Hyperhidrosis

Dermatologic Symptoms and Treatment

Hyperhidrosis is the condition of excessive sweating regardless of the internal thermoregulation mechanism or the environmental temperature. Hyperhidrosis can cause social and psychological problems because of the significant embarrassment that can be experienced at any time during day-to-day activities. Sufferers of hyperhidrosis often need to change clothes many times a day because of excessive sweating even if they have done little activity or had little emotional stimulation. Furthermore, individuals with Hyperhidrosis suffer embarrassment and loss of self-confidence in situations such as when people refuse to shake hands during meetings or parties or when paper continuously gets wet with sweat when they write or work on a project.

Symptoms of Hyperhidrosis

Excessive sweating is the popular term for hyperhidrosis and this type of disorder affects many individuals in the United States. The most common disorder is the excessive sweating of the palms or hands and this condition occurs even without triggers. The primary symptom and most visible sign of hyperhidrosis is wetness. Hyperhidrosis typically involves the underarms, the feet, and the hands. Other symptoms of hyperhidrosis may be fever, weight loss, or night sweating.
Statistics of affected individuals

About 2.8% of the population suffers from Hyperhidrosis 50% have feet sweating disorder and 25% have hands sweating disorder. In 2003, there were about 8 million people in the United States suffering from hyperhidrosis, as reported by the St. Lois University. About 50.8% suffered from axillary Hyperhidrosis (sweating of the armpits) with ages ranging from 25 to 65 years old. Only 38% consulted a specialist about their excessive sweating disorders. About 3% of the world population or 25 million people have some form of Hyperhidrosis. Hyperhidrosis is generally recognized as a functional disturbance that needs proper treatment.

Evaluation of affected areas

Evaluation of the affected areas is essential in working out the treatment program and many evaluation methods are available. The minor iodine-starch evaluation method helps identify affected areas as the iodine changes its color to purple and makes it easy to see affected areas. The copy paper evaluation is best for the hands, and this method compares absorption by a reference ranking or image processing method. The gravimetric evaluation weighs the amount of wetness or sweating produced by an individual at a given time by placing the affected area on absorbent paper and weighing the paper after one to five minutes. The gravimetric evaluation test best measures the person's rate of eccrine gland secretion.
Causes and Quality of Life
Hyperhidrosis is an eccrine sweat glands function disorder. The eccrine glands tend to produce amounts of sweat above the normal level of what is necessary for thermoregulation. Hyperhidrotics are healthy people who have a hyperactive autonomic nervous system. Heavy physical exertion or thermal provocation may trigger physiological hyperhidrosis. An imbalance may be present during extreme physical activity that may make the excessive sweating assume a pathological character. This kind of disorder is fever related because it brings along pyrogens, which are thea fever causing bacteria.

The causes of excessive sweating of the armpits, feet, and hands are still undefined. Occurrence of the disorder may be isolated, but most of the times is combined. Combined hyperhidrosis occurs symmetrically on predisposed regions and is triggered by emotions. It is evident that stress or fear activates the sweat glands because the emotions center of the brain communicates closely with the midbrain that is responsible for perspiration control. If the condition becomes a permanent state for an individual it is considered to be pathological and it will create an overburdened autonomic nervous system that is extremely over activated. Continuity of the psychological stress experienced will result in excessive perspiration.

Treatment Options for excessive sweating

Antiperspirants
The standard treatment for hyperhidrosis is use of an antiperspirant. The individual only needs to apply the topical treatment to regions that demonstrate excessive sweating. However, depending on the antiperspirants formulation, the product could simply be cosmetically disguising the wetness of the armpits. The deodorant's effect is based on the microbial activity and not on the eccrine sweat glands, which are the root of the problem. Antiperspirants with anticholinergic agents are best because they block the eccrine sweat glands from secreting fluid. The absorption of prolonged and large amounts of these antichlonergic agents, however, could produce systemic adverse effects.

Botulinum Toxin A
The botulinum toxin A has been a leading treatment for hyperhidrosis for over ten years. Botulinum toxin A is used to treat primary hyperhidrosis effectively in most cases. However, axillary hyperhidrosis treatment requires a hospital setting and a specialist accustomed to using the Botox technique. Multiple studies have confirmed botulinum toxin A's effectiveness for treating axillary hyperhidrosis disorder. It is advisable to choose this type of treatment because several studies proved this well-established procedure works effectively on the disorder. The treatment, however, is quite painful and requires that the patient be pricked with a needle several times Botulinum toxin also requires 1 to 3 series of injections per year.

ETS
The Endoscopic Transthoracic Sympathectomy (ETS), is a micro-invasive approach that has recently become the preferred method to treat hyperhidrosis. The ETS procedure involves accessing the patient's thorax nerve nodes that sustain the nerve supply on both the face and the upper limb's sweat glands. The ETS surgical procedure requires general anesthesia. Sympathectomy is the procedure used to cut relevant parts of the nerve that triggers hyperhidrosis in specific regions of the body. Compensatory sweating, is the most common side effect. Compensatory sweating involves the increase of sweating on other regions of the body after the procedure. Compensatory sweating is a common result when changes are made to the body's thermoregulatory function, in this case the sympathetic denervation procedure is the causal factor. The body's physiologic response to ETS is to increase sweating on in other areas of the body for homeostasis. Surgery is not always the cause of the possible occurrence of compensatory sweating, but is most often the trigger to it. ETS terminates hyperhidrosis in the treated areas most effectively when the clamps are in the right position, but comes with a high risk of heavy compensatory sweating and/or horner syndrome.

Iontophoresis
Conservative treatments may work on mild hyperhidrosis disorders, but severe cases may require iontophoresis treatment. Iontophoresis works by applying a current to normal tap water via electrodes. Iontophoresis is a non invasive, fully reversible treatment.
Surgical Ablation- Extraction of the sweat glands
Some people prefer the permanent benefit they obtain from surgical treatment of axillary hyperhidrosis. The Skoog-Thyresson technique directs surgical ablation to each active sweating locus and terminates hyperhidrosis effectively when done correctly. Some surgeons guarantee that if the first extraction fails, the second is free. Sometimes the surgery has to be repeated if excessive sweating remains after the first surgery.