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Hyperhidrosis

Hyperhidrosis is excessive perspiration which can be either primary or secondary to the systemic diseases or medications.

Primary hyperhidrosis 

The aetiology of primary hyperhidrosis is idiopathic highest incidence among young patients without any comorbidities onset of symptoms is usually observed in individuals aged 14–25 years and their intensity reduce with time in most patients in 30–50% of cases, a positive family history of the disease can be observed, which suggests a potential genetic background of the hyperhidrosis excessive perspiration usually manifests as a solitary area or multiple symmetrically localized areas. The most frequently affected areas of the body are axillae (about 50%), soles (about 30%), palms (about 25%), and face (about 20%).

The symptoms that patients commonly complain about are sweaty stains on clothing, shoes or touched objects (for example paper sheets), visible sweat drops on the forehead, wet handshakes or sensation of body odor.  The primary type of sweat overproduction occurs episodically and can be triggered by emotions and stress.  In addition, the symptoms emerge during daytime and disappear oversleep other rare variants of primary hyperhidrosis include:

  • Hexsel’s hyperhidrosis is characterized by excessive perspiration in the groin region, which can expand to anterior thigh surface, pubis, external genital organs and gluteal fissure.

Secondary hyperhidrosis 

 Affects older patients and may result from fever, physiological processes like pregnancy or menopause as well as comorbid systemic diseases, drug adverse reactions or complications of medical procedures (for example after thoracic sympathectomy most often manifests itself as a generalized overproduction of sweat.  The symptoms can also appear in asymmetrically localized areas. The disease is not associated with any familial inheritance and may characteristically manifest itself during sleep as the night sweats 

The most common triggering factors involve proliferative diseases, endocrinopathies, cardiac, infectious, nervous system diseases, metabolic and psychiatric disorders.

Excessive perspiration can also develop from adverse reactions after intake of a wide range of medications like opioid analgesics and cyclooxygenase inhibitors, antibiotics and antivirals, cardiac and hypotensive medicaments, antidepressants and mood stabilizers, anticholinergic agents, antipyretics, hypoglycemic agents or topically used formulas (for example Gluc corticosteroids, isotretinoin). 

Secondary hyperhidrosis may also rarely manifest itself as a localized excessive perspiration, especially in the face area. It can be induced by intake of spicy meals, impairment of the sympathetic nervous system associated with pathology of the parotid gland (known as the Frey syndrome) or as a compensatory reaction after endoscopic thoracic sympathectomy.

Treatments

  • Antiperspirants containing   the aluminum salts are a base- line treatment option of the mild and moderate sweat overproduction 
  • Glycopyrrolate is an anticholinergic agent, currently available as a 0.5–4% concentrated topical formulation recommended for the craniofacial and gustatory sweating treatment. 
  • 3% and 10% oxybutynin gel for the focal hyperhidrosis management. Both demonstrated meaningful symptom reduction and patients’ life quality enhancement. Although considerable systemic side. 

Oral treatment is given as an option for those who do not respond to topical treatments. Options include glycopyrrolate and oxybutynin.

Treatments performed in doctors’ rooms include:

  • Iontophoresis
  • Microwave thermolysis, radiofrequency therapy, ultrasound and laser treatments
  • Botox injection

Surgical options are offered to the most severe cases not responding to above treatments. They include local destruction of sweat glands or disruption of the sympathetic nerves sweat overproduction contribute to the major deterioration of patients ‘quality of life. 

It affects many areas of life, such as psychological, social and even economic areas, leading to the disruption of daily life activities. It constitutes a heavy burden for patients leading to self-isolation and loss of self-esteem. 

Researchers have observed an association between hyperhidrosis and the overall greater risk of psychiatric diseases, including depression. Hyperhidrosis has also a direct effect on skin condition by interfering with its natural protective mechanisms. This leads to an increased risk of dermatological conditions among affected patients, especially of fungal, bacterial and less often viral origin. Therefore, excessive perspiration constitutes a complex problem that requires a diligent professional care supported by the novel hyperhidrosis treatment modalities.

We therefore encourage people suffering from hyperhidrosis to see their dermatologist for treatments.

 

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