A Family Doctor's Tale - HYPERHYDROSIS

DOC I AM SWEATING EXCESSIVELY

Have you ever shake the hand of a person and find your hand wet with sweats. The person is suffering from hyperhidrosis. There are also patients who sweats excessively not only in their hands but also in their armpits, groins and forehead. You can practically see the sweats pouring from their foreheads. It is an uncomfortable 
condition but many patients have to learn to live with it or see a doctor to be treated for it.

Hyperhidrosis is the condition when a person suffers from excessive perspiration due to overactivity of the sweat glands.


This may cause a social problem in people who need to shake hands or write with sweaty palms.


Excess perspiration with foul odor may also be offensive to people around the patient



The cause of Hyperhidrosis is usually unknown.


It has been linked to :

1.excessive sweat glands


2.psychogenic excess production of sweats under stress and nervous conditions


3.Endocrine disorder such as hyperthyroidism


4.Skin diseases with increased hydration of skin such as in weeping eczema


5.Genetic - inherited as an autosomal dominant trait. Family has a history of Hyperhidrosis


6.diseases of the nervous system



7.Tuberculosis-night sweats are a typical feature of tuberculosis


8.diabetes mellitus and pituitary disorders


9.Certain medicines such as aspirin, paracetamol may provoke excess sweating


10.alcohol, caffeine, and certain food(spices) may stimulate the sweat glands



Persons who has Hyperhidrosis has the following
Symptoms:
1.Generalised sweating


2.localized sweating of palms, soles, axilla and groins


3.Foul smell from the excess sweat is caused by the decomposition of skin cells by bacteria and yeast infection


Signs:
1.Skin may become thickened, fissured or scaly


2.Nail deformities may occur


3.Secondary bacterial and fungal infections may be present



Diagnosis can usually be made by :
1.Sweaty palms or soles


2.thickened, fissured skin with nail deformities


Treatment is by:
1.Treat the underlying cause such as hyperthyroidism, diabetes


2.Clean involved skin frequently with baths etc. Use talcum powder to dry skin.


3.Wear cotton socks and underwear and change daily.


4.Local application of aluminium chloride, hexahydrate, glutaradehyde and even tannic acid from tea. Some side effects may be allergic dermatitis or staining of skin


5.Anticholinergic drugs can reduce the sweating but has side effects such as dryness of mouth and flushing


6.Surgery in severe cases may be required such as sympathectomy (for palms).
Sweat glands suction by removing some of the sweat glands has been shown to reduce sweating


7.Iontophoresis: may help but may be painful


8.Botox injection may disable the sympathetic nerves to the sweat glands but only lasts for 6-9 months


9.Hypnosis, relaxation and meditation has help to certain extent


10.Radiotherapy has been known to be effective but not used because of the danger of bone cancer.



Prognosis is usually palliative as the sweat glands and nerve cells may grow back.


Recurrence is quite common.