Hyperhidrosis (excessive sweating) is a condition that is characterized by abnormally increased perspiration, which is in excess of that required for the body’s temperature regulation.

Hyperhidrosis can be either generalized or localized to specific areas of the body. The hands, the feet, the armpits, and the groin regions are amongst the most active areas of perspiration, this is due to the relatively high concentration of sweat glands, but any area of the body can be affected.

It can also be classified dependant on if it is congenital or acquired. Primarily excessive sweating is found to start during someone’s adolescence or perhaps before and appears to be inherited as an autosomal dominant genetic trait. It must be distinguished from the secondary hyperhidrosis, which can begin at any time in life. The latter form may well be due to a thyroid disorder or pituitary gland, tumors, or gout, diabetes mellitus, or menopause, certain drugs, or even mercury poisoning.

It may also be divided into emotional palmoplantar, gustatory or generalized excessive sweating. It may also be classified according to the quantity of skin that becomes affected and its possible causes. Excessive sweating in any area that’s greater than 100 cm 2, up to the general sweating of the complete body, is differentiated from sweating that only affects a small region.

Causes

The primary hyperhidrosis cause is unknown, although some physicians claim that it is caused by sympathetic over activity. Anxiety may exacerbate the situation for many. One common complaint of sufferers is that they become nervous because they sweat, then they sweat more because they are nervous. Other factors may play a role, such as certain foods and drinks, caffeine, nicotine, and some smells can trigger a response.

Medications

Aluminium chloride has been used regularly in antiperspirants. But hyperhidrosis victims need solutions with a much greater concentration to effectively treat symptoms of the condition. The secondary effect is that it might cause irritation. Also, the solution is generally not effective for hands and feet. There has been some success using conservative measures such as aluminium chloride antiperspirants for severe cases of palmar and plantar hyperhidrosis.

Type A Botulinum toxin injections are used to disable sweat glands. The effects of these injections can last from 4 – 9 months depending on the area of injection. The procedure for underarm sweating has been approved by the U.S. Food and Drug Administration.

Some anticholinergic drugs can reduce excessive sweating. Oxybutynin is one that has shown promise but it has important side effects, which can include drowsiness, dryness in the mouth and other mucus membranes and visual symptoms. Glycopyrrolate is another drug used. It seems to be almost as effective as oxybutynin and has similar side effects. Other anticholinergic agents that have been tried include propantheline bromide and benzatropine.

Anxiolytics and antidepressants were originally used in the belief that primary hyperhidrosis was related to an anxious personality.

Surgical Treatments

Endoscopic thoracic sympathectomy, the main sympathetic chain that runs beside the spine, often with the addition of the ganglia nerve, are either, burned, clamped or cut out. Clamping is designed to permit reversal procedure. It is generally considered a safe, effective and reproducible procedure. Satisfaction rates of above 80% have been reported. ETS may be helpful in treating axillary hyperhidrosis, facial sweating and facial blushing; but, patients with excessive facial sweating or facial blushing experience higher failure rates, and patients may be more likely to experience unwanted side effects.

ETS side-effects have been described ranging from trivial to devastating. The common secondary effect of ETS is compensatory sweating. Drawbacks relating to compensatory sweating are seen in 20-80%. Most sufferers find the compensatory sweating to be tolerable, whilst 1-51% claim that their quality of life decreased. Body perspiration in response to heat has been claimed to increase after sympathectomy. Compensatory sweating is often a self limiting, temporary condition. Also, the original sweating may recur due to nerve regeneration.

Some other side effects can include Horner’s Syndrome, gustatory sweating and occasionally very dry hands. Some patients have also experienced a cardiac sympathetic denervation, this results in about a 10% lowered heartbeat; leading to an impairment of the heart rate to any workload relationship.

A relatively new procedure is a Lumbar sympathectomy. It is aimed at those patients for who an endoscopic thoracic sympathectomy has not relieved excessive foot sweating. The sympathetic chain in the lumbar region is divided or clipped to relieve the severe foot sweating. Success rates are in the region of 90%. The operation should only be carried out if patients have first tried other conservative measures. This is also a controversial type of sympathectomy as patients under-going this procedure often end up with hypotension.

Sweat gland suction and percutaneous sympathectomy are other techniques that are used. Sweat gland suction is a technique that has been adapted from liposuction, where approximately 30% of the sweat glands are removed, which has a proportionate reduction in sweat. Percutaneous sympathectomy is a minimal invasive procedure where the nerve is blocked with an injection of phenol. Temporary relief is experienced in most cases. Some doctors and surgeons advocate the use of this procedure before the permanent surgical sympathectomy.

Iontophoresis, originally described in the 1950s, mode of action remains elusive to date. The affected region is placed into a device that has two pails of water with a conductor in each one. The foot or hand acts like a conductor between the positive and negative charged pails. As a low current passes through the area, the minerals in the water begin to clog up the sweat glands, limiting the amount of sweat being able to be released. Some have seen great results whilst others have seen no effect. The treatment can be painful but over time the body will adjust to the procedure. The process is time-consuming and is usually used for the hands and feet, but there has been a device designed for the armpit area.

Some success has been gained by using hypnosis in improving the process of administering injections for the treatment of hyperhidrosis. Talcum powder or baby powder can be utilized for a temporary treatment, the powder will absorb the sweat, but it may become a messy white coating where applied. Absorbent insoles can help decrease the sweat in shoes. Meditation and relaxation, and weight loss have also been suggested to help.

Hand excessive sweating interferes with many routine activities, like securely grasping objects. Some excessive sweating sufferers will avoid situations where they come into physical contact with others, such as a handshaking. Embarrassing sweat marks under the armpits limit sufferers’ pose and arm movements. With severe cases, shirts will have to be changed several times during the day. Plus, anxiety caused by the self consciousness to the may aggravate the sweating. Excessive feet sweating makes it more difficult to wear open-toe or slide-on shoes, as the feet slip in the shoes because of sweat.

Some challenges present themselves in some careers for excessive sweating sufferers. Example, careers that require the deft use of knives may not be safely performed by sufferers with excessive hand sweating. Sales staff, who have to interact with many new people can be negatively affected by social rejection. Risk of dehydration can limit the ability of some to function in extremely hot and humid conditions. Some playing of musical instruments may be difficult or uncomfortable due to sweaty hands.

Primary hyperhidrosis (excessive sweating) is estimated to affect 2.8% of the population, affecting men and women equally, and will most commonly occur amongst people aged in the 25 – 64 year age group. Around 30 – 50% will have had another family member afflicted, therefore implying a genetic predisposition.

Excessive sweating can very often be effectively managed. Some natural treatments recently have had some extremely good results in their effectiveness to reduce and stop underarm excessive sweating.