hyperhidrosis, Do you sweat more than normal

Hyperhidrosis  or excessive perspiration can be defined as a sweating greater than necessary for the maintenance of normal body thermoregulation. Hyperhidrosis  can be either generalized or localized. This chronic autonomic disorder that can be debilitating as it can  lead to emotional and social embarrassment, as well as occupational, physical and psychological disability.

Risk factors or causes

Hyperhidrosis results due to excessive production of sweat by the sweat glands. This can be a result of   overactive cholinergic innervations of these glands. Cause of excessive sweating can be primary (idiopathic/essential) or secondary to another underlying disease. Secondary hyperhidrosis can be further studied generalized (autonomic dysregulation or secondary to systemic condition), local (abnormal regeneration of sympathetic nerves), or emotionally induced.   

Treatments

Treatment of hyperhidrosis  consist of  nonsurgical  and surgical treatment .   Non-surgical treatment includes the use of aluminum chloride, anti cholinergic drugs, botox injection and iontophoresis  while surgical treatment   involves local excision of eccrine sweat gland, liposuction curettage, and sympathetic denervation.  As explained above, hyperhidrosis takes place due to overactive cholinergic innervations of sweat glands.  Hence, agents which can block the epidermal duct of sweat glands serve as treatment modalities. Aluminium chloride hexahydrate not only blocks the epidermal duct of eccrine sweat glands but also  induces atrophy and vacuolization of glandular secretory cells. Hence, they are the first line of treatment in case of axillary, palmar, plantar and craniofacial hyperhidrosis. Botox  by paralyzing neuromuscular junction inhibits the sweat secretory line and hence used while  topical anticholinergics are used mostly in the treatment of craniofacial hyperhidrosis. Iontophoresis is used for palmar and plantar hyperhidrosis, in which botox or anticholinergic drugs are used.

Local excision of eccrine sweat gland has been a treatment option for ages.  Although radical skin excision involves removal of dermally located eccrine gland along with dermal–subcutaneous junction, the procedure is often associated with a number of complications and side effects. Except that,  liposuction curettage and  sympathetic  denervation are the other common treatment modalities

Self care

Patient with hyperhidrosis should keep a track record of situations which can trigger excessive sweating. Learning about the triggering factors can help in controlling the sweating. Common triggers include certain foods like spicy food, coffee and tea, MSG and alcohol. Antiperspirants should be used to reduce sweating. It is advised to use antiperspirants at night, as at that time they have a better chance to get into pores and block perspiration in the morning. Antiperspirants with clinical strength should be used. Clinical strength antiperspirants are more effective at stopping sweat and hyperhidrosis because they have higher concentrations of active ingredients.

When the sweaty foot is present, a risk for foot odor and infections like athlete’s foot is increased. In order to prevent that, footwear of natural material like leather should be worn, wear socks that keep moisture away from the skin. Apply antiperspirant to feet before going to bed.

Drugs used in treating

Aluminium chloride, anticholinergics and botox injections are the primary drugs used for hyperhidrosis. As explained above aluminium chloride blocks the eccrine sweat glands. Systemic anticholinergics   competitive blocks muscarinic receptors near the eccrine sweat glands and prevent sweating. While botox paralyzes the neuromuscular junction.