Hyperhidrosis & Treatments

Hyperhidrosis is a condition characterized by abnormally increased sweating, which is more than necessary to regulate body temperature. Although it is primarily a physical burden, hyperhidrosis can impair quality of life psychologically, emotionally, and socially.

This excessive sweat happens even when the person is not doing jobs that require muscle strength and is not due to heat exposure. Common places for sweating include the armpits, face, neck, back, groin, feet, and hands.

Visual Scaling

Classification

Hyperhidrosis can either be generalized or localized to specific parts of the body. Hands, feet, armpits, groin, and the facial area are among the most active regions of perspiration due to the high number of sweat glands (eccrine glands in particular) in these areas.

When excessive sweating is localized (e.g. palms, soles, face, underarms, scalp) it is referred to as primary hyperhidrosis or focal hyperhidrosis. Excessive sweating involving the whole body is termed generalized hyperhidrosis or secondary hyperhidrosis. It is usually the result of some other, underlying condition.

Primary or focal hyperhidrosis may be further divided by the area affected, for instance, palmoplantar hyperhidrosis (symptomatic sweating of only the hands or feet) or gustatory hyperhidrosis (sweating of the face or chest a few moments after eating certain foods).

Hyperhidrosis can also be classified by onset, either congenital (present at birth) or acquired (beginning later in life).

Conditions that may lead to heavy sweating include:

• Diabetes
• Menopause hot flashes
• Thyroid problems.
• Low blood sugar
• Some types of cancer
• Heart attack
• Nervous system disorders
• Infections
• Miscellaneous
  • Lacrimal sweating (due to postganglionic sympathetic deficit, often seen in Raeder’s syndrome)
  • Harlequin syndrome
  • Emotional hyperhidrosis

Treating severe excessive sweating

1. Taking tablets that reduce sweating.
   1. Several anticholinergic drugs can reduce hyperhidrosis. Oxybutynin (brand name Ditropan) is one that has shown promise, although it can have side effects, such as drowsiness, visual symptoms, and dryness of the mouth and other mucous membranes. Glycopyrrolate is another drug sometimes used. It is said to be nearly as effective as oxybutynin but has similar side effects. In 2018, the U.S. 
   2. Food and Drug Administration (FDA) approved a glycopyrronium bromide-containing disposable cloth (brand name Qbrexza) for the treatment of primary axillary hyperhidrosis (“News Releases | Investors & Media | Dermira”. investor.dermira.com. Retrieved 2018-07-04).

2. Treating the areas with a weak electric current passed through water or on a wet pad (iontophoresis)
3. Having botox injections for sweating under the armpits.
   • Currently, Botox has only been approved for the treatment of underarm sweating. In studies, Botox was extremely effective in treating underarm sweating. Studies also show that Botox works to treat forehead sweat. It can reduce sweating by 75 percent for about five months.

4. Microwave therapy. With this therapy, a device that delivers microwave energy is used to destroy sweat glands. Treatments involve two 20- to 30-minute sessions, three months apart. Possible side effects are a change in skin sensation and some discomfort. This therapy may be expensive and not widely available.
5. Surgery – ETS Sympathectomy or removal of the sweat glands.

1. Sweat gland removal. If excessive sweating occurs just in your armpits, removing the sweat glands there may help. A minimally invasive technique called suction curettage may be an option, too, if you aren’t responding to other treatments.
2. Nerve surgery (ETS Sympathectomy). During this procedure, the surgeon cuts, burns, or clips the SYMPATHETIC nerves that control sweating in your hands. In some cases, this procedure triggers excessive sweating in other areas of your body (compensatory sweating). Surgery is generally not an option for isolated head and neck sweating. A variation on this procedure interrupts the nerve signals without removing the sympathetic nerve (sympathectomy).
   • Clamping/clipping is intended to permit the reversal of the procedure. ETS is generally considered a “safe, reproducible, and effective procedure and most patients are satisfied with the results of the surgery”. Satisfaction rates above 80% have been reported, and are higher for children. The procedure brings relief from excessive hand sweating in about 85–95% of patients. ETS may be helpful in treating axillary hyperhidrosis, facial blushing, and facial sweating, but failure rates in patients with facial blushing and/or excessive facial sweating are higher and such patients may be more likely to experience unwanted side effects.
   • ETS side-effects have been described as ranging from trivial to devastating. The most common side-effect of ETS is compensatory sweating (sweating in different areas than prior to the surgery). Major problems with compensatory sweating are seen in 20–80% of patients undergoing the surgery. Most people find the compensatory sweating to be tolerable while 1–51% claim that their quality of life decreased as a result of compensatory sweating.” Total body perspiration in response to heat has been reported to increase after sympathectomy. The original sweating problem may recur due to nerve regeneration, sometimes as early as 6 months after the procedure.
   • Other possible side-effects include Horner’s Syndrome (about 1%), gustatory sweating (less than 25%), and excessive dryness of the palms (sandpaper hands). Some patients have experienced cardiac sympathetic denervation, which can result in a 10% decrease in heart rate both at rest and during exercise, resulting in decreased exercise tolerance.

References

1. Hyperhidrosis. https://en.wikipedia.org/wiki/Hyperhidrosis
2. Hyperhidrosis. https://www.mayoclinic.org/diseases-conditions/hyperhidrosis/symptoms-causes/syc-20367152
3. Evidence-Based Review of the Surgical Management of Hyperhidrosis”. Thoracic Surgery Clinics. 18 (2): 209–16.