hyperhidrosis

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Hyperhidrosis

 

Definition

Hyperhidrosis is a disorder marked by excessive sweating. It usually begins at puberty and affects the palms, soles, and armpits.

Description

Sweating is the body's way of cooling itself and is a normal response to a hot environment or intense exercise. However, excessive sweating unrelated to these conditions can be a problem for some people. Those with constantly moist hands may feel uncomfortable shaking hands or touching, while others with sweaty armpits and feet may have to contend with the unpleasant odor that results from the bacterial breakdown of sweat and cellular debris (bromhidrosis). People with hyperhidrosis often must change their clothes at least once a day, and their shoes can be ruined by the excess moisture. Hyperhidrosis may also contribute to such skin diseases as athlete's foot (tinea pedis) and contact dermatitis.
In addition to excessive sweat production, the texture and color of the skin itself may be affected by hyperhidrosis. The skin may turn pink or bluish white. Severe hyperhidrosis of the soles of the feet may produce cracks, fissures, and scaling of the skin.
Hyperhidrosis in general and axillary hyperhidrosis (excessive sweating in the armpits) in particular are more common in the general population than was previously thought. A group of dermatologists in Virginia reported in 2004 that 2.8% of the United States population, or about 7.8 million persons, have hyperhidrosis. Of this group, slightly more than half (4 million persons) have axillary hyperhidrosis. One-third of the latter group, or about 1.3 million persons, find that the condition significantly interferes with daily activities and is barely tolerable. Only 38%, however, had ever discussed their excessive sweating with their doctor.

Causes and symptoms

There are three basic forms of hyperhidrosis: emotionally induced; localized; and generalized. Emotionally induced hyperhidrosis typically affects the palms of the hands, soles of the feet, and the armpits. Localized hyperhidrosis typically affects the palms, armpits, groin, face, and the area below the breasts in women, while generalized hyperhidrosis may affect the entire body.
Hyperhidrosis may be either idiopathic (of unknown cause) or secondary to fever, metabolic disorders, alcoholism, menopause, Hodgkin's disease, tuberculosis, various types of cancer, or the use of certain medications. The medications most commonly associated with hyperhidrosis are propranolol, venlafaxine, tricyclic antidepressants, pilocarpine, and physostigmine.
Most cases of hyperhidrosis begin during childhood or adolescence. Hyperhidrosis that begins in adult life should prompt the doctor to look for a systemic illness, medication side effect, or metabolic disorder.
Hyperhidrosis affects both sexes equally and may occur in any age group. People of any race may be affected; however, for some reason unknown as of the early 2000s, Japanese are affected 20 times more frequently than members of other ethnic groups.

Diagnosis

Hyperhidrosis is diagnosed by patient report and a physical examination. In many cases the physician can directly observe the excessive sweating.
The doctor may also perform an iodine starch test, which involves spraying the affected areas of the patient's body with a mixture of 500 g of water-soluble starch and 1 g iodine crystals. Areas of the skin producing sweat will turn black.
The doctor will order other laboratory or imaging tests if he or she suspects that the sweating is associated with another disease or disorder.

Treatment

Most over-the-counter antiperspirants are not strong enough to effectively prevent hyperhidrosis. To treat the disorder, doctors usually prescribe 20% aluminum chloride hexahydrate solution (Drysol), which the patient applies at night to the affected areas that are then wrapped in a plastic film until morning. Drysol works by blocking the sweat pores. Formaldehyde- and glutaraldehyde-based solutions can also be prescribed; however, formaldehyde may trigger an allergic reaction and glutaraldehyde can stain the skin (for this reason it is primarily applied to the soles). Anticholinergic drugs may also be given. These drugs include such medications as propantheline, oxybutynin, and benztropine.
Injections of botulinum toxin (Botox) given under the skin work well for some patients. Botox works to stop the excessive sweating by preventing the transmission of nerve impulses to the sweat glands. These injections must be repeated every 4-12 months, however.
In addition, an electrical device that emits low-voltage current can be held against the skin to reduce sweating. These treatments are usually conducted in a doctor's office on a daily basis for several weeks, followed by weekly visits. Dermatologists also recommend that patients wear clothing made of natural or absorbent fabrics also may help, avoid high-buttoned collars, use talc or cornstarch, and keep underarms shaved.
The only permanent cure for hyperhidrosis of the palms is a surgical procedure known as a sympathectomy. To treat severe excessive sweating, a surgeon can remove a portion of the nerve near the top of the spine that controls palm sweat. However, not very many neurosurgeons in the United States will perform the procedure, because it often results in compensatory sweating in other regions of the body. Alternatively, it is possible to surgically remove the sweat gland-bearing skin of the armpits, but this is a major procedure that may require skin grafts.
More recently, liposuction under the armpits has been successfuly used to treat hyperhydrosis in this region of the body. The liposuction removes some of the excess sweat glands responsible for axillary hyperhidrosis. The procedure also has the advantage of leaving smaller scars and being less disruptive of the overlying skin.

Prognosis

Hyperhidrosis is not associated with increased mortality; it primarily affects the patient's quality of life rather than longevity. While the condition cannot be cured without radical surgery, it can usually be controlled effectively.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Disorders of Sweating." Section 10, Chapter 124 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Altman, Rachel, MD, George Kihiczak, MD, and Robert Schwartz, MD. "Hyperhidrosis." eMedicine August 18, 2004. http://www.emedicine.com/derm/topic893.htm.
Licht, P. B., and H. K. Pilegaard. "Severity of Compensatory Sweating after Thoracoscopic Sympathectomy." Annals of Thoracic Surgery 78 (August 2004): 427-431.
Strutton, D. R., J. W. Kowalski, D. A. Glaser, and P. E. Stang. "US Prevalence of Hyperhidrosis and Impact on Individuals with Axillary Hyperhidrosis: Results from a National Survey." Journal of the American Academy of Dermatology 51 (August 2004): 241-248.

Organizations

American Academy of Dermatology (AAD). P. O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-0230. http://www.aad.org.

Key terms

Anticholinergic drugs — Drugs that block the action of the neurotransmitter acetylcholine.
Axilla (plural, axillae) — The medical term for the armpit.
Bromhidrosis — Bacterial breakdown of sweat and cellular debris resulting in a foul odor.
Contact dermatitis — Skin inflammation that occurs when the skin is exposed to a substance originating outside of the body.
Idiopathic — Of spontaneous origin or unknown cause. Many cases of hyperhidrosis are idiopathic.
Sympathectomy — Surgical cutting or interruption of any of the pathways in the sympathetic nervous system. It may be performed to control hyperhidrosis that does not respond to medications.
Sympathetic nervous system — The part of the nervous system that originates in the lumbar and thoracic portions of the spinal cord. It regulates involuntary reactions to stress, including sweating as well as heart rate, breathing rate, and digestive secretions.
Tinea pedis — Fungal infection of the feet of the skin characterized by dry, scaly lesions.

hyperhidrosis

 [hi″per-hi-dro´sis]
excessive sweating. adj., adj hyperhidrot´ic.
emotional hyperhidrosis an autosomal dominant disorder of the eccrine sweat glands, most often of the palms, soles, and axillae, in which emotional stimuli (e.g., anxiety) and sometimes mental or sensory stimuli elicit volar or axillary sweating (usually not both in the same individual); eccrine sweat glands in other areas of the body are affected less often and are less sensitive to such stimuli.

hy·per·hi·dro·sis

(hī'pĕr-hī-drō'sis),
Excessive or profuse sweating.
Synonym(s): polyhidrosis, sudorrhea
[hyper- + hidrosis]

hyperhidrosis

/hy·per·hi·dro·sis/ (-hi-dro´sis) excessive perspiration.hyperhidrot´ic
emotional hyperhidrosis  an inherited disorder of the eccrine sweat glands in which emotional stimuli cause axillary or volar sweating.

hyperhidrosis

(hī′pər-hī-drō′sĭs, -hĭ-) or

hyperidrosis

(hī′pər-ĭ-)
n.
Excessive or profuse perspiration.

hy′per·hi·drot′ic (-drŏt′ĭk) adj.

hyperhidrosis

[hī′pərhīdrō′sis, -hidrō′sis]
Etymology: Gk, hyper + hidros, perspiration
excessive perspiration often caused by heat, hyperthyroidism, strong emotion, menopause, or infection. Symptomatic therapy usually includes topical antiperspirants and anticholinergics or Botox. Severe cases may be treated with surgery. Also called hyperidrosis, polyhidrosis, polyidrosis.

Böök syndrome

An extremely rare autosomal dominant OMIM 112300 condition characterised by premolar aplasia, palmo-plantar hyperhidrosis and premature grey hair, described in a single Swedish family in 1950.

hyperhidrosis

 Sweat, sweat, much, much

hy·per·hi·dro·sis

(hī'pĕr-hi-drō'sis)
Excessive or profuse sweating.
Synonym(s): hyperidrosis, polyhidrosis, polyidrosis.

hyperhidrosis

Excessive sweating. This is not usually the result of disease but may be caused by fever, overactivity of the thyroid gland and occasionally nervous system disorders. It is commonly the result of a stress reaction or other psychological upset. Treatment is by topical applications of aluminium chloride, subcutaneous injection of botulinum toxin, excision of axillary tissue or sympathectomy.

hyperhidrosis

excessive sweating; associated with hormonal imbalance (e.g. puberty) or hyperthyroidism; caused by changes in skin mechanics; predisposes to maceration, skin fissures, bacterial and fungal infections, vesicle formation and local inflammation; treated by topical antiperspirant solutions (e.g. aluminium chloride, potassium permanganate) and contrast foot baths; managed by wearing sweat-absorbing insoles, cotton hosiery and sandals and addressing aspects of the underlying cause; severe and persistent cases may respond to injected botulinum-A neurotoxin complex (Botox); see Table 1and Table 2
Table 1: Topical agents with astringent/anhidrotic action
AgentFormulation
AlcoholIMS; 70% isopropyl alcohol; spirituous lotions, e.g. 3% salicylic acid in IMS; surgical spirit; evaporates to cool skin and reduce maceration
Formalin10% solution causes a toughening effect on epidermis (may cause hypersensitivity)
AgNO320-25% solution (higher strengths can be used as NaCl in sweat mitigates the action of AgNO3)
Tannic acidAs dusting powder, or as borotannic complex giving an antifungal action
HamamelisWitch hazel: cooling effect
CalamineLotion or cream with a mild astringent and absorbent action; it will take up 1.5 times its own weight of water
Salicylic acid 3%Astringent and antiseptic as a lotion or dusting powder
Burow's solutionAluminium acetate ∼5% solution; diluted 1:3 in water to reduce sweat flow
TalcAntipruritic and absorbent; used as a base for dusting powders and to lubricate the skin
Dusting powdersAstringent medicament (e.g. tannic acid, salicylic acid), or antifungal medicament (e.g. boric acid, undecenoic acid) and lubricating applications in a talc, kaolin and/or zinc oxide base
OthersAgents that coincidentally show astringent/anhidrotic action include potassium permanganate, sodium polymetaphosphate, ferric chloride and compound tincture of benzoin

Note: Astringents act variously to cause protein precipitation (and thereby reduce epidermal maceration), cooling of tissues, constriction of sweat ducts and skin lubrication); anhidrotics act variously as cooling agents, astringents, and to alter epidermal reaction to retained sweat (e.g. reduce friction at the skin surface).

Both are used to control hyperhidrosis and bromidrosis by preventing the accumulation of sweat, increasing the skin's reaction to the action of sweat, and to compensate for any loss of resistance to infection at the skin surface.

IMS, industrial methylated spirit.

Table 2: Treatment of hyperhidrosis and bromidrosis
Treatment rationaleModality
Reduction of local sweat flowTreatment of painful conditions (orthoses, footwear, correction of chronic foot strain)
Determination whether there is a systemic cause of increased sweating (e.g. hyperthyroidism; menopause; stress)
Prevention of sweat accumulation at skin surfacePersonal hygiene (washing, rotation of shoes, clean socks; use of antiperspirants; contrast foot baths)
Airing feet (sandals; cotton not nylon hose; leather not plastic shoes)
Absorbents (charcoal-containing insoles; allowing shoes to air thoroughly between wearing
Note: Foot powders do not absorb sweat, but do lubricate the skin
Reduction of the local effects of macerationTopical astringents
Counteraction of proneness to fungal and bacterial infectionsTopical antiseptics and fungicides
Treatment of associated minor skin pathologies• Blistering: weak iodine solution; 50:50 weak iodine and compound tincture of benzoin (TBCo); TBCo
• Moist fissuring: TBCo with 3% salicylic acid; industrial methylated spirit (IMS) with 3% salicylic acid
• Dry fissuring: reduction of local callosity; application of emollients

hy·per·hi·dro·sis

(hī'pĕr-hi-drō'sis)
Excessive or profuse sweating.
[hyper- + hidrosis]

hyperhidrosis (hī´purhīdrō´sis),

n the presence of excessive sweating, which may be generalized or localized.
hyperhidrosis, gustatory
n the presence of increased sweating in the preauricular region, forehead, or face associated with eating. See also syndrome, auriculotemporal.
hyperhidrosis, masticatory
n excessive sweating associated with chewing. The cause is traumatic injury producing anastomosis of the facial nerve with a sympathetic branch.

hyperhidrosis

excessive sweating.

bovine hyperhidrosis syndrome
inherited in Shorthorn cattle and associated with conjunctivitis, pityriasis and digestive disturbances.

Patient discussion about hyperhidrosis

Q. How can I treat hyperhidrosis without surgery? My hands and feet sweat all the time. I can't even wear flip flops. I can't leave the house without a towel for my hands. I can just be sitting there and the sweat will just be rolling off of my hands. Please help!!!

A. For your feet swelling set with your feet proped up on a stool with a pillow under your feet for at least an hour a day.

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