the axilla, palms, soles, and face (Doolabh et al., 2004). A major limitation of this surgical procedure is compensatory hyperhidrosis with an incidence of 80%. Other surgical complications include pneumothorax and hemothorax. Although this procedure has a high efficacy rate, the associated risk of complications necessitates proper patient selection (generally those with severe hyperhidrosis who are unresponsive to other treatments) and detailed informed consent to avoid unnecessary frustration following treatment. Other surgical procedures with reported efficacy in axillary hyperhidrosis include liposuction and subcutaneous curettage (Hornberger et al., 2004).
Botulinum toxin A (Botox®)
Botulinum toxin is produced by Clostridium botulinum and acts by inhibiting acetylcholine release at the neuromuscular junction. Botulinum toxin has a reported efficacy of greater than 90% for primary focal hyperhidrosis of the axilla, palms, and soles (Heckmann, Ceballos-Baumann, & Plewig, 2001; Lowe et al., 2002; Naumann & Lowe, 2001; Naumann, Hamm, & Lowe, 2002; Voudoud-Seyedi, Simonart, & Heenen, 2000). This treatment method is extremely safe. Transient intrinsic muscle weakness is reported in less than 1% of patients treated for palmar hyperhidrosis. The major contraindications include neuromuscular disorders such as myasthenia gravis, pregnancy and lactation, organic causes of hyperhidrosis, and medications that may interfere with neuromuscular transmission. The cost of the drug and need for repeated treatments appear to be a notable limitation to this modality.Botulinum toxin for axillary hyperhidrosis is a safe, well tolerated, and highly efficacious treatment modality. Dosages range from 50 to 100 units per axilla. The usual starting dose is 50 units per axilla. A starch iodine test is often used and results in purple to black discoloration which delineates the affected area of excessive sweating (see Figure 1). Pain associated with these intradermal injections is minimal; however, a topical anesthetic can be used to further minimize the discomfort. The mean duration of effect is 6 to 7 months.Botulinum toxin for palmar or plantar hyperhidrosis is also reported to be safe and effective; however, the main limitation of this indication is the fact that most patients find the injections in the palms and soles quite painful. Therefore, a regional nerve block is required prior to the botulinum toxin injections. The duration of efficacy for palmar and plantar hyperhidrosis treated with botulinum toxin is in the range of 4 to 6 months.
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