Hyperhidrosis

Hyperhidrosis - excessive sweating, which can be limited or common and has multiple causes.

Sweating underarms, palms and feet are most often caused by stress. A common sweating usually has an idiopathic basis, but malignant tumors, infections and diseases of the endocrine system are possible. The diagnosis is obvious, but it is necessary to conduct a survey for possible causes. In the treatment of hyperhidrosis, aluminum chloride, iontophoresis of water, botulinum toxin, in emergency cases, surgical intervention is possible.

[1], [2], [3], [4]

What causes hyperhidrosis?

Hyperhidrosis may be local or general.

Local hyperhidrosis

Often sweating of the palms, soles, axillary depressions, forehead causes emotions, anxiety, excitement, anger or fear. Although this is a normal reaction of the body, in patients with hyperhidrosis, sweating occurs even in situations in which most people do not have this reaction.

Increased sweating around the lips and mouth is observed when eating foods and drinks that are spicy or hot. There is no specific cause, but this type of sweating can occur with diabetic neuropathy, herpes zoster, CNS disease or parotid glandular injury. Perhaps the development of Frey syndrome, infection or trauma can disrupt the innervation of the parotid gland and lead to an increase in parasympathetic influences that cause an increase in the function of the sweat glands.

Other causes: follicular mucinosis of the skin, hypertrophic osteoarthropathy, blue nevus, cavernous tumor. A compensatory increase in sweating is observed after sympathectomy.

General hyperhidrosis

Although most cases are idiopathic, numerous conditions can be present, including endocrine disorders (especially hyperthyroidism, hypoglycemia, hyperpituitarism), pregnancy and menopause, drugs (especially antidepressants of all types, aspirin, nonsteroidal anti-inflammatory drugs, hypoglycemic substances, caffeine and theophylline); carcinoid syndrome, autonomic neuropathy and CNS lesions. In the presence of heavy sweating at night, studies should be conducted on the presence of malignant tumors (especially lymphoma and leukemia), infections (especially tuberculosis, endocarditis or systemic fungal disease), although this can often be caused by anxiety and stress.

Symptoms of hyperhidrosis

Sweating is often present during the examination, and sometimes very plentiful, clothes can be soaked in sweat, and the skin of the palms and soles can become loose and acquire a white color. Hyperhidrosis can cause emotional stress and lead to a restriction of interpersonal communication.

Diagnosis of hyperhidrosis

The diagnosis is made clinically and anamnestic, it can be confirmed by a test with iodine solution (apply iodine, let it dry - sweaty places will darken).

Studies that help determine the causes of hyperhidrosis include a clinical blood test that can detect leukemia, blood sugar and thyroid hormones to detect its dysfunction.

[5], [6], [7], [8], [9], [10]

Treatment of hyperhidrosis

First, treatment of any type of hyperhidrosis is the same.

A solution of aluminum chloride hexahydrate of 6-20% is used for topical treatment of axillary, palmar and plantar sweating, this prescription is required for this medicine. The solution blocks the flow channels and is most effective at night, under occlusion. In the morning, the solution should be washed off. Sometimes the use of anticholinergic drugs is required to prevent the elution of aluminum chloride. Initially, it is required to apply the solution several times a week until certain results are achieved, then it is enough 1-2 times a week. If occlusive dressings lead to irritation, then they can be canceled. The solution should not be applied to inflamed, damaged, moist or newly shaved skin. In moderate cases, a highly concentrated solution of aluminum chloride on a water basis can provide adequate assistance. An alternative to the use of aluminum chloride are formaldehyde, glutaraldehyde, tannin, but it is possible to develop contact dermatitis and skin discoloration.

Ionophoresis of ordinary water is a possible way of treating patients who do not respond to local treatment. Affected areas (typically the palms or soles) are placed in tubs with tap water, each containing an electrode of 15-25 milliamperes, and an exposure time of 10-20 minutes. The procedure is carried out daily for a week, then every week or twice a month. Although the treatment is usually effective, it takes a lot of time and causes some difficulties, which worries patients.

Botulinum toxin A is a neurotoxin that reduces the release of acetylcholine by sympathetic nerves. Entered directly into the axillary basins, palms or forehead, botulinum blocks sweating for about 5 months depending on the dosage. Complications include muscle and headaches. Injections are effective, but painful and expensive.

Surgical intervention is necessary if other treatments fail. In patients with increased axillary sweating, sweat glands can be removed. The most painful part of surgical intervention is considered to be sympathectomy. Potential complications include phantom sweating, sweating in the mouth, neuralgia and Bernard-Horner syndrome.