Hyperhidrosis
Primary hyperhidrosis is the medical condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature. Some patients afflicted with the condition experience a distinct reduction in the quality of life. Sufferers feel at a loss of control because perspiration takes place independent of temperature and emotional state.
However, anxiety can exacerbate the situation for many sufferers. A common complaint of patients is that they get nervous because they sweat, then sweat because they are nervous. Other factors can play a role; certain foods, nicotine, caffeine, and smells can trigger a response (see also diaphoresis).
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 body may be affected. Primary hyperhidrosis is found to start during adolescence or even before, and interestingly, 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 or certain drugs.
Primary hyperhidrosis is estimated at around 1% of the population, afflicting men and women equally.
Treatment
Hyperhidrosis can usually be treated, but achieving a cure is difficult.
- Surgery (Endoscopic thoracic sympathectomy or ETS): Select nerves or nerve ganglia in the chest are either cut or burned (completely destroying their ability to transmit impulses), or clamped, which may allow for reversal of the procedure. The procedure often causes anhidrosis from the mid-chest upwards. A majority of patients experience compensatory hyperhidrosis in other parts of the body. Some people find it tolerable while others feel that the compensatory hyperhidrosis is disabling. Patients typically lose vascular control, have lowered cardiac function, and fatigue. The entire syndrome caused by ETS surgery is corposcindosis, which means "split-body syndrome". There are other risks, such as chronic pain and personality changes. There is a less than 1% chance of Horner's syndrome, and other risks common to minimally-invasive surgery. The surgery can be expensive, but can be covered by insurance. Increasingly, because of multitudes of disabled patients and many lawsuits, the use of the procedure is being curtailed.
- Aluminum chloride (hexahydrate) solution: The most common brands are Drysol®, Maxim® and Odaban®. Aluminum chloride is used in regular antiperspirants, but hyperhidrosis sufferers need a much higher concentration. A 15% aluminum chloride solution or higher usually takes about a week of nightly use to stop the sweating, with one or two nightly applications to maintain the results. An aluminum chloride solution can be very effective; some people, however, cannot tolerate the irritation that it can cause. Also, the solution is usually not effective for palmar (hands) and plantar (feet) hyperhidrosis.
- Botulinum toxin type A (trademarked as Botox®): Injections of the botulinum toxin are used to disable the sweat glands. The effects can last from 4-9 months depending on the site of injections. With proper anesthesia the hand and foot injections are almost painless. The procedure when used for underarm sweating has been approved by the US FDA, and now some insurance companies pay partially for the treatments.
- Iontophoresis: 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 hand, the minerals in the water clog the sweat glands, limiting the amount of sweat released. A common brand of tap water iontophoresis device is the Drionic®, Idrostar or MD1 Fischer. Some people have seen great results while others see no effect. However, since the device can be painful to some and a great deal of time is required, no cessation of sweating in some people may be the result of not using the device as required. The device is usually used for the hands and feet, but there has been a device created for the axillae (armpit) area as well.
- Oral medication: There are several drugs available with varying degrees of success. A class of anticholinergic drugs are available that have shown to reduce hyperhidrosis. Ditropan® (generic name: oxybutynin) is one that has been the most promising. For some people, however, the drowsiness and dry-mouth associated with the drug cannot be tolerated. A time release version of the drug is also available, called Ditropan XL®, with purportedly reduced effectiveness. Robinul® (generic name: glycopyrrolate) is another drug used on an off-label basis. The drug seems to be almost as effective as oxybutynin, with similar side-effects. Other less affective anticholinergic agents that have been tried include propantheline bromide (Probanthine®) and benztropine (Cogentin®). A different class of drugs known as beta-blockers has also been tried, but don't seem to be nearly as effective.
- Weight-Loss: Hyperhidrosis can be aggravated by obesity, so weight-loss can help. However, most people with hyperhidrosis do not sweat excessively due to obesity.
- Relaxation and meditation: Relaxation techniques have been tried with limited success.
- Hypnosis: Hypnosis has been used with limited success.
Social effects
Excessive sweating is impractical for doing many things considered routine to most. Actions like driving, taking tests and simply grasping objects are severely hampered by sweaty hands. In addition, many careers are more difficult to pursue, such as for cook/chefs, doctors, and people who work with computers. However, it is the social embarassment that most hyperhidrosis sufferers find most troubling.
Some hyperhidrosis sufferers feel they have to avoid situations where they will come into physical contact with others. Interviews, a common source of anxiety for many people, are particularly harrowing for hyperhidrosis patients. Sadly, it is the handshake before and after the interview that they will be stressing most about.
The social stigma goes further. While the number is undocumented, the condition has driven some patients to commit suicide. While those may be extreme cases, some hyperhidrosis patients will be depressed and seclude themselves. They may find it difficult to meet new people as a wet handshake or a sweat-stained shirt can be repulsive.
The very social interaction that could help lift the spirits of an individual suffering with hyperhidrosis is reduced. Interaction with others is extremely important. The simple experience of touch by another is proving to be extremely important to the psychological well-being of a person.[1]