Hyperhidrosis

Sweating is a normal bodily function.

We all sweat to help keep the body at a steady temperature so that all the chemical reactions inside work properly.

We sweat more when it is hot, when we exercise and when we are stressed or anxious.

Some people sweat much more than is needed to control their body temperature and this is known as hyperhidrosis. Some people sweat more than average but might not be diagnosed as having hyperhidrosis by their doctor, if that is the case then you will still find information here to help you.

Hyperhidrosis

Dermatology,?Fact sheets

What is hyperhidrosis?

Hyperhidrosis is a medical condition of excessive sweating. Sweat normally helps cool the body, but a person with hyperhidrosis sweats even when the temperature is cool or when the person is resting.

When someone has hyperhidrosis, he or she might sweat four to five times more than necessary or normal -- so much that the sweat soaks through clothes and interferes with everyday activities.

Types of hyperhidrosis

There are two types of hyperhidrosis: primary focal and secondary generalized.

Secondary generalized hyperhidrosis is caused by another medical condition, and it might occur all over the body. There are numerous possibilities, such as:

• Acromegaly is a hormonal disorder in which the pituitary gland produces too much growth hormone
• Anxiety conditions
• Cancer
• Carcinoid syndrome
• Diabetes
• Encephalitis
• Gout
• Heart disease, such as heart attack
• Obesity
• Overactive thyroid
• Lung disease
• Menopause
• Parkinson disease
• Pheochromocytoma (adrenal gland tumor)
• Rheumatoid arthritis
• Spinal cord injury
• Stroke
• Tuberculosis or other infections

On the other hand, primary focal hyperhidrosis is not a side effect, nor is it caused by another condition -- it is its own medical condition. It occurs in specific areas of the body, commonly the hands, feet, underarms, and face, and/or head. Primary focal hyperhidrosis almost always affects more than one of these areas of the body, and it often begins in childhood or adolescence.

The International Hyperhidrosis Society recommends asking the following criteria to determine which type of hyperhidrosis a person has:

First, have you experienced focal visible excess sweat for at least six months without apparent cause? If so, do you meet at least two of the following criteria?

• Your sweat is bilateral and relatively symmetrical, meaning you sweat the same on both sides of your body.
• Your excess sweat impairs your daily activities.
• You experience at least one episode a week.
• The onset of your excess sweat is earlier than age 25.
• Other members of your family suffer from similar sweating problems.
• You stop sweating when you're sleeping.

If you meet at least two of these criteria, it is likely you have primary focal hyperhidrosis.

It’s advisable to seek medical help if you have primary focal hyperhidrosis, or if you have secondary generalized hyperhidrosis and don’t know the cause.

Complications of hyperhidrosis

Hyperhidrosis doesn't usually pose a serious threat to your health, but it can sometimes lead to physical and emotional problems.

Fungal infections

Hyperhidrosis increases the risk of developing fungal infections, particularly?on the feet?– most?commonly?fungal nail infections?and athlete’s foot. This is because excessive sweat combined?with wearing socks and shoes creates an ideal surrounding for fungi to grow.

Fungal infections can be treated with antifungal creams. More severe cases may require antifungal tablets or capsules.

Skin conditions

Excessive sweat can make you more vulnerable to?certain skin conditions, such as:

• Warts?– small, rough lumps on the skin that are caused by the HPV virus
• Boils?– swollen red-yellow bumps in the skin that can develop when a hair follicle becomes infected
• Eczema?can?also be made worse by excessive sweating.

Body odor

Although people with hyperhidrosis sweat a lot, most don't have problems with body odor. This is because hyperhidrosis doesn't usually affect the sweat glands responsible for producing unpleasant-smelling sweat – called the apocrine sweat glands.

However, if bacteria are allowed to break down the sweat, it can start to smell unpleasant. Eating spicy food and drinking alcohol can also make sweat secreted from the eccrine smell.

This can be prevented or eased by following lifestyle advice, such as frequently using antiperspirant spray and using armpit shields to absorb sweat. See?treating hyperhidrosis?for more information.

Emotional impact

The emotional impact of living with hyperhidrosis can be severe. Many people with the condition feel unhappy and, in some cases, depressed. Signs that you may be depressed include:

• feeling down, depressed, or hopeless during the past month
• having little interest or pleasure in things during the past month

It is important not to neglect your mental health. Make an appointment to see your GP if you think that you may be depressed.?

Read?more about?depression?or find out more about?tackling stress, anxiety and depression

Diagnosis

Keeping track of the specific circumstances of excessive sweating can help a physician figure out what’s causing it and how to treat it. Keep track of:

• The part or parts of the body where the sweating occurs.
• When it happens.
• Possible triggers (what near the time the sweating starts?).
• Accompanying symptoms (such as a fever, a change in appetite, or a fast heartbeat).

Blood tests, imaging tests, or tests to measure the amount or location of excess sweating might be ordered to help find the cause.

Treatment

A variety of treatments ranging from antiperspirants to major surgery have been used to help alleviate hyperhidrosis. Options include:

• Antiperspirants: These block the sweat glands, providing temporary relief. Treatment usually involves a process of starting with gentle over-the-counter antiperspirants; then, if those aren’t effective, try gradually more powerful prescription-strength products that contain high percentages of aluminum chloride hexahydrate.
• Iontophoresis: The treatment involves putting the hands and/or feet into shallow trays of water. An electric current is passed through the water, causing a slight tingling sensation. The electricity temporarily “turns off” sweat glands. Treatment is given three times a week until results appear. Sessions last 10 to 30 minutes.
• Removal of sweat glands: Lasers; microwaves; or procedures involving cutting, scraping, or liposuction under local anesthetic remove or injure glands so they stop producing sweat.
• Botox injections: Primarily used for the underarms, palms, and soles of the feet, Botox injections block the nerves that stimulate sweating. A treatment usually lasts four to 12 months.
• Medication: Medicines to alleviate excessive sweating typically involve significant side effects.
• Endoscopic thoracic sympathectomy (ETS): This last resort cuts the nerve pathways from the spinal column to the sweat glands. It’s a permanent procedure that involves major surgery.?

A note from?Dr. Shaymaa Adil - Aesthetic Gp Doctor / MBCHB - MFM

Hyperhidrosis

?Is an overactivity of eccrine sweat glands. HH is categorized as either primary or secondary.

?Primary hyperhidrosis (PHH) is idiopathic bilateral symmetric excessive sweating; not derived from other known medical causes or medication side effects; commonly affects the axillae, palms, soles, or craniofacial region; and severely disturbs patients’ quality of life.

?Secondary HH may be focal or generalized and is caused by an underlying medical condition or medication side effect. PHH accounts for 93% of HH patients.

How to diagnose PHH?

?PHH is diagnosed?when excessive sweating lasts for more than six months and includes two or more of the following?characteristics:

1.??????Occurs more than once per week;

2.??????Presents in patients younger than 25 years of age;

3.??????A family history exists;

4.???????Sweating is bilateral and symmetric;

5.???????Sweating ceases while asleep, and sweating severely affects the patient’s daily activities. Importantly

6.?????PHH is diagnosed after possible causes of secondary HH are excluded.

?In 90% of PHH cases, commonly affected areas include the axillae, palms, soles or craniofacial regions. Various nonsurgical (antiperspirants, iontophoresis, anticholinergics, laser 90 or ultrasound therapy, microwave thermolysis, fractional microneedle radiofrequency, etc.) and surgical?(excision of subcutaneous tissue, subcutaneous liposuction curettage, endoscopic sympathectomy, etc.) therapies are available for the treatment of PHH.

Method of Delivery

?BTX injections are widely used for PHH treatment. BTX should be administered via intradermal injections at the dermal-subcutaneous junction to target the?sweat glands. It is often difficult to precisely detect the HH area. For example, the axillary HH area does not always overlap with the hair-bearing region, or the plantar HH zone may expand to the sides and the dorsal parts of the foot. Minor’s (starch-iodine) test or Ponceau Red staining can be used to precisely detect the hyperhidrosis area in order to accurately target the drug. The number of injections depends on the treated area size and the severity of PHH. Injection volumes of 0.1-0.2 mL are commonly used. Higher volumes may diffuse to unwanted areas or extrude from the injection site. The optimal result is achieved when confluent overlapping anhidrotic halos are created.

?OnabotulinumtoxinA (Allegan)

is the only FDA-approved BTX formulation for the management of adult patients with severe axillary PHH when topical agents have failed. It has been determined to be a safe, effective, and long-lasting treatment option. Studies have shown that the off-label use of onabotulinumtoxinA is also effective for other hyperhidrosis regions such as the palms, soles, trunk, and craniofacial regions.

?Adverse effects

pain, hematomas, bruises, headaches, muscle soreness, mild local pruritus, and urticaria, as well as compensatory sweating in 5% of the patients.

?After BTX/A treatment, the anhidrotic effect is commonly observed within 7-10 days and lasts for 6-10 months. Patient satisfaction rates with axillary BTX injections range from 66% to 100%.

Contraindications

1.??????pregnant or breastfeeding women

2.??????patients with hypersensitivity to any of the formulation components

3.??????Infection at the injection site

4.??????patients with secondary HH

5.??????patients who have already undergone surgical removal of sweat glands or those with significant blood-clotting disorders.?

Before the BTX?administration,

patients are advised to avoid aspirin, nonsteroidal anti-inflammatory medications, and?vitamin E to minimize the risk of bruising or bleeding. Additionally, patients with pre-existing?amyotrophic lateral sclerosis, peripheral neuropathy, neuromuscular junctional disorders (i.e., myasthenia gravis or Lambert-Eaton myasthenic syndrome), contraindications to anticholinergic drugs, or co-administration of drugs that can modify the metabolism of BTX (i.e., aminoglycosides, calcium channel antagonists, cholinesterase inhibitors or other neuromuscular blocking agents), should be monitored carefully after BTX administration.

Dr. Shaymaa Adil