"A patient with hyperhidrosis has to be evaluated by a dermatologist. This will indicate a treatment with botulinum toxin or anticholinergic drugs, or will be inclined to a surgical solution or other procedures".
DR. AGUSTÍN ESPAÑA
DIRECTOR. DERMATOLOGY DEPARTMENT
What is hyperhidrosis?
Hyperhidrosis is an increase in sweating of certain areas of the body, resulting from an increase in the secretion of the sweat glands.
This increased sweating is usually due to an overactivity of these glands due to nervous hyperstimulation, motivated by situations involving emotional tension or stress, by the action of pharmacological substances or for thermal reasons.
Despite the control of body temperature by the hypothalamus that occurs in normal situations, in hyperhidrosis, the sweat glands in the palms of the hands, soles of the feet, armpits and craniofacial region are particularly sensitive to emotional or thermal stimuli, producing more intense sweating to regulate temperature and counteract the sudden rise in temperature.
Hyperhidrosis can cause work and social disability, affects about 1% of the population, in which almost half of the cases are hereditary.
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What are the symptoms of hyperhidrosis?
Hyperhidrosis can lead to disability in the workplace and in the social sphere, as sweat can soak into clothing, work utensils, and even drip and wet the floor.
In addition to these discomforts, other complications occur such as:
- Bad smell or bromhidrosis.
- In the soles of the feet, skin superinfection by bacteria (pitted keratolysis).
- In the palms of the hands, it favors the development of dishidrosis and contact dermatitis, besides causing cold and cyanotic hands.
The most common symptoms are:
- Excessive sweating.
- Bad smell.
- Overinfection of the skin.
Do you have any of these symptoms?
You may suffer from hyperhidrosis
What are the causes of hyperhidrosis?
The causes of hyperhidrosis tend to be mainly thermal and emotional stimuli, which trigger the cholinergic response (sympathetic nervous system) of the sweat glands, thus causing this excess sweating.
The factors that cause stress in the person can be speaking in public, fear of being observed, of remaining in the company of other people, fear of various situations and even of one's own blushing.
It can also be caused by some pharmacological treatments.
Types of Hyperhidrosis
Depending on your location:
- Generalized: they affect the whole body surface.
- Localized: they affect circumscribed areas.
According to their causes:
- Unknown cause (idiopathic or essential). It is the most frequent. It is located in the armpits, hands, feet and face. It begins in childhood/adolescence and affects 0.6%-1% of the population. It persists for some years and sometimes there is a spontaneous tendency towards improvement by the age of 25. It often has a family history.
- Identified or pathological cause. They can appear accompanying infectious diseases (such as Malta fever), neurological diseases, tumors (such as lymphoma or carcinoid tumor) or general diseases such as diabetes mellitus or alcoholic intoxication. In addition, it can be a side effect of certain drugs, such as antidepressants.
How is hyperhidrosis treated?
Pathological facial blushing and hyperhidrosis are approached from a multidisciplinary perspective that includes different types and intensities of treatments.
Facilitating the appropriate treatment is essential for this pathology, since it can cause work and social disability.
Some cases of hyperhidrosis can be corrected with pharmacological treatments.
The initial treatment is topical, with anticholinergic drugs, such as glycopyronium bromide, and astringent and tanning preparations, such as aluminum chloride, glutaraldheide or salicylic acid. The mechanism of action is the occlusion of the duct of the sweat glands. They should be applied at night and with dry skin.
A second pharmacological option is systemic treatments: propantheline bromide, tranquilizers and sedatives, such as clonazepam or diazepam, and calcium antagonists, such as diltiazem.
Suitable for certain cases of hand or armpit sweating.
The administration of this drug produces a selective blockage in the action of acetylcholine on the ecrine glands, decreasing the production of sweat.
First a test is performed to know which areas sweat the most and thus act more selectively, avoiding systemic side effects.
Surgical treatment is effective and definitive in more than 80% of the cases of hyperhidrosis in hands, feet, armpits and face.
It is indicated for the most severe cases, in which the rest of the procedures have failed. It should always be dictated by the surgeon, since it is not effective for all patients.
The intervention is performed on an outpatient basis with a very low complication rate. It lasts approximately one hour, with very satisfactory results for the patient from the first days.
The minimally invasive surgical procedure is called videothoracoscopic thoracic sympathectomy. It consists of making a small incision of only 5 mm, on each side of the thorax to locate and section or compress by means of clips, in a specific point, the sympathetic chain, which is the one that controls the sweating and facial blushing.
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