Hyperhidrosis
| Hyperhidrosis: Hospital, Surgery & Home Treatments |
| Excessive sweating is a problem all too common for M.E. sufferers. Here Julie Halford RGN of the Hyperhidrosis Support Group gives help & advice. Please Tell-A-Friend about this article and the work of the Hyperhidrosis Support Group. |
 Plantar Hyperhidrosis |  Palmer Hyperhidrosis |  Axillae Hyperhidrosis |
| Overview |
| Sweating is regulated by the sympathetic nervous system. In about 1.0% of the population, this system is revved-up, over-stimulating the eccrine sweat glands causing excessive sweating to occur at inappropriate times in specific areas of the body. This condition is known as Hyperhidrosis and causes considerable social, psychological and occupational problems leading to a marked negative effect on the patients’ life. Shaking hands becomes uncomfortable and working with paper and metal cause a problem, making business and day-to-day life a struggle. Sports enthusiasts, especially those who play racquet sports often find it difficult, as they are not able to grip sufficiently. Likewise musicians can experience difficulties, not only in playing, but due to the damage caused to the instrument from the excessive sweating. Patients report that they are even embarrassed to hold the hands of those they love. Furthermore, excess sweating of the feet is often associated with an unpleasant odour, maceration of the toes and mycotic infections. Regardless of where it is located, Hyperhidrosis presents an embarrassing problem to all those afflicted with it. |
| Causes |
| We do not know why Hyperhidrosis starts, however, it has been successfully linked it to over activity in the sympathetic nervous system. Specifically, it is the Thoracic Sympathetic Ganglion Chain, which runs along the vertebra of the spine inside the chest cavity. This chain controls the apocrine and eccrine glands, responsible for perspiration throughout the entire body. Sometimes people will sweat excessively because of other illnesses such as hyperthyroidism, psychiatric disorders, menopause and obesity. These causes must first be ruled out before Primary Hyperhidrosis can be diagnosed. On examination, it is important to rule out generalized Hyperhidrosis. If generalized, it is necessary to perform routine screens (FBC, ESR or CRP, U&E, RBS, TFT) and further screens if clinically indicated. (LTFs, blood film for malarial parasites, HIV.) |
| Symptoms |
| Hyperhidrosis can occur in many different areas of the body, but most commonly affects the hands and feet. Palmar and Plantar Hyperhidrosis are most disabling as they are difficult for the patient to hide. Hyperhidrosis is also common in the axillae, causing staining of clothes and, together with an embarrassing odour, forces most sufferers to change their clothes several times a day. Facial, groin and back sweating, although less common, affect a considerable number of people. The typical age of onset is in the teenage years, although it is not uncommon in children. The disease follows a chronic course in the majority of patients. |
| Treatment |
| • Primary Care |
| Initial treatment should be carried out in primary care using simple topical preparations of aluminium (Al) salts (Driclor) for all sites of Hyperhidrosis. Irritation of the skin is common and these products should be used with caution and intermittently when this occurs. If patients are not able to tolerate these they should then be referred to a specialist for further treatment. At diagnosis, patients should be given reassurance, together with basic information and advice about their Hyperhidrosis by a member of the primary care team, including the following: |
 | 1. Avoid tight clothing 2. Avoid all man made fabrics 3. Minimize obvious signs of sweating by wearing black or white clothing 4. Use emollient washes and moisturizers rather than soap-based cleansers 5. Identify any trigger factors for sweating such as crowded rooms, alcohol etc. 6. Introduce to patient support group – www.hyperhidrosisuk.org (free information for patients) |
| Follow up should be after 1-2 months and treatment reviewed at that stage. Anticholinergic drugs are helpful, but should be used as a last resort as they often have unnecessary side effects. |
| • Secondary Care |
| Iontophoresis |
 Iontophoresis treatment for palmer & plantar hyperhidrosis |  The i2ma machine |  The Idrostar machine |
| Most patients now use electrical stimulation (Iontophoresis) which has proven to be most effective. This is only suitable for palmer and plantar Hyperhidrosis, but can be carried out in the surgery or at home, or the patient can be referred to a Dermatology Department. Trials are underway for the treatment of axillae Hyperhidrosis using iontophoresis. The results of these trials should be available within the next few months. Iontophoresis is now mostly performed in Dermatology departments with the use of the Iontophoresis machines introduced into this country a few years ago, by STD Pharmaceuticals. The results have been quite outstanding. These machines run on re-chargeable batteries and can be used with tap water alone. Nearly all patients achieve a complete cessation of sweating after about four, 20 minute sessions. The absence of sweating tends to last from about 2 weeks to 3 months. Patients then undergo another course of treatment, which can be practiced at home, as patients are now able to buy their own ‘home kit’ for a reasonable price. The treatment is pain free, safe, cheap to run and can be done as often as is necessary. Iontophoresis is defined as the topical introduction of ionized drugs into the skin using direct current. However, iontophoresis with simple tap water alone is successful in about 85% of patients. Those who do not respond to tap water alone can add an Anticholinergic drug such as Glycopyrromium Bromide to the water, resulting in a complete cessation of sweating after the required amount of treatment sessions. Contraindications: Pregnancy – Cardiac pacemakers and similar devices – Metal orthopaedic implants |
| Botulinum Toxin A |
| This procedure is carried out by Dermatologists or interested specialists throughout the UK. However, this treatment is rarely available on the NHS and costs approx £400 per session. ‘Botox’ as it has become more widely known, is now licensed in the UK to treat axillae Hyperhidrosis only. The treatment consists of a series of injections intradermally into the axillae. ‘Botox’ works by blocking acetylcholine release and hence neurotransmission. Eventually neurotransmission is restored and the eccrine gland activity returns requiring further injection from about 4-12 months after the initial treatment. The injections can be painful, but usually tolerated without anaesthesia in the axillae. Side effects: Diffusion may affect muscle function and it is important to warn patients about weakness of the intrinsic muscles of the hand. Contraindications: Those who are sensitive to any of the ingredients. Pregnancy and breastfeeding. Disorders of the neuromuscular junction (myasthenia gravis, myopathies and Eaton-Lambert syndrome.) |
| Disposable Axillae Pads |
| These pads prevent excessive sweating of the axillae showing on clothes and hence, prevent staining of clothes, and are available from STD Pharmaceutical. |
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| Endoscopic Thoracic Sympathectomy |
| In order to end Hyperhidrosis, the surgeon must divide the overactive sympathetic nerves that cause the excessive perspiration. The surgery is done endoscopically with results being most successful for palmar & facial Hyperhidrosis. There are a number of potential complications including, pheumothorax, bleeding, infection, Horner’s syndrome and neuralgia. Perhaps most significant is the compensatory sweating which occurs in a high proportion of patients. Gustatory sweating is less common. Surgery is therefore reserved for severe cases in which other methods of treatment have failed. |
| Further Information |
| The Hyperhidrosis Support Group is a website designed for patients and medical staff who wish to obtain further information on the treatments of Hyperhidrosis. An information pack on Hyperhidrosis and Iontophoresis is available from STD Pharmaceuticals. © Hyperhidrosis Support Group _________________________________________________ The photographs of Axillae and Plantar Hyperhidrosis are courtesy of the International Hyperhidrosis Society © |
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