Hyperhidrosis

Hyperhidrosis is excessive sweating that most commonly occurs in the hands (palmar hyperhidrosis), axillae or armpit (axillary hyperhidrosis) and feet (plantar hyperhidrosis). This occurs in about 3 percent of the population and 6 percent of the Asian population. In 40 percent of patients, other members of the family also suffer with hyperhidrosis. The excessive sweating is usually intermittent, but can be continuous and usually increases with stress and elevated temperature. Hyperhidrosis is over-activity of the sympathetic nervous system. This leads to narrowing of arteries and excessive stimulation of sweat glands. This means that less blood flow to the hands makes them cold and clammy at the time when the excessive stimulation to the sweat glands makes the hands wet.

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Symptoms

Palmar hyperhidrosis can be a severely debilitating problem. Wet hands are embarrassing when shaking hands with people and it interfere with social and business activities.

Axillary sweating can be so severe that sufferers often need to change their shirts several times a day, wear only dark colors that do not show the sweat as much, and avoid certain materials, such as silk, can be ruined by the sweat.

Plantar hyperhidrosis (foot sweating) may be so severe it can cause the foot to slip off the brake when driving a car, a slip in a sandal to cause a twisted ankle, or fill a shoe with sweat so that the shoes cannot be worn on consecutive days.

 

Causes

The cause of hyperhidrois is unknown although obesity and increased thyroid function may be responsible in most patients.

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Diagnosis

Diagnosis of this condition is usually made on the basis of the symptoms and a physical examination. There is no blood test or X-ray to diagnose hyperhidrosis.  A starch test can be performed on hands, but is rarely performed.

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Treatments

Non-surgical treatments for patients with hyperhidrosis:

  • Drysol: (brand name for aluminum chloride hexahydrate) is a prescription medication commonly prescribed for hyperhidrosis. Generally treatment is repeated nightly until sweating is under control. This may happen after just two or more treatments. Thereafter, you can apply Drysol once or twice weekly or as needed. Your physician will instruct you on how to take the medication.
  • Botox: Botox injections have been used for the hands and the armpit area. For the hands and armpit, the treatment requires many injections of Botox during a single session. These are usually effective in reducing the sweat and the effect will last for three to six months.
  • Iontophoresis: Iontophoresis when hands or feet are placed in water with low voltage DC electrical current.
  • Anti-anxiety drugs: These types of drugs have been tried but they have very little role in the treatment of hyperhidrosis.  While sweating may increase with tension and anxiety, these symptoms do not necessarily point to hyperhidrosis.
  • Psychotherapy: Psychotherapy has been tried but seems to play little role in the treatment of hyperhidrosis because, while the sweating may increase with tension and anxiety these symptoms do not necessarily point to hyperhidrosis.
  • Drying medicines: There are pills that can be taken to dry up the sweating, however, patients complain that these medicines can cause dry mouth and dry eyes.

 

Surgical treatment options for patients with hyperhidrosis:

Surgery for hyperhidrosis has been performed for 70 years. In the past, the procedure required a chest incision and spreading the ribs, which is painful and required admission to the hospital. Currently, the procedure is performed with minimally invasive surgery and on an outpatient basis. There are several methods for surgical treatment of hyperhidrosis, including cutting the nerve, clipping the nerve and removing the nerve. The most common method is cutting the nerve.

Almost all patients have substantial reduction in sweaty hands after the operation, however, improvement in the armpit and plantar (foot) sweating is much less consistent and not as predictable.

While the procedure is usually performed with low risk on an outpatient basis, there are risks to every procedure. Normally, patients have mild chest pain for a few days (though it can last longer or be severe). But they are normally able to work after a few days.

Most patients experience compensatory hyperhidrosis which means they experience increased sweating in other areas of the body, such as the scalp, chest wall, thighs or feet. The increased sweating may decrease in the months following the operation and patients usually do not mind mild increased sweating because the severely debilitating hand sweating has improved so much.

About five percent of patients experience severe compensatory sweating. Some patients may find this so severe that they are unhappy that they underwent the procedure.

Horner’s Syndrome (droopy eyelids) occurs in about 1 percent of people undergoing the procedure. If this occurs, it may be temporary or may require eye surgery to correct the droop.

Patients also have the usual risks of any operation, including bleeding, infection, and collapsed lung.

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