Hyperhidrosis is a medical condition where an excessive amount of sweat is produced by the sweat glands. The amount of sweat produced is out of proportion to the amount required to cool the body. This does not mean that sweating a lot after running on a hot summer’s day that you have hyperhidrosis. However, producing a deluge of sweat whilst at rest in a cool environment is more indicative of hyperhidrosis.
Generalised vs. Focal Hyperhidrosis
Generalised hyperhidrosis affects the entire body, whereas focal hyperhidrosis only affects a specific site of the body. Common sites that are affected by focal hyperhidrosis include the soles of the feet, the palms of the hands and the armpits (or the axillae). Another distinction between focal and generalised hyperhidrosis is that focal hyperhidrosis tends to only occur during the day, whereas generalised hyperhidrosis occurs during both night and day.
Generalised hyperhidrosis may occur with no known underlying cause, or in association with another disease. Some of the diseases which have been associated with generalised hyperhidrosis include diabetes, hyperthyroidism, heart failure, certain infectious diseases (HIV, tuberculosis) and sometimes Parkinson’s disease. Certain medications have also been identified which may also cause excessive sweating. Some examples include some beta-blocker drugs and antidepressant medications.
Focal hyperhidrosis tends to be seen in younger patients, aged 25 years and under. The majority of patients with focal hyperhidrosis also have a family history of the problem. Some cases of focal hyperhidrosis are triggered by eating and chewing. Following a spinal injury, some people may also develop focal hyperhidrosis.
Effects of Hyperhidrosis
Excessive sweating has important physical and psychological effects for the sufferer. Psychologically, excessive sweating can be very embarrassing. Normal things, such as greeting somebody with a handshake can be awkward for people with excessive sweating. Sufferers are often very self-conscious of the problem and can lead to other psychological issues, including anxiety and depression. The condition can also have a significant impact on one’s working and general daily life. Some people need to change their shirt several times a day and for occupations where precision control and handling of tools and objects is necessary. Excessive sweating can impair performance at work. Simple tasks, such as writing with a pen can also be difficult.
Excessive sweating and the Nervous System
Although the precise physiological cause of excessive sweating is as yet unknown and controversial, it is believed to be the result of dysfunction of the sympathetic nervous system. All of the organs and glands in our body are controlled by the autonomic nervous system; which we have no conscious control over.
There are two major divisions of the autonomic nervous system; the sympathetic nervous system and the parasympathetic nervous system. The parasympathetic nervous system is active during rest and controls activities such as the digestion of food. The sympathetic nervous system is activated in times of stress, exercise or danger and produces the ‘fight or flight’ response. If the sympathetic nervous system is over-active, it can stimulate the sweat glands to produce and secrete much more sweat than necessary onto the skin.
Sweat is usually produced in response to stimuli including heat, stress and exercise. However, in people with excessive sweating, too much sweat is produced in what is hypothesised to be an over-reaction to normal stimuli.
The treatments for generalised and focal hyperhidrosis differ and there are more options for treating focal hyperhidrosis than generalised hyperhidrosis. It is also important to control any of the other diseases which a person with generalised hyperhidrosis may have. Generalised hyperhidrosis may be treated to some extent using oral medications called anticholinergics. Focal excessive sweating also responds well to treatment with anticholinergic medications, however, these can also be given topically as a cream or ointment to rub into the affected area. Like all medications, anticholinergics have side effects, including headaches, urinary retention and a dry mouth.
In normal supermarket deodorants, the active ingredient that stops sweating is a special type of aluminium compound. These are not potent enough to help treat excessive sweating, so deodorants have been developed for people with excessive sweating – with a more potent aluminium compound. These can sometimes be effective for excessive sweating of the hands, soles and armpits. Often, these only need to be applied once per day, and are generally applied at night.
Another successful technique which can be used to treat excessive sweating is called iontophoresis. Iontophoresis is mainly used on the hands and feet. The affected hand or foot is placed on wet pads, which are then used to deliver the electric current through the skin to the sweat glands. It produces a tingling sensation, but should not cause any pain. A number of treatments are often required before an effect is noticed. If effective, it may be used long term prophylactically. It is possible also to buy a machine so that iontophoresis can be performed at home.
Injections for sweating
Injections for sweating can also be used in the treatment of focal hyperhidrosis. Treatment of axillary hyperhidrosis is now subsidised by Medicare for eligible patients. The injections need to be administered by an accredited practitioner. People over the age of 12 years need to have trialled and failed at least a two month course of topical 20% aluminium chloride (extra-strength deodorant). injections for sweating stop the release of a chemical neurotransmitter called acetylcholine from the nerves. These nerves innervate the sweat glands and tell the gland to produce and release sweat. The effects of one single series of injections for sweating can last as long as six to nine months.
Surgery is not a first-line treatment for excessive sweating and is only used in severe cases which do not respond to other medical therapies and are significantly impacting upon the life of the sufferer. One form of surgery is called a thoracic sympathectomy which disrupts part of the sympathetic nervous system that is controlling the group of affected sweat glands. This type of surgery is very expensive and is not always effective. As with all surgery, this procedure carries risks. Some of the potential side effects include Horner’s syndrome, which affects one side of the face, excessive sweating when eating, compensatory hyperhidrosis and warm hands.
If you have any questions or concerns about hyperhidrosis contact your local doctor, who will arrange for you to see a dermatologist. Contact Us Today!
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