Hyperhidrosis
From Wikipedia, the free encyclopedia
| ICD-10 | R61 |
|---|---|
| ICD-9 | 780.8 |
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.
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 women more.
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[edit] 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.
[edit] 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. ETS was thought to be helpful in treating facial blushing and facial sweating. According to Dr. Reisfeld, the only indication for ETS at present is excessive and severe palmar hyperhidrosis (excessive hand sweating). Statistics have shown that when treated for facial blushing and/or excessive facial sweating, the failure rate of ETS for those two clinical presentations is higher and patients are more prone to side effects.
- Surgery (Sweat gland suction): A new technique adapted and modified from liposuction. On an out-patient basis with only local anaesthesia, the sweat glands are permanently removed in a gentle, non-aggressive manner. The sweat glands and armpits are first softened and anaesthetized with a special solution. After a short period, the sweat glands can then be removed in a manner similar to liposuction. Only small incisions above and under the armpits are required to remove the sweat glands through quick suction. The entire minimally invasive operation takes between 60 and 90 minutes. Patients can go home directly after the procedure. Some can even return to work after leaving the practice, although it is recommend taking the rest of the day off. Over 95% of patients report considerably less discomfort and permanent dryness.
- Aluminum chloride (hexahydrate) solution: The most common brands are Drysol®, Maxim®, Odaban®, and Driclor®. 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 - for which iontophoresis (see below) yields much better results.
- 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 U.S. Food and Drug Administration (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. Common brands of tap water iontophoresis devices are the Drionic®, Idrostar and MD-1A (RA Fischer). Some people have seen great results while others see no effect. However, since the device can be painful to some (it is important to note that pain is usually limited to small wounds and that over time the body adjusts to the procedure) 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. Devices can also easily and cheaply be built at home, although great care must be taken to ensure safe operation.
- 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 such as a dry mouth or dry throat often leading to pain in these areas. 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 does not seem to be nearly as effective. Since the disorder is often caused by or exacerbated by high-anxiety, antidepressant drugs, such as Zoloft®, often help alleviate symptoms.
- Weight-Loss: Hyperhidrosis can be aggravated by obesity, so weight-loss can help. However, most people with hyperhidrosis do not sweat excessively due to obesity.
- Relaxation and meditation: Relaxation techniques have been tried with limited success.
- Hypnosis: Hypnosis has been used with limited success.
- Percutaneous Sympathectomy: a minimally invasive procedure in which the sympathectomy nerve is blocked by an injection of phenol.
[edit] Social effects
Excessive sweating impedes the performance of many routine activities. Things like driving, taking tests and simply grasping objects are severely hampered by sweaty hands. In addition, many careers present challenges for hyperhidrosis sufferers, such as for cook/chefs, doctors, and people working with computers. However, it is the social embarrassment that most hyperhidrosis sufferers find most troubling.
Some hyperhidrosis sufferers feel they have to avoid situations where they will come into physical contact with others. Interviews, a common source of anxiety for many people, are particularly harrowing for hyperhidrosis patients. Most often, it is the handshake before and after the interview that they will be stressing most about.
The very social interaction that could help lift the spirits of an individual suffering with hyperhidrosis is reduced. Interaction with others is extremely important. The simple experience of touch by another is proving to be extremely important to the psychological well-being of a person.[1]
