Hyperhidrosis — excessive sweating

Hyperhidrosis or excessive sweating is a very common condition in general population. Almost 1% to 2% of the population has increased gland function in some region of the body and in some period of life.

The basic function of sweating is to cool down the body and regulate body temperature. During high outside temperatures, exercise, stress or hormonal changes, the central nervous system sends signals to the sweat glands to start contractions of myoepithelial cells and secretory activities. With hyperhidrosis, sweating is not proportional to external stimuli and it functions without any activity and need to cool down the body.

Palms, soles, forehead, scalp and other parts of the body with sweat, may cause anxiety, discomfort in society, so they can also interfere with the daily routine and professional activities. Excessive sweating is most often encountered on the palms, armpits, soles, but it can affect any part of the body.

Sweat often shows on a wardrobe, so people with hyperhidrosis wear exclusively black or white cloths in order to hide wet spots.

hyperhidrosis — excessive sweating
hyperhidrosis — excessive sweating

Hyperhidrosis is divided

into two categories:

1. Primary hyperhidrosis is also called focal, essential hyperhidrosis. It is of unknown cause or dominantly hereditary, and occurs in children as early as childhood. Two to four million eccrine (sweat) glands, under the influence of sympathetic nervous system, constantly produce and exert sweat, even at the very thought of an unpleasant situation.

2. Secondary hyperhidrosis is general hyperhidrosis caused by diseases of other organs or by drugs.

Unlike focal, secondary hyperhidrosis affects large areas of the body or the whole body. Night sweating is characteristic of this type of hyperhidrosis.

It occurs in people with other conditions: diabetes, thyroid disease, hormonal imbalances, obesity, cardiac failure, alcoholism, infectious conditions, lymphomas.

Drugs used to treat diabetes, parkinsonism, depression, glaucoma can stimulate increased sweating.

How to treat hyperhidrosis?

Focal hyperhidrosis has different ways of treatment depending on the region and the degree of sweating.

Applying a cream containing antiperspirant aluminum chloride in a large percentage is the first line of therapy. It is used for palms, soles and armpits. If the face is affected, creams with glycopyrrolate are prescribed. It is successful in mild forms of hyperhidrosis. They can cause irritation, so they are applied in the evening and washed off in the morning. When the result is achieved, the frequency of application decreases.

Iontophoresis is administered if the creams are not enough. Water is poured into the tub for iontophoresis and palms or soles are laid inside. When a low voltage current passes through the body, the ions on the sweat glands are modified and the function decreases. The exact mechanism is not fully known. If after a month the result is not available, electrolytes are added in the bathtubs. The procedure is safe and it is best to perform it at home. At first it is carried out several times a week, and when the results are achieved, several times a month.

Anticholinergic drugs are used in general sweating or sweating that encompasses large areas of the body. They block acetylcholine to bind to the muscles of the sweat glands, as a result of which their contraction decreases. As a frequent side effects, nausea, constipation, dryness of the mouth, urinary retention may occur.

Botox is a very successful method of stopping sweating and a method of choice for treating individual regions on the body. Botulinum toxin acts directly on the muscles of the sweat glands of the treated region and for several months it can completely stop hyperhidrosis. The best therapeutic response is given in the armpit region, where the result lasts 6 to 8 months after application. Forehead, armpits, palms, soles can be treated.

Botox treatment is completely safe. When treating the armpit, there is no side effect. When treating palms and soles, there may be a slight discomfort of the palms for several days, but it is transient.

With hyperhidrosis of the armpits curettage of sweat glands can be effective and simple.

Sympatectomy is nerve fiber surgery. During the procedure, the surgeon cuts or burns the nerve fibers in the region that contains the part of the body that sweats excessively. Complication may be compensatory sweating. The surgical method carries all the risks of operative treatment and should be the last resort of treatment.

Svetlana Đurišić specijalista dermatovenerologije

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