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Hyperhidrosis
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Hyperhidrosis is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature.
rhidrosis 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 the body may be affected.
Hyperhidrosis can also be classified depending on if it is a congenital or accquired trait.
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Encyclopedia
Hyperhidrosis is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature.
Classification
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 the body may be affected.
Hyperhidrosis can also be classified depending on if it is a congenital or accquired trait. Primary hyperhidrosis is found to start during adolescence or even before and 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, certain drugs, or mercury poisoning. Such secondary forms may have more serious consequences than hyperhidrosis.
Hyperhidrosis may be also divided into palmoplantar (emotional), gustatory or generalized hyperhidrosis.
Cause
The cause of primary hyperhidrosis is unknown, although some surgeons claim that it is caused by sympathetic overactivity. 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.
Treatment
Hyperhidrosis can often be very effectively managed.
Medications
Aluminium chloride is used in regular antiperspirants. However hyperhidrosis sufferers need solutions with a much higher concentration to effectively treat the symptoms of the condition. Its main secondary effect is that it can cause irritation. Also, the solution is usually not effective for hand and foot hyperhidrosis. For severe cases of palmar and plantar hyperhidrosis there is some success using conservative measures such as aluminium chloride antiperspirants.
Botulinum toxin type A injections are used to disable the sweat glands. The effects can last from 4-9 months depending on the site of injections. The procedure when used for underarm sweating has been approved by the U.S. Food and Drug Administration (FDA).
Several anticholinergic drugs reduce hyperhidrosis. Oxybutynin (brand name Ditropan ) is one that has shown promise. although it has important side effects, which include drowsiness, visual symptoms and dryness in the mouth and other mucus membranes. A time release version of the drug is also available (Ditropan XL ), with purportedly reduced effectiveness. Glycopyrrolate (Robinul) is another drug used on an off-label basis. The drug seems to be almost as effective as oxybutynin and have similar side-effects. Other anticholinergic agents that have been tried include propantheline bromide (Probanthine ) and benzatropine (Cogentin ).
Antidepressants and anxiolytics were formerly used on the belief that primary hyperhidrosis was related to an anxious personality style. Beta-blockers have also been tried, but do not seem to be very effective.
Surgical procedures
In Endoscopic thoracic sympathectomy (ETS) the main sympathetic chain that runs alongside the spine, - often with the addition of nerve ganglia, - are either cut out, burned, or clamped in the latter case with the aim of permitting the reversal of the procedure.
It 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; being higher for children. The procedure causes relief of excessive hand sweating in about 85-95%. ETS was thought to be helpful in treating axillary hyperhidrosis, facial blushing and facial sweating. 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, although this has not been established in a controlled trial or independent study.
The most common secondary effect of ETS is compensatory sweating. Recurrence rate can be high, and return of the sweating can be seen within 6 months of the procedure due to nerve regeneration. Major drawbacks related to compensatory sweating are seen in 20-80%. 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 resported to increase after sympathectomy.
Other side effects include Horner's Syndrome (about 1%), gustatory sweating (less than 25%) and on occasion very dry hands (sandpaper hands). Some patients have also been shown to experience a cardiac sympathetic denervation, which results in a 10% lowered heartbeat during both rest and exercise; leading to an impairment of the heart rate to workload relationship. ETS side effects, have been described to range from trivial to devastating.
Lumbar sympathectomy is a relatively new procedure aimed at those patients for whom endoscopic thoracic sympathectomy has not relieved excessive plantar (foot) sweating. With this procedure the sympathetic chain in the lumbar region is clipped or divided in order to relieve the severe or excessive foot sweating. The success rate is about 90% and the operation should be carried out only if patients first have tried other conservative measures. This type of sympathectomy is also controversial, as patients undergoing the procedure often end up with hypotension, (a sign of autonomic dysfunction), and in males retrograde ejaculation (male infertility) and inability to maintain erection has been reported. New information has become available and shown that the issues of retrograde ejaculation, inability to maintain erection and hypertension are not validated. In a 2007 paper none of the patients experienced sexual dysfunction.
Other used techniques are sweat gland suction and percutaneous sympathectomy. Sweat gland suction is a technique adapted from liposuction, in which approximately 30% of the sweat glands are removed, with a proportionate reduction in sweat. Percutaneous sympathectomy is a minimally invasive procedure in which the nerve is blocked by an injection of phenol. The procedure allows for temporary relief in most cases. Some medical professionals advocate the use of this more conservative procedure before the permanent surgical sympathectomy.
Other
Iontophoresis was originally described in the 1950s, and its exact mode of action remains elusive to date. 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. Some people have seen great results while others see no effect. The device can be painful (pain is usually limited to small wounds and over time the body adjusts to the procedure) and the process is time-consuming. 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.
Hypnosis has been used with some success in improving the process of administering injections for the treatment of hyperhidrosis . Talc or baby powder can be used as a temporary treatment because the powder will absorb the sweat; however, it may also become a messy white coating on the place of application. Absorbent shoe insoles decrease the sweat in shoes. Relaxation and meditation and weight loss have also been proposed to be of help.
Prognosis and impact
Excessive sweating of the hands interferes with many routine activities, such as securely grasping objects. Some hyperhidrosis sufferers avoid situations where they will come into physical contact with others, such as greeting a person with a handshake. Hiding embarrassing sweat spots under the armpits limits the sufferers' arm movements and pose. In severe cases, shirts must be changed several times during the day. Additionally, anxiety caused by self-consciousness to the sweating may aggravate the sweating.
Excessive sweating of the feet makes it harder for patients to wear slide-on or open-toe shoes, as the feet slide around in the shoe because of sweat.
Some careers present challenges for hyperhidrosis sufferers. For example, careers which require the deft use of a knife may not be safely performed by people with excessive sweating of the hands. Employees, such as sales staff, who interact with many new people can be negatively affected by social rejection. The risk of dehydration can limit the ability of some sufferers to function in extremely hot (especially if also humid) conditions. Even the playing of musical instruments can be uncomfortable or difficult because of sweaty hands.
ETS surgery can produce similar outcomes. With extremely dry hands they have problems with grasping objects. Patients become dependent on hand lotions in order to function. Anhidrosis also includes total lack of moisture of the face. They have a high risk of dehydration due to the abnormal sweating that can increase considerably following the surgery and can cover the whole body surface, below the level of the cut. A case of heat-stroke was reported in a person with previous sympathectomy hipothetizising the authors that it could be due to the reduced ability to regulate body temperature, but no relationship between both facts could be proved.
Epidemiology
Primary hyperhidrosis is estimated at 2.8% of the population. It affects men and women equally, and most commonly occurs among people aged 25–64 years. About 30–50% have another family member afflicted, implying a genetic predisposition.
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