Hyperhidrosis is excessive regional sweating; It develops due to hypersensitivity and activity of the sympathetic nervous system. It is a disorder that causes complaints such as excessive sweating in the hands, armpits, and feet, flushing of the face, sweating, and hot flashes, generally in the age group of childhood or adolescence.
In these people, the hands or armpits are constantly moist and wet, affecting their daily life of the people. These people change their clothes frequently, avoid shaking hands, cause restrictions in their social life, such as getting the paper wet while writing, and negatively affect the person's psychological state by disrupting daily activities.
While there is usually no sweating problem at night, excessive sweating of dry hands can be seen in minutes in stressful situations. Hyperhidrosis is encountered in 2-4% of the population. There is no gender difference; both are equal. In general, there is a familial tendency. Stress, fear, excitement, and hot weather are triggering factors. Sweating observed from the whole body; is not always a sign of disease but may develop due to excess weight or medications used.
It may occur due to hormonal diseases (especially the thyroid gland), cancers, microbial diseases, menopause, low blood sugar, or diabetes. First, we should rule out these diseases. Laboratory tests include TSH, T3, T4, Parathormone (PTH), and cortisol.
When diagnosing excessive regional sweating, detailed information and examination from the patients are usually sufficient. When making the diagnosis, it is emphasized that the following symptoms are present: Excessive regional sweating such as hands, feet, armpits, and face-head without any other disease.
If you are experiencing these;
- If you have trouble shaking hands or even hesitate to meet someone new because of this,
- If the edge of your clothes is constantly getting dirty and changing color because you wipe your hands,
- If you have trouble using a computer, phone, and typing and always carry something to wipe your hand with,
- If you carry spare clothes with you,
- If your social life and psychology are starting to be affected by this situation, you need treatment.
In addition, the presence of at least two of the following features;
- Beginning in childhood or adolescence,
- Bilateral and symmetrical sweating,
- Family history,
- Sweating for at least six months,
- The absence of excessive sweating at night increased in stressful and exciting situations.
- Affected daily life and comfort
Excessive Regional Sweating Treatment Methods
Surgical Treatment-Videothoracoscopic thoracic sympathectomy (ETS)
It is a surgical method applied by Thoracic Surgeons. The procedure is performed with a thoracoscopic, a closed method, and it is performed by entering the armpit area with a small diameter camera through a single incision of only 0.5 cm. This process is completed in approximately 30 minutes.
Types of surgery:
- Clamping or clip placement of the sympathetic chain (Thoracoscopic sympathetic block)
- Interruption of the sympathetic chain
- Removal of part of the sympathetic chain and ganglion (sympathectomy)
It is applied to prevent the function of sympathetic nerve fibers and nodes that give impulses to sweat glands, which cause excessive regional sweating by burning, cutting, or clipping. Patients are discharged from the hospital on the same or the next day for preventive purposes. An average of 98% (90-100%) cure for the hand, face, armpit, and sometimes for the foot area. After surgical treatment, facial flushing decreases by 95% and facial sweating by 90%. Immediately after this surgery, the complaint of excessive regional sweating ceases. They can return to their daily lives and work within a few days.
Side effects of ETS
Compensatory (reflex) sweating: While areas such as the hand, and armpit, which is the main complaint area of the patient, remain dry, excessive regional sweating occurs on the trunk. This unwanted compensatory sweating can be seen at approximately 5-10%.
Some surgeons think that the patient can return to the preoperative state when this compensatory sweating occurs if the clip is removed. Hence, the first choice in surgery is the clip. This clip removal situation still needs to be fully clarified.
Low heart rate: Slow heart rate, which does not usually cause a severe problem, can also be counted among the rare side effects.
Dryness: Dryness of the hands
Eyelid drooping is sporadic; ; usually, there is no sympathetic ganglion in the place where we put the clip. Still, sometimes this can be seen if the sympathetic ganglion is abnormally located.
As with any surgery, there are risks related to the time of surgery due to anesthesia and surgical interventions. Examples are allergic conditions to drugs, bleeding, and incision wound problems.
External topical drugs and creams: These are products applied externally to the sweating area, such as aluminum-containing creams or lotions. It is generally used before bed, and the product is removed after washing. Its effects are temporary and short and are insufficient in severe cases. They may irritate the application area.
Botox (Botulinum Toxin Injection) Application: It is a form of treatment in which botulinum toxin, which is used to correct facial wrinkles, is applied by blocking the nerves that stimulate the sweat glands by making many small injections into the sweating area. It is not preferred for the hand area because it can be very painful in the application into the hand and cause problems such as numbness and muscle weakness. It is applied most frequently and efficiently in the armpit area. However, botox is not a healing agent, its effect lasts an average of 6 months, and it is necessary to repeat the method at the end of this period.
Advantages:
- Effect lasts for 6 months
Disadvantages:
- Effect duration limited to 6 months
- Injection is painful (pain can be reduced with anesthesia methods)
- Possible development of muscle weakness and numbness
Iontophoresis Treatment
It is a treatment method based on giving low-voltage electrical stimulation to the sweating area. This process blocks the sweat glands temporarily. Regarding applicability, it is mostly preferred in excessive sweating of hands and feet. It is a treatment method that needs to be repeated intermittently since the effect lasts an average of one to two weeks. Iontorophesis is generally safe and a conservational therapy that can also be done at home.
Advantages:
- Serious complications, no risk
- Not an interventional method
- One application in 1-2 weeks may be sufficient.
Disadvantages:
- Not easily accessible
- It is necessary to repeat
Antidepressant Treatment
Some treatments for depression prevent sweating as well as reduce anxiety that causes hyperhidrosis.
Hyperhidrosis, Excessive Sweating Types, Causes, Symptoms and Treatment
Hyperhidrosis causes your sweat glands to go into overdrive even when your body doesn't need to cool down. Many people have had at least one experience of sweating profusely, perhaps after an intense workout or during high-stress times.
For many of us, these instances come and go and can be just frustrating. However, for about 4.8 percent of people living in Turkey, hyperhidrosis or excessive sweating is common. Hyperhidrosis is a condition where sweating is frequent and difficult to control. It is often visible to others and, therefore, can trigger anxiety and make you depressive. Fortunately, modern medicine offers several ways to reduce or stop excessive local sweating. But first, let's look at some of the basics of hyperhidrosis, including its causes, symptoms, and diagnosis.
Function of Thymus
In ancient times, it was believed that the thymus was the seat of the soul or the organ of purification of the nervous system. Later, the thymus was thought to be a protective thoracic pillow or regulator of fetal and neonatal respiratory function.
In 1832, Sir Astley Cooper suggested that this organ performs some essential functions; however, the nature of this "important function" is not yet fully understood. We know about the thymic function that the thymus is one of the central lymphoid organs and plays a vital role in cellular immunity by producing circulating T lymphocytes.
Although the need for the thymus to produce a sustained supply of T cells decreases with advancing age, the thymus continues to serve as the site of T-cell differentiation and maturation throughout life. The development of thymocytes, one of the essential functions of the thymus, has been extensively studied by molecular and cellular biology.
We know that various inductive, hormonal, and proliferative signals from epithelial cells contribute to the maturation of thymocytes. Of note, T-cell antigen receptors of thymocytes interact with epithelial histocompatibility complex antigens during thymocyte maturation.
What Are the Different Types of Hyperhidrosis?
There are two different types of hyperhidrosis:
1. Primary Focal Hyperhidrosis
Primary focal hyperhidrosis is not the result of another medical condition or medication. In this scenario, excessive sweating is diagnostic. Sweating occurs symmetrically, affecting both the hands and feet or armpits. This type of hyperhidrosis can begin in childhood or adolescence. And in most cases, some of your family members have excessive sweating.
2. Secondary Generalized Hyperhidrosis
In this case, excessive sweating is either the result of a medical condition or a side effect of a medication. This type may start once you are older or after you start using a particular medicine. Secondary hyperhidrosis can also cause excessive sweating while sleeping.
Medical conditions that can lead to secondary hyperhidrosis include:
- Gout
- Menopause
- Hyperthyroidism
- Tumor
- Cold
- Diabetes
Diagnosing Excessive Regional Sweating
Your doctor will ask about your medical history and symptoms during your appointment. You may also need a physical exam or tests to evaluate your condition's cause further.
Laboratory Tests
Your doctor may recommend blood, urine, or other laboratory tests to see if your sweating is due to another medical condition, such as an overactive thyroid (hyperthyroidism) or low blood sugar (hypoglycemia).
Sweat tests
Thermoregulator Sweat Test
Several tests are available to identify sweating areas and estimate the severity of your condition, including an iodine-starch test, skin conductivity, and a thermoregulatory sweat test.
Hyperhidrosis Treatment
If an underlying medical condition contributes to the problem, it will be treated first. If the cause of excessive sweating is not found, the focus is on minimizing the dimensions of sweating. Sometimes you may need to try a combination of treatments. And even if your sweating improves after treatment, it may recur.
Medicines
Medications used to treat hyperhidrosis include:
Your doctor may prescribe an antiperspirant with aluminum chloride. However, it should be noted that aluminum chloride products can cause eye and skin irritation. It is usually applied to the affected skin at bedtime. Then, when you get up, you wash the product, careful not to get it in your eyes. If your skin becomes irritated, hydrocortisone cream may help. A prescription cream containing glycopyrrolate can help with hyperhidrosis affecting the face and head. Some oral medications block chemicals that allow specific nerves to communicate with each other. It can reduce sweating in some people. Possible side effects include dry mouth, blurred vision, and bladder problems.
Some medications used to treat depression can also reduce sweating. At the same time, antidepressants help reduce the stress and anxiety of hyperhidrosis.
Treatment with botulinum toxin (Botox, Myobloc, others) temporarily blocks the nerves that cause sweating. First, your skin will be iced or anesthetized. Several injections are required in each affected area of your body. The effects last six to 12 months, and then the treatment must be repeated. This treatment can be painful, and some people experience temporary muscle weakness in the treated area.
Hyperhidrosis Surgery and Other Procedures
Other hyperhidrosis treatments include:
Microwave therapy: This therapy uses a device that emits microwave energy to destroy the sweat glands. Treatments include two 20- to 30-minute sessions three months apart. Possible side effects are a change in skin sensation and some discomfort. This therapy can be expensive and not widely available.
Sweat gland removal: If excessive sweating occurs only in your armpits, removing the sweat glands may help. A minimally invasive technique called suction curettage may also be an option if you're not responding to other treatments.
Nerve surgery (sympathectomy): During this procedure, the surgeon cuts, burns, or pinches the spinal nerves that control sweating in your hands. This procedure can sometimes trigger excessive sweating in other parts of your body. Nerve surgery cannot be a treatment option for head and neck sweating, which is usually isolated. A change in this procedure interrupts nerve signals without removing the sympathetic nerve (sympathectomy).
Lifestyle and Home Remedies in Hyperhidrosis
There are many ways to prevent you from sweating.
Use antiperspirant. Over-the-counter antiperspirants contain aluminum-based compounds that temporarily block sweat pores. It reduces the amount of sweat that reaches your skin. Such products may be helpful in minor hyperhidrosis. Take a daily bath. Regular bathing helps keep the number of bacteria on your skin under control. Dry yourself thoroughly, especially between the toes and under the arms. Choose shoes and socks made from natural materials. Shoes made using raw materials can help prevent sweaty feet by allowing your feet to breathe. Athletic socks that wick moisture are an excellent choice when you're active.
Change your socks often. Change your socks once or twice a day, drying your feet thoroughly each time. Try pantyhose with cotton soles. Use over-the-counter foot powders to help absorb sweat.
Air your feet. Choose clothes suitable for your activity. Usually, wear natural fabrics such as cotton, wool, and silk that allow your skin to breathe. You can choose materials designed to wick moisture away from your skin while exercising. Try relaxation techniques. Consider relaxation techniques such as meditation and yoga. Activities such as yoga and meditation can help you learn to control the stress that triggers sweating.
Hyperhidrosis can cause discomfort and embarrassment. You may have difficulty enjoying work or recreational activities due to wet hands or feet or wet stains on clothing. You may feel anxious and withdrawn or self-conscious about your symptoms. Other people's reactions can make you angry or upset. In addition to talking to your doctor, you should consult a counselor or a psychologist. You may find it helpful to talk to other people with hyperhidrosis. You can start by seeing your primary care provider. They may refer you to a dermatologist (dermatologist). Your care may include a neurologist or a surgeon if your condition does not respond to initial treatments.
What are the Causes and Risk Factors of Hyperhidrosis?
Hyperhidrosis, or excessive sweating, is the result of overactive sweat glands.
Sweating is how the body naturally cools itself and prevents overheating. Your nervous system signals your body to produce sweat when your temperature rises, for example, after a workout, when the temperature is hot, or when you're feeling anxious or nervous.
How Much Is Sweating Normal?
If you are sweating in any of the scenarios mentioned above and sweating is not disrupting your daily life, you are probably sweating an average amount. But in the case of hyperhidrosis, excessive sweating happens without triggers like heat and exercise, and you may sweat even when your body temperature isn't rising.
Frequently Asked Questions in Hyperhidrosis
Sweating is a natural response to certain conditions, such as hot weather, physical activity, stress, and feelings of fear or anger. You sweat more than usual with excessive local sweating for no apparent reason. The underlying cause depends on the type of hyperhidrosis you have.
The most commonly used drugs to manage excessive sweating are anticholinergics. These include glycopyrrolate, oxybutynin, benztropine, propantheline, and others. Many hyperhidrosis patients experience success with anticholinergic therapy. It is recommended that you consult your doctor and use prescription medication.