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Hyperhidrosis

Primary hyperhidrosis is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature. Some patients afflicted with the condition experience a distinct reduction in the quality of life. Sufferers feel at a loss of control because perspiration takes place independent of temperature and emotional state. more...

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However, anxiety can exacerbate the situation for many sufferers. A common complaint of patients is that they get nervous because they sweat, then sweat more because they are nervous. Other factors can play a role; certain foods & drinks, nicotine, caffeine, and smells can trigger a response (see also diaphoresis).

There is controversy regarding the definition of hyperhidrosis, because any sweat that drips off of the body is in excess of that required for thermoregulation. Almost all people will drip sweat off of the body during heavy exercise.

Hyperhidrosis can either be generalized or localized to specific parts of the body. Hands, feet, axillae, and the groin area are among the most active regions of perspiration due to the relatively high concentration of sweat glands; however, any part of body may be affected. Primary hyperhidrosis is found to start during adolescence or even before, and interestingly, seems to be inherited as an autosomal dominant genetic trait.

Primary hyperhidrosis must be distinguished from secondary hyperhidrosis, which can start at any point in life. The latter form may be due to a disorder of the thyroid or pituitary gland, diabetes mellitus, tumors, gout, menopause or certain drugs.

Primary hyperhidrosis is estimated at around 1% of the population, afflicting men and women equally.

Cause

It is not known what causes primary hyperhidrosis. One theory is that hyperhidrosis results from an over-active sympathetic nervous system, but this hyperactivity may in turn be caused by abnormal brain function.

Treatment

Hyperhidrosis can usually be treated, but there is no cure.

  • Surgery (Endoscopic thoracic sympathectomy or ETS): Select sympathetic nerves or nerve ganglia in the chest are either cut or burned (completely destroying their ability to transmit impulses), or clamped (theoretically allowing for the reversal of the procedure). The procedure often causes anhidrosis from the mid-chest upwards, a disturbing condition. Major drawbacks to the procedure include thermoregulatory dysfuction (Goldstien, 2005), lowered fear and alertness (Teleranta, Pohjavaara, et al 2003, 2004) and the overwhelming incidence of compensatory hyperhidrosis. Some people find this sweating to be tolerable while others find the compensatory hyperhidrosis to be worse than the initial condition. It has also been established that there is a low (less than 1%) chance of Horner's syndrome. Other risks common to minimally-invasive chest surgery, though rare, do exist. Patients have also been shown to experience a cardiac sympathetic denervation, which results in a 10% lowered heartbeat during both rest and exercise.
  • Aluminum chloride (hexahydrate) solution: The most common brands are Drysol®, Maxim® and Odaban®. Aluminum chloride is used in regular antiperspirants, but hyperhidrosis sufferers need a much higher concentration. A 15% aluminum chloride solution or higher usually takes about a week of nightly use to stop the sweating, with one or two nightly applications per week to maintain the results. An aluminum chloride solution can be very effective; some people, however, cannot tolerate the irritation that it can cause. Also, the solution is usually not effective for palmar (hand) and plantar (foot) hyperhidrosis.
  • Botulinum toxin type A (trademarked as Botox®): Injections of the botulinum toxin are used to disable the sweat glands. The effects can last from 4-9 months depending on the site of injections. With proper anesthesia the hand and foot injections are almost painless. The procedure when used for underarm sweating has been approved by the US FDA, and now some insurance companies pay partially for the treatments.
  • Iontophoresis: The affected area is placed in a device that has two pails of water with a conductor in each one. The hand or foot acts like a conductor between the positively- and negatively-charged pails. As the low current passes through the area, the minerals in the water clog the sweat glands, limiting the amount of sweat released. A common brand of tap water iontophoresis device is the Drionic®, Idrostar or MD1 Fischer. Some people have seen great results while others see no effect. However, since the device can be painful to some and a great deal of time is required, no cessation of sweating in some people may be the result of not using the device as required. The device is usually used for the hands and feet, but there has been a device created for the axillae (armpit) area and for the stump region of amputees.
  • Oral medication: There are several drugs available with varying degrees of success. A class of anticholinergic drugs are available that have shown to reduce hyperhidrosis. Ditropan® (generic name: oxybutynin) is one that has been the most promising. For some people, however, the drowsiness and dry-mouth associated with the drug cannot be tolerated. A time release version of the drug is also available, called Ditropan XL®, with purportedly reduced effectiveness. Robinul® (generic name: glycopyrrolate) is another drug used on an off-label basis. The drug seems to be almost as effective as oxybutynin, with similar side-effects. Other less effective anticholinergic agents that have been tried include propantheline bromide (Probanthine®) and benztropine (Cogentin®). A different class of drugs known as beta-blockers has also been tried, but don't seem to be nearly as effective.

A potential for the temporary treatment of hyperhidrosis is dricor. It is primarily an odorless deodorant that is applied at night. Many find it irritating but the results could be apparent depending on the individual.

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FDA approves Botox for hyperhidrosis.(PIPELINE PREVIEWS) : An article from: Journal of Drugs in Dermatology $5.95 Sympathotomy instead of sympathectomy for palmar hyperhidrosis: Minimizing postoperative compensatory hyperhidrosis : An article from: Mayo Clinic Proceedings $20.00
Botulinum toxin A quells axillary hyperhidrosis.(Dermatolog ic Therapy) : An article from: Skin & Allergy News $5.95 Panel outlines treatments for excessive sweating: primary focal hyperhidrosis.(Clinical Rounds) : An article from: Family Practice News $5.95
Craniofacial hyperhidrosis successfully treated with topical glycopyrrolate. : An article from: Southern Medical Journal $5.95 Facial flushing in infants may not be food allergy. (Case Report).(Brief Article) : An article from: Skin & Allergy News $5.95
Thoracoscopic sympathectomy for palmaris hyperhidrosis. (Original Article). : An article from: Southern Medical Journal $5.95 Sternocleidomastoid muscle flap reconstruction during parotidectomy to prevent Frey's syndrome and facial contour deformity. : An article from: Ear, Nose and Throat Journal $5.95
Hyperhidrosis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References $34.95 Botox gains FDA approval for axillary hyperhidrosis; off-label use has been fairly common.(Food and Drug Administration)(botulinum toxin type A) : An article from: Skin & Allergy News $5.95

Palmoplantar hyperhidrosis: a therapeutic challenge
Excessive sweating from the palms and soles, known as palmoplantar hyperhidrosis, affects both children and adults. Diagnosis of this potentially embarrassing ...
Video-assisted sympathectomy for essential hyperhidrosis: effects on cardiopulmonary function
Background: Essential hyperhidrosis is characterized by overactivity of the sympathetic fibers passing through the upper-dorsal ganglia (second and third thoracic ganglia [D2-D3]), and the treatmen
Hyperhidrosis: comparative evaluation of the results before and after sympathectomy in 263 patients
PURPOSE: Primary hyperhidrosis is a condition that leads to functional disability with social and psychological effects. Although several therapeutic ...
Treatment of hyperhidrosis
Abstract Hyperhidrosis, or excessive sweating, is a disorder that may cause social isolation or occupational disability. It may be generalized or localized, and although frequently idiopathic it
Thoracoscopic Sympathectomy for Palmar Hyperhidrosis
Palmar hyperhidrosis (ie, excessive sweating of the palms) usually appears at puberty and causes psychological, social, educational, and occupational ...
Treatment of hyperhidrosis with botulinum toxin type-A improves quality of life - Washington Whispers - Brief Article
The objective of this study was to assess the quality of life (QOL) of patients with hyperhidrosis before and after treatment with botulinum toxin type-A ...
No compensatory sweating after botulinum toxin treatment of palmar hyperhidrosis
No Compensatory Sweating after Botulinum Toxin Treatment of Palmar Hyperhidrosis Krogstad AL, et al. British Journal of Dermatology. 2005;152:329-333.
Hyperhidrosis
A disorder marked by excessive sweating. It usually begins at puberty and affects the palms, soles, and armpits.

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