Hyperhidrosis which is simply excessive sweating most often affects the palms, feet and face, causing embarrassment and interfering with daily chores. Excessive sweating is considered rare but recent estimates show that 2.8 percent of populations have hyperhidrosis doubling in Asian communities and some other countries. Only half of those affected have bought treatment because the rest does not know that treatment is available.
Excessive sweating occurs in two distinct forms, primary hyperhidrosis and the secondary hyperhidrosis.
In primary focal excessive sweating; emotional stimuli are believed to trigger hyperhidrosis although doctors do not understand why this happens.
Palmar hyperhidrosis affects the hands and plantar hyperhidrosis affects the feet. Sweaty palms are the most embarrassing situation.
Palmar axillary hyperhidrosis affects the palms and armpits.
Isolated axillary hyperhidrosis affects the armpits only.
The least common form excessive sweating is craniofacial hyperhidrosis which affects the face and the head.
Secondary hyperhidrosis is caused by an underlying medical condition such as infections, spinal cord injury, endocrine disorders, malignancy, neurologic or and other conditions. Treatment will obviously focus on improving the underlining condition.
Many patients visit a dermatologist for hyperhidrosis. The doctor will start the diagnostic process with a physical examination. If you have the condition the doctor l will see sweat droplets on your body, even when you are not anxious and have a normal heart rate and blood pressure. Family history must be analyzed because studies have shown that 25 to 50 percent of patients with palmar hyperhidrosis have a family history of hyperhidrosis.
To rule out serious conditions that can cause sweating, such as hyperthyroidism, diabetes, growth hormone disorder, and tumor of the adrenal gland, blood tests are carried out.
Minor-starch iodine test help to determine the severity of hyperhidrosis and response to treatment.
Thermoregulatory sweat test determines the severity and extent of primary hyperhidrosis.
People who have primary hyperhidrosis sweat more in the palms in a warm environment while those who do not have excessive sweating tend not to sweat in the palms. The findings help the physician to accurately diagnose and define the severity of the hyperhidrosis and plan for optimal treatment. Sometimes a patient will have excessive sweating on other parts of the body caused by secondary hyperhidrosis and require to be diagnosed and treated.
Many treatment methods are available for primary hyperhidrosis. The least invasive treatment options that relieve symptoms are preferred. Surgery is reserved for patients with serious condition and have not found cure from other treatments.
As pointed earlier treatment for secondary hyperhidrosis aims at diagnosing and treating the underlying health condition causing the sweating.
For light and moderate hyperhidrosis the physician will recommend applying a nonprescription, over-the-counter, clinical strength antiperspirant on problem areas as an initial treatment. Methods that work well include Certain Dri, Secret Clinical Strength, Degree Clinical Protection and 5 Day.
The next step is to use prescription antiperspirants with aluminum chloride. Normally prescription antiperspirants are applied to dry skin before bedtime. Covering the problem areas during sleep has proved to be helpful. The antiperspirant should be washed off after seven to eight hours. Red, swollen and itchy skin can occur when using prescription antiperspirants.
In this procedure a battery-powered device is used to deliver a low current of electricity to the hands or feet and sometimes the armpits through water-saturated wool pads. The old method of using pails of water is outdated Iontophoresis treatment changes the outer layers of skin to prevent sweat from coming to the surface.
Iontophoresis is safe but it is not more effective than antiperspirant treatment.
Oral administered medications
Oral medications which control hyperhidrosis, including anticholinergics which block nerve impulses to sweat glands. Carbonic anhydrase inhibitors inhibit sweating. Clonidine reduces nerve responses thereby reducing sweating.
Botox or Botulinum Toxin injections.
This temporarily blocks the nerves that trigger your sweat glands. Injections of up to 20 small doses of Botox are transported out in a treatment session. The injection sites are determined by diagnostic sweat tests. To reduce the pain caused by the injections, anesthetic techniques that include oral, intravenous sedation medication and topical creams are used.
Surgery is an option if you have severe hyperhidrosis and other treatments have not worked. Two approaches are often used. One entail interrupting the nerve signal triggering excessive sweating and the other procedure is to remove some sweat glands.
Types of surgery
There are three main surgical approaches as explained below.
Sympathectomy involves clipping or removing part of the sympathetic nerve.
Sympathotomy is a new procedure which interrupts the nerve signals without removing the sympathetic nerve. The benefit is a greatly reduced risk of compensatory sweating.
Minimally invasive sympathectomy
In minimally invasive sympathectomy the surgeon places clips on the sympathetic nerve to block nerve signals. This treatment is effective in reducing hyperhidrosis symptoms on many people. When carried out by experienced surgeons, the procedure stops excessive palmar sweating but less for the underarms and feet. Compensatory sweating rarely occurs as a side effect. The procedure can be reversed by removing the clip.
Orthopedic sympathectomy performed by many surgeons involves removing most or all of the upper thoracic sympathetic nerve chain. This method also called a ganglionectomy and is not reversible. A common complication of this surgery is compensatory sweating in which patients experience new excess sweating elsewhere.
Minimally invasive sympathotomy.
In a sympathotomy, the surgeon disconnects two clusters of nerve cells or ganglions on the sympathetic nerve by the second rib thus blocking the nerve pathway that causes excessive sweating.
This surgery is for a bilateral hyperhidrosis and surgeons remove targeted sweat glands. The method requires small incisions to be made on the affected part and can be performed with local anesthesia. Many people report significant and permanent reduction in sweating.
The surgeon makes two or three small cuts below the armpit. A miniature fiber optic camera is gently inserted to allow the surgeon to see the targeted nerves that stimulate the sweat glands. Small surgical instruments are then inserted through the other incisions to complete the procedure. This is performed by thoracic surgeons or neurosurgeons.
During the surgery, lungs are collapsed to allow enough room for the surgeon to work. When one side is completed, the surgeon performs an identical procedure on the opposite side. On completion of the surgery, the lung is re-expanded, and the incisions are closed.