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  FAQ's ( Hyperhidrosis )  
 
  1. What is Hyperhidrosis?
  2. What makes us sweat?
  3. Is it a frequent condition?
  4. What’s the cause of hyperhidrosis?
  5. How I will know that I have hyperhidrosis?
  6. Which investigations are required?
  7. How disabling is this condition?
  8. What are the therapeutic options?

 

1. What is Hyperhidrosis?

Many people who complain of excessive sweating have primary hyperhidrosis. This disorder is characterised by excessive, bilateral and symmetrical sweating, most commonly affecting the axillae (armpits), palms, feet and face.

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2. What makes us sweat?

2 major types of sweat glands.

  • The eccrine glands secrete an odourless, clear fluid which help to control the body temperature when exercising or in summer by allowing heat loss by evaporation. They are most numerous on the palms, soles of the feet, face, axillae and to a lesser extent the back and the chest. They are active from birth.
  • The apocrine glands which start to work from puberty and produce a thick fluid and are responsible for the body odour.

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3. Is it a frequent condition?
The precise prevalence is uncertain because it depends on the perception of the person of excessive sweating. However a survey of 150 000 households in the USA suggested that around 3% (7.8 million Americans) think they sweat excessively or abnormally. However, only 38% of those with hyperhidrosis consulted their physicians about it.

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4. What’s the cause of hyperhidrosis?
It’s due to an overproduction from the sweat glands which are normal in size and number. Patients with hyperhidrosis have an increased response to stimuli, in particular to the emotions, due to sympathetic hyperactivity.. Since hyperhidrosis can be familial and can start in childhood, the physiological basis for this condition is likely to be genetically determined. It’s not a psychological condition, as still unfortunately many healthcare professionals suggest to their patients.

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5. How I will know that I have hyperhidrosis?

Typical features are focal visible sweating (axillae, hands, feet or face) of at least 6 months duration without apparent cause and with at least 2 of the following features:

  1. Age of onset less than 25 years
  2. Positive family history
  3. Cessation of focal sweating during sleep
  4. Exclusion of an underlying cause, some drugs (propanolol, tricyclic antidepressants), infection, thyrotoxicosis, hypoglycaemia, and menopause

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6.Which investigations are required?

The minor’s iodine starch test is useful in mapping the areas of excessive sweating prior to the treatment. It involves painting the affected area with iodine solution and allowing it to dry, before dusting with starch powder. Areas of sweating become purple as the sweat dissolves the starch which reacts with the iodine.

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7-How disabling is this condition?

Different questionnaire of quality of life have been used to assess the burden of hyperhidrosis in the quality of life and compared it with other skin conditions. Hyperhidrosis patients score as high as patients with psoriasis and severe eczema in term of impact on quality of life.
The patients end up in a vicious circle, more they loose their confidence and reduce their social contact, more they become obsess and emotional about their condition, and more they sweat.

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8- What are the therapeutic options?

  1. The aluminium chloride solutions which the patient apply topically to dried axillae once every night and then washed off in the morning.There is a risk of skin irritation
  2. The Iontophoresis which is based on passing an electrical weak current through an electrolyte solution through the skin, suitable for palmar or plantar HH,with session of 30 to 40 minutes,daily, 4 days per week
  3. The Drugs :which are Antimuscarinic agents. There is some anectodal reports of benefit with propantheline, oxybutinine and amytriptiline. The side effects such as dry mouth, blurred vision, constipation can minimised by increasing very slowly the doses. It advised to try in case of generalised sweating and failures to other strategies.
  4. The BTX injections which are the most efficient non invasive treatment. The BTX blocks the transmission of the nerve to the sweat gland, which in turn reduces sweating. The Botox is licensed in UK for severe axillary hyperhidrosis. Double blind randomised studies since 1997 have shown the efficacy of BTX in the treatment of axillary, palmar and facial hyperhidrosis.. The injected sites become dry for about 7 months on average ( 6 to 12 months)

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Surgery

The local axillary surgery with local curettage of the sweat glands or excision of the area are not advice considering the risk of permanent side effects (paresthesia, scar tissue) and the efficacy of the botulinum toxin injections

The Sympathectomy involves ablation of the sympathetic nerve supply to the sweat glands with the aim of reducing sweat production. On long term( 14 years) only 33% of axillary hyperhidrosis remains satisfied with the results compared with 73 % for palmar hyperhidrosis.Therefore sympathectomy should be reserved to severe palmar hyperhidrosis. Even if results are good on long term with dry hands, the satisfaction of the patients with this procedure is not as high, likely because of compensatory sweating around the back and the chest .Surgery is not advice before the age of 20 year.

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