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Causes and symptoms
hyperhidrosis/hy·per·hi·dro·sis/ (-hi-dro´sis) excessive perspiration.hyperhidrot´ic
hyperhidrosis(hī′pər-hī-drō′sĭs, -hĭ-) or
Böök syndromeAn 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.
hyperhidrosisSweat, sweat, much, much
hyperhidrosisExcessive 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.
hyperhidrosisexcessive 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
|Alcohol||IMS; 70% isopropyl alcohol; spirituous lotions, e.g. 3% salicylic acid in IMS; surgical spirit; evaporates to cool skin and reduce maceration|
|Formalin||10% solution causes a toughening effect on epidermis (may cause hypersensitivity)|
|AgNO3||20-25% solution (higher strengths can be used as NaCl in sweat mitigates the action of AgNO3)|
|Tannic acid||As dusting powder, or as borotannic complex giving an antifungal action|
|Hamamelis||Witch hazel: cooling effect|
|Calamine||Lotion 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 solution||Aluminium acetate ∼5% solution; diluted 1:3 in water to reduce sweat flow|
|Talc||Antipruritic and absorbent; used as a base for dusting powders and to lubricate the skin|
|Dusting powders||Astringent 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|
|Others||Agents 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.
|Reduction of local sweat flow||Treatment 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 surface||Personal 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 maceration||Topical astringents|
|Counteraction of proneness to fungal and bacterial infections||Topical 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
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!!!