Hyperhydrosis

We divide hyperhydrosis into Two types: Idiopathic – of which the cause is unknown and the second one is secondary to some disease process.

Causes of Secondary Hyperhydrosis

• Hyperthyroidism or other endocrine diseases
• Tuberculosis – night sweats
• Severe psychiatric disorders
• Obesity
• Menopause
• Infantile scurvy, Rickets, Pink disease
• Intake of drugs – salicylates and alcohol.

Idiopathic Hyperhydrosis

This is a far more frequent condition than secondary hyperhydrosis and is generally, localized in one or several locations of the body (most often hands, feet, armpits or a combination of them). It usually starts during childhood or adolescence and persists all life. Nervousness and anxiety can elicit or aggravate sweating, but psychological/psychiatric disturbances are only rarely the cause of the disorder.

Sweating can appear suddenly or manifest itself more continuously.
It can be elicited by high outside temperatures or emotional stress, or appears without any obvious reason.
Generally, it worsens during the warm season and gets better during winter.

Treatment

In patients with primary hyperhidrosis or for symptomatic treatment of heavy sweating in patients with secondary hyperhidrosis, not treatable otherwise, the following methods have been adopted.

Anti Perspirants

Aluminium chloride (20-25%) in 70-90% alcohol, applied in the evening Alternate days.
This treatment is helpful in cases with light to moderate hyperhidrosis.
Iontophoresis

This method consists in 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. It is difficult to apply in axillary, and impossible to use in diffuse hyperhidrosis of the face or the trunk/thigh region.

Drugs

There are no specific drugs available against profuse sweating. Sedatives or Anticholinergics are often tried. Anticholinergics show too many side effects.

Surgery

• Excision of the axillary sweat glands

Patients with axillary hyperhidrosis who are unresponsive to medical therapy can be effectively treated by excision of the axillary sweat glands.

• Sympathectomy

The principle of sympathectomy is to interrupt the nerve tracks which transmit the signals to the sweat glands.
Today, the treatment of choice for moderate to severe palmar and facial hyperhydrosis consists in a surgical procedure known as Endoscopic Thoracic Sympathectomy.

The endoscopic technique is very safe, if performed by a surgeon experienced in this type of procedure, leads to definitive cure in nearly 100% of patients, leaving only a minimal scar in the armpit.

Individuals with combined hyperhydrosis of the palms and soles have a good chance to improve the sweating of their feet after an operation aiming to suppress sweating of the hands. Isolated plantar hyperhydrosis can, however, only cured by Lumbar Sympathectomy, an open abdominal procedure.

Diffuse hyperhydrosis of the trunk or general sweating of the whole body cannot be treated by surgery.

OTHER TREATMENT METHODS

• Hypnosis has been tried but with uncertain results.

• Botulinum toxin

A family of toxins produced by bacteria known as Clostridium botulinum. This toxin is one of the most lethal poisons known, interfering with the effect of the transmitter substance acetylcholine 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, botulinus toxin has been adopted in cases with localized muscle hyperactivity (lid spasms, torticollis, etc), resulting in a reduction in transmitting impulses to the muscle. It has been tried in hyperhidrosis. It seems to work adequately in axillary hyperhidrosis.