Hyperhidrosis is a common problem suffered by millions of people around the world. Hyperhidrosis can either be generalized or localized to specific parts of the body; i.e., excessive sweating may occur all throughout the body or it can be focused on particular parts only, such as the underarms, the palms, the feet or the face. In particular, 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 that and 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.
Causes of Hyperhidrosis
The sympathetic chain of the nervous system of the body is primarily responsible for a person’s sweating. The sympathetic chain is autonomous, which means that it cannot be voluntarily controlled. Severe cases of excessive sweating have various practical consequences that make life hard to live. For people who are suffering from these severe cases, holding a pen, gripping the car’s steering wheel or shaking hands can be an uncomfortable task.
Furthermore, hyperhidrosis may also be caused by a disorder of the thyroid or pituitary gland, diabetes mellitus, tumors, gout, menopause, certain drugs or mercury poisoning. Indeed, some of these secondary underlying conditions may have even more serious repercussions than just hyperhidrosis.
People suffering from excessive sweating know how embarrassing and uncomfortable their condition is. It may seem as if treating the condition is hopeless, but there are actually highly effective treatments for excessive sweating. The methods outlined above are the trusted ways to get rid of excessive sweating.
Treatment of Hyperhidrosis
- Antiperspirant: The most common option is using a different antiperspirant. This method is usually recommended as the first therapeutic measure. The most effective agent appears to be aluminum chloride (20-25%) in 70-90% alcohol, applied in the evening two-three times/week. This treatment is sufficient in cases with light to moderate hyperhidrosis, but it has to repeated regularly. There’s a big difference between antiperspirant and deodorant that a lot of people don’t realize. Antiperspirants contain aluminum salts that deodorants don’t. Aluminum salt works in blocking off sweat ducts that create perspiration and sweat. It also prevents the sweat from reaching up to the surface of the skin.On the other hand, deodorants simply work to eliminate odors, hence their name. There have been many people claiming that antiperspirants have been the cause of breast cancer, but nothing of the kind has ever been proven. What antiperspirants can do is to irritate the skin in some people. This can make your underarms red or even itchy at times. Most deodorants won’t cause this since they don’t contain the same ingredients. If you have difficulty in finding an antiperspirant that’ll prevent excessive sweating, talk with your doctor about trying a stronger prescription antiperspirant.
- Two of the most commonly used antiperspirants for excessive sweating are Maxim and Drysol. Drysol is available in various strengths and needs a prescription to be used; Maxim, on the other hand, is less acidic and can be bought without prescription. More patients show positive results with Maxim, which is generally less irritating than Drysol.
- Iontophoresis: Iontophoresis can be tried if antiperspirants haven’t lead to the desired result. This method consists of applying low intensity electric current (15-18 mA) supplied by a D/C generator to the palms and/or soles immersed in an electrolyte solution. The procedure has to be repeated regularly, initially in 20 sessions several times/week, gradually stretching out the interval between treatments to 1-2 weeks.The results vary. Many patients suffering from light or moderate hyperhiderosis are happy with the method, while some may consider it too time-consuming or inefficient and comparably expensive. It’s difficult to apply in axillary, and impossible to use in diffuse hyperhidrosis of the face or the trunk/thigh region. Equipment specifically designed for the treatment of hyperhidrosis at home or in the physician’s office is commercially available from different suppliers.
- Medications: Doctors may also prescribe medications to treat excessive sweating. One example of a prescription medication for excessive sweating is glycopyrrolate. Medications for excessive sweating work by preventing the over-production and over-stimulation of sweat glands. Three of the most commonly used medications for excessive sweating are Ditropan, Robinul and Probanthine, all of which come from the same family of drugs.There are no specific drugs available against profuse sweating. Psychotropic (mostly sedative) and/or anticholinergic drugs are often tested but show usually too many side effects before any noticeable result can be achieved. Hence, drugs are, as a rule, not recommended. In those few cases where patients suffer from profuse sweating on the trunk (but not the extremities), a low dose of anticholinergic agent can slightly alleviate the symptoms without rendering life unsupportable from side effects (dry mouth, accommodation difficulties of the eyes, and so on), but a dosage necessary to normalize the amount of sweating will rarely be tolerated.
- Surgery: It’s possible to surgically remove sweat ducts to cure excessive sweating, but it should be reserved as a last resort. Patients with axillary hyperhidrosis who’re unresponsive to medical therapy can be effectively treated by excision of the axillary sweat glands. If sweating extends beyond the hairy portion of the axilla, several skin incisions may be needed, sometimes resulting in formation of hypertrophic and/or constrictive scars.
- Sympathectomy: The principle of sympathectomy is to interrupt the nerve tracks and nodes (ganglia) that transmit the signals to the sweat glands. Basically, this can be achieved for all locations in the body, but only the nerve nodes responsible for the sweat glands of the palms and the face are accessible without the need for a major surgical procedure.Today, the treatment of choice for moderate to severe palmar and facial hyperhidrosis (but also axillary, especially if combined with palmar sweating), consists in a surgical procedure known as Endoscopic Thoracic Sympathectomy (ETS). This minimal-invasive endoscopic technique has been developed in recent years in a few hospitals in Europe, superseding Conventional Thoracic Sympathectomy, a very traumatic procedure performed in the past. The endoscopic technique is very safe, if performed by a surgeon experienced in this type of procedure, and leads to definitive cure in nearly 100% of patients, leaving only a minimal scar in the armpit.
- ETS is performed through the back, lower part of the neck, or the chest cavity. On each side of the chest cavity, small incisions are made through where medical instruments, such as a fiber optic camera, are inserted. The sympathetic chain is then resected, coagulated or clamped. The success rate for curing sweaty palms with this procedure is a high 98 percent, although there is the possibility of reversal.
- For patients suffering from excessive foot sweating or plantar hyperhidrosis, the procedure performed is Lumbar Sympathectomy, which is done with the patient under general anesthesia. Usually, the surgeon makes three small cuts on both sides of the retro-peritoneal area. The success rate for Lumbar Sympathectomy is around 90 percent, with possible side effects that can include pain, bleeding and discomfort.
- Clostridium botulinum: Another method of hyperhidrosis treatment involves a family of toxins produced by a bacteria known as Clostridium botulinum. This toxin is one of the most lethal poisons known, interfering with the effect of the transmitter substance acethylcholine at the synapses (the contact point of a nerve ending with another nerve cell or a muscle) and leading to progressive paralysis of all muscles in the body, including the respiratory muscles.In extremely low doses (botox injections, for example), botulinus toxin has been adopted in cases with localized muscle hyperactivity (lid spasms, torticollis and so on), resulting in a reduction in transmitting impulses to the muscle. Initial reports have been published regarding the use of botulinum toxin in hyperhidrosis. It seems to work adequately in axillary hyperhidrosis, lasting for 6-12 months depending on the dosage (0.5-1.0 Units/cm2).
- Long story short, botox has shown to work fairly well in preventing excessive sweating. Still, keep in mind that there’s a drawback in terms of the costliness of this procedure, which has to be repeated at regular intervals (twice a year at most, in fact). The good news is that the side effects seem to be negligible if dosages are kept low (and cheap).
You may have been surprised at the variety of cures and treatments available for hyperhidrosis, with some cures as simple as changing antiperspirants and deodorants and others as complex as surgical procedures. In any case, they’re all valid treatments that should help, if not outright cure, your hyperhidrosis problem.
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