HYPERHIDROSIS

Hyperhidrosis is a condition characterized by excessive sweating. The sweating can affect just one specific area or the whole body. Hyperhidrosis is also known as Polyhidrosis or Sudorrhea. It is defined as sweating that disrupts normal activities. Episodes of excessive sweating occur at least once a week for no clear reason and have an effect on social life or daily activities. Although not life-threatening, it can be uncomfortable and cause embarrassment and psychological trauma.

The excessive sweating associated with hyperhidrosis is normally most active in the hands, feet, armpits, and the groin because of their relatively high concentration of sweat glands. Hyperhidrosis can be focal or generalized.

1. Focal hyperhidrosis: When the excessive sweating is localized. For example, palmoplantar hyperhidrosis is excessive sweating of the palms and soles.

2. Generalized hyperhidrosis: Excessive sweating affects the entire body.

Hyperhidrosis may be present from birth or might develop later in life. However, most cases of excessive sweating tend to start during an individual’s teenage years.

The condition can be due to an underlying health condition, or have no apparent cause:

• Primary idiopathic hyperhidrosis: “Idiopathic” means “of unknown cause.” In the majority of cases, the hyperhidrosis is localized.
• Secondary hyperhidrosis: The person sweats too much because of an underlying health condition, such as obesity, gout, menopause, a tumour, mercury poisoning, diabetes mellitus, or overactive thyroid gland.

The causes of primary hyperhidrosis are not well-understood; on the other hand, secondary hyperhidrosis has a long list of known causes.

Primary hyperhidrosis appears to have a genetic component. It was a common belief that primary hyperhidrosis was linked to the patient’s mental and emotional state, that the condition was psychological and only affected stressed, anxious, or nervous individuals. Recent research has demonstrated that individuals with primary hyperhidrosis are no more prone to feelings of anxiety, nervousness, or emotional stress than the rest of the population when exposed to the same triggers. In fact, it is the other way round – the emotional and mental feelings experienced by many individuals with hyperhidrosis are because of the excessive sweating.

Studies have also shown that certain genes play a role in hyperhidrosis, making it look more likely that it could be inherited. The majority of patients with primary hyperhidrosis have a sibling or parent with the condition.

Causes of secondary hyperhidrosis include the following:

• Spinal cord injury
• Alcohol abuse
• Anxiety
• Diabetes
• Gout
• Heart disease
• Hyperthyroidism – an overactive thyroid gland
• Obesity
• Parkinson’s disease
• Pregnancy
• Respiratory failure
• Some cancers, such as Hodgkin’s disease
• Some infections – HIV, malaria, TB (tuberculosis)
• Some medications, including some antidepressants, anticholinesterases (for Alzheimer’s disease), pilocarpine (for glaucoma), propranolol (for high blood pressure)
• Substance abuse

Signs and symptoms of hyperhidrosis may include:

• Clammy or wet palms of the hands
• Clammy or wet soles of the feet
• Frequent sweating
• Noticeable sweating that soaks through clothing

People with hyperhidrosis might experience the following:

• Irritating and painful skin problems, such as fungal or bacterial infections
• Worrying about having stained clothing
• Reluctant to make physical contact
• Self-conscious
• Socially withdrawn, sometimes leading to depression
• Select employment where physical contact or human interaction is not a job requirement
• Spend a large amount of time each day dealing with sweat, such as changing clothes, wiping, placing napkins or pads under the arms, washing, wearing bulky, or dark clothes
• Worry more than other people about body odour

Some alterations in daily activity and lifestyle may help improve symptoms:

1. Antiperspirants – deodorants do not stop sweating, but antiperspirants sprays do. Some prescription antiperspirants include aluminum chloride, which plugs the sweat glands.

2. Armpit shields – pads worn in the armpit to protect a garment from perspiration.

3. Clothing – certain synthetic fibers, such as nylon, may worsen symptoms. Loose clothing is better.

4. Shoes – synthetic materials are more likely to worsen symptoms. Natural materials, such as leather, are recommended.

5. Socks – some socks are better at absorbing moisture, such as thick, soft ones made of natural fibers.

If these measures are not effective, medical treatment may help. A doctor may refer the person to a skin specialist, or dermatologist. They may recommend:

1. Iontophoresis: The hands and feet are submerged in a bowl of water. A painless electric current is passed through the water. Most patients need two to four 20-30 minute treatments.

2. Botulinum toxin (Botox injections): Botox injections block the nerves that trigger the sweat glands. Patients with hyperhidrosis may need several injections for effective results.

3. Anticholinergic drugs: These medications inhibit the transmission of parasympathetic nerve impulses. Patients generally notice an improvement in symptoms within about 2 weeks.

4. ETS (Endoscopic thoracic sympathectomy) : This is a surgical intervention and it is only recommended in severe cases which have not responded to other treatments. The nerves that carry messages to the sweat glands are cut.

ETS may be used to treat hyperhidrosis of the face, hands or armpits. ETS is not recommended for treating hyperhidrosis of the feet because of the risk of permanent sexual dysfunction.

If hyperhidrosis is not treated, it can lead to complications.

• Nail infections: Especially toenail infections.
• Warts: Skin growths caused by the HPV (human papillomavirus).
• Bacterial infections: Especially around hair follicles and between the toes.
• Heat rash (prickly heat, miliaria): An itchy, red skin rash that often causes a stinging or prickling sensation. Heat rash develops when sweat ducts become blocked and perspiration is trapped under the skin.
• Psychological impact: Excessive sweating can affect the patient’s self-confidence, job, and relationships. Some individuals may become anxious, emotionally stressed, socially withdrawn, and even depressed.

On average, an individual with hyperhidrosis seeks medical help after living with the condition for several years. It is important to spread the word that the symptoms of excessive sweating can be effectively treated.

Thank you for reading.