|This article needs additional citations for verification. (May 2012)|
|Classification and external resources|
Hyperhidrosis is a condition characterized by abnormally increased sweating, in excess of that required for regulation of body temperature. It can be associated with a significant quality of life burden from a psychological, emotional, and social perspective. It has been called by some 'the silent handicap'.
Both the words diaphoresis and hidrosis can mean either perspiration (in which sense they are synonymous with sweating) or excessive perspiration, in which case they refer to a specific, narrowly defined, clinical disorder.
Hyperhidrosis can either be generalized, or localized to specific parts of the body. Hands, feet, armpits, and the groin area are among the most active regions of perspiration due to the high number of sweat glands in these areas. When excessive sweating is localized (e.g. palms, soles, face, underarms, scalp) it is referred to as primary hyperhydrosis or focal hyperhidrosis. Excessive sweating involving the whole body is termed generalized hyperhidrosis or secondary hyperhidrosis. It is usually the result of some other, underlying condition.
Primary or focal hyperhidrosis may be further divided by the area affected, for instance palmoplantar hyperhydrosis (symptomatic sweating of only the hands or feet) or gustatory hyperhidrosis (sweating of the face or chest a few moments after eating certain foods).
Hyperhidrosis can also be classified by onset, either congenital (present at birth) or acquired (beginning later in life). Primary or focal hyperhidrosis usually starts during adolescence or even earlier and seems to be inherited as an autosomal dominant genetic trait. It must be distinguished from secondary hyperhidrosis, which can start at any point in life. Secondary hyperhydrosis may be due to a disorder of the thyroid or pituitary glands, diabetes mellitus, tumors, gout, menopause, certain drugs, or mercury poisoning.
One classification scheme uses the amount of skin affected. In this scheme, excessive sweating in an area of 100 square centimeters (16 square inches) or more is differentiated from sweating that affects only a small area.
Another classification scheme is based on possible causes of hyperhydrosis.
The cause of primary hyperhidrosis is unknown, although some physicians[who?] claim it is caused by sympathetic over-activity. Nervousness or excitement can exacerbate the condition for many sufferers. A common complaint of patients is they get nervous because they sweat, then sweat more because they are nervous. Other factors can play a role, including certain foods and drinks, nicotine, caffeine, and smells.
- Causes of Focal (Primary) Hyperhidrosis, affecting a relatively small area (less than 100 cm2)
- Idiopathic unilateral circumscribed hyperhydrosis
- Reported association with:
- Gustatory sweating associated with:
- Causes of Generalized (Secondary) Hyperhidrosis, affecting a relatively large area (generalized; over 100 cm2)
- In people with a past history of spinal cord injuries
- Associated with peripheral neuropathies
- Associated with probable brain lesions
- Associated with intrathoracic neoplasms or lesions
- Associated with systemic medical problems
- Associated with toxins
Aluminium chloride is used in regular antiperspirants. However, hyperhidrosis requires solutions or gels with a much higher concentration. These antiperspirant solutions or hyperhidrosis gels are especially effective for treatment of axillary or underarm regions. Normally it takes around three to five days to see improvement. The most common side-effect effect is skin irritation. For severe cases of plantar and palmar hyperhidrosis, there has been some success with conservative measures such as higher strength aluminium chloride antiperspirants. Treatment algorithms for hyperhidrosis recommend topical antiperspirants as the first line of therapy for hyperhidrosis. Both the International Hyperhidrosis Society and the Canadian Hyperhidrosis Advisory Committee have published treatment guidelines for focal hyperhidrosis that are said to be 'evidence-based.'
Prescription medications called anticholinergics, taken by mouth, are sometimes used in the treatment of both generalized and focal hyperhidrosis. Anticholinergics used for hyperhidrosis include propantheline, glycopyrronium bromide or glycopyrrolate, oxybutynin, methantheline, and benztropine. Use of these drugs can be limited, however, by side-effects, including dry mouth, urinary retention, constipation, and visual disturbances such as mydriasis (dilation of the pupils) and cycloplegia. For people who find their hyperhidrosis is made worse by anxiety-provoking situations (public speaking, stage performances, special events such as weddings, etc.), taking an anticholinergic medicine before the event may be helpful. (Reference: Böni R. Generalized hyperhidrosis and its systemic treatment. Curr Probl Dermatol. 2002;30:44-47.)
Several anticholinergic drugs can reduce hyperhidrosis. Oxybutynin (brand name Ditropan) is one that has shown promise, although it can have side-effects, such as drowsiness, visual symptoms and dryness of the mouth and other mucous membranes. A time release version of the drug is also available (Ditropan XL), which may cause less side-effects. Glycopyrrolate (Robinul) is another drug sometimes used. It is said to be nearly as as effective as oxybutynin, but has similar side-effects. Other anticholinergic agents that have tried to include propantheline bromide (Probanthine) and benztropine (Cogentin).
Injections of botulinum toxin type A, (Botox, Dysport) can be used to block neural control of sweat glands. The effect can last from 3–9 months depending on the site of injections. This use has been approved by the U.S. Food and Drug Administration (FDA). The duration of the beneficial effect in primary palmar hyperhidrosis has been found to increase with repetition of the injections.  The Botox injections tend to be painful. Various measures have been tried to minimize the pain, one of which is the application of ice.
A microwave-based device has been tried for excessive underarm perspiration and appears to show promise. Iontophoresis as a treatment for palmoplantar hyperhidrosis was originally described in the 1950s.
Sweat gland removal or destruction is one surgical option available for axillary hyperhidrosis (excessive underarm perspiration). There are multiple methods for sweat gland removal or destruction, such as sweat gland suction, retrodermal currettage, and axillary liposuction, Vaser, or Laser Sweat Ablation. Sweat gland suction is a technique adapted for liposuction.
The other main surgical option is endoscopic thoracic sympathectomy (ETS), which cuts, burns, or clamps the thoracic ganglion on the main sympathetic chain that runs alongside the spine. Clamping is intended to permit the reversal of the procedure. ETS is generally considered a "safe, reproducible, and effective procedure and most patients are satisfied with the results of the surgery". Satisfaction rates above 80% have been reported, and are higher for children. The procedure brings relief from excessive hand sweating in about 85-95% of patients. ETS may be helpful in treating axillary hyperhidrosis, facial blushing and facial sweating, but failure rates in patients with facial blushing and/or excessive facial sweating are higher and such patients may be more likely to experience unwanted side effects.
ETS side-effects have been described as ranging from trivial to devastating. The most common side-effect of ETS is compensatory sweating (sweating in different areas than prior to the surgery). Major problems with compensatory sweating are seen in 20–80% of patients undergoing the surgery. Most people find the compensatory sweating to be tolerable while 1–51% claim that their quality of life decreased as a result of compensatory sweating." Total body perspiration in response to heat has been reported to increase after sympathectomy. The original sweating problem may recur due to nerve regeneration, sometimes as early as 6 months after the procedure.
Other possible side-effects include Horner's Syndrome (about 1%), gustatory sweating (less than 25%) and excessive dryness of the palms (sandpaper hands). Some patients have experienced cardiac sympathetic denervation, which can result in a 10% decrease in heart rate both at rest and during exercise, resulting in decreased exercise tolerance.
Lumbar sympathectomy is a relatively new procedure aimed at those patients for whom endoscopic thoracic sympathectomy has not relieved excessive plantar (foot) sweating. In this procedure, the sympathetic chain in the lumbar region is clipped or cut. The success rate is about 97%, but the operation should be used only if other, conservative measures have failed to provide relief. The development of retrograde ejaculation, inability to maintain erection and hypotension as a result of this surgery appears to be very rare. Journal articles describing the technique and case reports suggest that none of 18 men who underwent the procedure at two separate surgical units experienced sexual disability following surgery. No mention is made of hypotension or sexual disabilities occurring in female patients.
Percutaneous sympathectomy is a minimally invasive procedure similar to the botulinum method, in which nerves are blocked by an injection of phenol. The procedure provides temporary relief in most cases. Some physicians advocate trying this more conservative procedure before resorting to surgical sympathectomy, the effects of which are usually not reversible.
Hyperhidrosis can have physiological consequences such as cold and clammy hands, dehydration, and skin infections secondary to maceration of the skin. Hyperhidrosis can also have devastating emotional effects on one’s individual life.
Affected people are constantly aware of their condition and try to modify their lifestyle to accommodate this problem. This can be disabling in professional, academic and social life, causing embarrassments. Many routine tasks can result in a disproportionate level of sweating, which can be emotionally draining to these individuals.
Excessive sweating or focal hyperhidrosis of the hands interferes with many routine activities, such as securely grasping objects. Some focal hyperhidrosis sufferers avoid situations where they will come into physical contact with others, such as greeting a person with a handshake. Hiding embarrassing sweat spots under the armpits limits the sufferers' arm movements and pose. In severe cases, shirts must be changed several times during the day and require additional showers both to remove sweat and control body odor issues or microbial problems such as acne, dandruff, or athlete's foot. Additionally, anxiety caused by self-consciousness to the sweating may aggravate the sweating. Excessive sweating of the feet makes it harder for patients to wear slide-on or open-toe shoes, as the feet slide around in the shoe because of sweat.
Some careers present challenges for hyperhidrosis sufferers. For example, careers that require the deft use of a knife may not be safely performed by people with excessive sweating of the hands. The risk of dehydration can limit the ability of some sufferers to function in extremely hot (especially if also humid) conditions. Even the playing of musical instruments can be uncomfortable or difficult because of sweaty hands. There is a nonprofit organization dedicated to improving awareness of hyperhidrosis, its serious effects, scientific and medical research related to the condition, available treatments, and other support and resources available to people with the condition and their loved ones. This organization is called the International Hyperhidrosis Society (http://www.SweatHelp.org).
It is estimated that the incidence of focal hyperhidrosis may be as high as 2.8% of the population of the United States. It affects men and women equally, and most commonly occurs among people aged 25–64 years, though some may have been affected since early childhood. About 30–50% of people have another family member afflicted, implying a genetic predisposition.
In 2006, researchers at Saga University in Japan reported that primary palmar hyperhidrosis maps to gene locus 14q11.2–q13.
- James, William; Berger, Timothy; Elston, Dirk (2006). Andrews' Diseases of the Skin: Clinical Dermatology (10th ed.). Saunders. pp. 777–8. ISBN 978-0-7216-2921-6.
- "Hyperhidrosis". Sweat Fighter. Sweat Fighter. Retrieved 25 June 2015.
- Swartling, Carl; et al. (2011). "Hyperhidros - det "tysta" handikappet". Läkartidningen (in Swedish) 108 (47): pp2428–2432.
- Elsevier, Dorland's Illustrated Medical Dictionary, Elsevier.
- Wolters Kluwer, Stedman's Medical Dictionary, Wolters Kluwer.
- Roberto de Menezes Lyra, Campos JR, Kang DW, Loureiro Mde P, Furian MB, Costa MG, Coelho Mde S; Sociedade Brasileira de Cirurgia Torácica. (Nov 2008). "Guidelines for the prevention, diagnosis and treatment of compensatory hyperhidrosis.". J Bras Pneumol. 34 (11): 967–77. PMID 19099105.
- Roberto de Menezes Lyra. (July–August 2013). "Visual scale for the quantification of hyperhidrosis.". J Bras Pneumol. 39 (4): 521–2. PMID 19099105.
- Freedberg, Irwin M.; Eisen, Arthur Z.; Wolff, Klaus; Austen, K. Frank; Goldsmith, Lowell A.; Katz, Stephen I., eds. (2003). Fitzpatrick's Dermatology in General Medicine (6th ed.). McGraw-Hill. p. 700. ISBN 978-0-07-138066-9.
- Reisfeld, Rafael; Berliner, Karen I. (2008). "Evidence-Based Review of the Nonsurgical Management of Hyperhidrosis". Thoracic Surgery Clinics 18 (2): 157–66. doi:10.1016/j.thorsurg.2008.01.004. PMID 18557589.
- Togel B1, Greve B, Raulin C. (May–June 2002). "Current therapeutic strategies for hyperhidrosis: a review.". US National Library of Medicine. National Institutes of Health.
- Mijnhout, GS; Kloosterman, H; Simsek, S; Strack Van Schijndel, RJ; Netelenbos, JC (2006). "Oxybutynin: Dry days for patients with hyperhydrosis". The Netherlands journal of medicine 64 (9): 326–8. PMID 17057269.
- Ba, K O; Park, D M (1994). "Botulinum toxin and sweating". Journal of Neurology, Neurosurgery & Psychiatry 57 (11): 1437–8. doi:10.1136/jnnp.57.11.1437. PMC 1073208. PMID 7964832.
- Togel, B (2002). "Current therapeutic strategies for hyperhidrosis: a review". Eur J Dermatol 12 (3): 219–23. PMID 11978559.
- "Information for Healthcare Professionals: OnabotulinumtoxinA (marketed as Botox/Botox Cosmetic), AbobotulinumtoxinA (marketed as Dysport) and RimabotulinumtoxinB (marketed as Myobloc)". U.S. Food and Drug Administration.
- "Commenting on: "Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis"". www.sciencedirect.com. Retrieved 2015-09-18.
- Jacob, C (March 2013). "Treatment of hyperhidrosis with microwave technology.". Seminars in cutaneous medicine and surgery 32 (1): 2–8. PMID 24049923.
- Kreyden, Oliver P (2004). "Iontophoresis for palmoplantar hyperhidrosis". Journal of Cosmetic Dermatology 3 (4): 211–4. doi:10.1111/j.1473-2130.2004.00126.x. PMID 17166108.
- Bieniek, A; Białynicki-Birula, R; Baran, W; Kuniewska, B; Okulewicz-Gojlik, D; Szepietowski, JC (2005). "Surgical treatment of axillary hyperhidrosis with liposuction equipment: Risks and benefits". Acta dermatovenerologica Croatica 13 (4): 212–8. PMID 16356393.
- Henteleff, Harry J.; Kalavrouziotis, Dimitri (2008). "Evidence-Based Review of the Surgical Management of Hyperhidrosis". Thoracic Surgery Clinics 18 (2): 209–16. doi:10.1016/j.thorsurg.2008.01.008. PMID 18557593.
- Steiner, Zvi; Cohen, Zahavi; Kleiner, Oleg; Matar, Ibrahim; Mogilner, Jorge (2007). "Do children tolerate thoracoscopic sympathectomy better than adults?". Pediatric Surgery International 24 (3): 343–7. doi:10.1007/s00383-007-2073-9. PMID 17999068.
- Dumont, Pascal; Denoyer, Alexandre; Robin, Patrick (2004). "Long-Term Results of Thoracoscopic Sympathectomy for Hyperhidrosis". The Annals of Thoracic Surgery 78 (5): 1801–7. doi:10.1016/j.athoracsur.2004.03.012. PMID 15511477.
- Prasad, A; Ali, M; Kaul, S (2010). "Endoscopic thoracic sympathectomy for primary palmar hyperidrosis". Surgical endoscopy 24 (8): 1952–7. doi:10.1007/s00464-010-0885-5. PMID 20112111.
- Reisfeld, Rafael (2006). "Sympathectomy for hyperhydrosis: Should we place the clamps at T2–T3 or T3–T4?". Clinical Autonomic Research 16 (6): 384–9. doi:10.1007/s10286-006-0374-z. PMID 17083007.
- Schott, G D (1998). "Interrupting the sympathetic outflow in causalgia and reflex sympathetic dystrophy". BMJ 316 (7134): 792–3. doi:10.1136/bmj.316.7134.792. PMC 1112764. PMID 9549444.
- Gossot, Dominique; Galetta, Domenico; Pascal, Antoine; Debrosse, Denis; Caliandro, Raffaele; Girard, Philippe; Stern, Jean-Baptiste; Grunenwald, Dominique (2003). "Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis". The Annals of Thoracic Surgery 75 (4): 1075–9. doi:10.1016/S0003-4975(02)04657-X. PMID 12683540.
- Yano, Motoki; Kiriyama, Masanobu; Fukai, Ichiro; Sasaki, Hidefumi; Kobayashi, Yoshihiro; Mizuno, Kotaro; Haneda, Hiroshi; Suzuki, Eriko; et al. (2005). "Endoscopic thoracic sympathectomy for palmar hyperhidrosis: Efficacy of T2 and T3 ganglion resection". Surgery 138 (1): 40–5. doi:10.1016/j.surg.2005.03.026. PMID 16003315.
- Boscardim, PC (2011). "Thoracic sympathectomy at the level of the fourth and fifth ribs for the treatment of axillary hyperhidrosis". J Bras. Pneumol. 37 (1): 6–12. PMID 21390426.
- Kopelman, Doron; Assalia, Ahmad; Ehrenreich, Marina; Ben-Amnon, Yuval; Bahous, Hany; Hashmonai, Moshe (2000). "The Effect of Upper Dorsal Thoracoscopic Sympathectomy on the Total Amount of Body Perspiration". Surgery Today 30 (12): 1089–92. doi:10.1007/s005950070006. PMID 11193740.
- Walles, T.; Somuncuoglu, G.; Steger, V.; Veit, S.; Friedel, G. (2008). "Long-term efficiency of endoscopic thoracic sympathicotomy: Survey 10 years after surgery". Interactive CardioVascular and Thoracic Surgery 8 (1): 54–7. doi:10.1510/icvts.2008.185314. PMID 18826967.
- Fredman, B (2000). "Video-assisted transthoracic sympathectomy in the treatment of primary hyperhidrosis: friend or foe?". Surg Laparosc Endosc Percutan Tech 10 (4): 226–9. PMID 10961751.
- Abraham, P; Picquet, J; Bickert, S; Papon, X; Jousset, Y; Saumet, JL; Enon, B (2001). "Infra-stellate upper thoracic sympathectomy results in a relative bradycardia during exercise, irrespective of the operated side". European Journal of Cardio-Thoracic Surgery 20 (6): 1095–100. doi:10.1016/S1010-7940(01)01002-8. PMID 11717010.
- Reisfeld, Rafael (2008-05-04). "Lumbar Sympathectomy". Retrieved 2008-05-04.
- Rieger, R.; Pedevilla, S. (2006). "Retroperitoneoscopic lumbar sympathectomy for the treatment of plantar hyperhidrosis: Technique and preliminary findings". Surgical Endoscopy 21 (1): 129–35. doi:10.1007/s00464-005-0690-8. PMID 16960674.
- Reisfeld, Rafael (2011-02-11). "Lumbar Sympathectomy with Clamping Method Paper". Retrieved 2011-02-11.
- Wang, Yeou-Chih; Wei, Shan-Hua; Sun, Ming-Hsi; Lin, Chi-Wen (2001). "A New Mode of Percutaneous Upper Thoracic Phenol Sympathicolysis: Report of 50 Cases". Neurosurgery 49 (3): 628–34; discussion 634–6. doi:10.1097/00006123-200109000-00017. PMID 11523673.
- Haider, A.; Solish, N (2005). "Focal hyperhidrosis: Diagnosis and management". Canadian Medical Association Journal 172 (1): 69–75. doi:10.1503/cmaj.1040708. PMC 543948. PMID 15632408.
- http://www.medscape.com/viewarticle/473206_2[full citation needed]
- Higashimoto, Ikuyo; Yoshiura, Koh-Ichiro; Hirakawa, Naomi; Higashimoto, Ken; Soejima, Hidenobu; Totoki, Tadahide; Mukai, Tsunehiro; Niikawa, Norio (2006). "Primary palmar hyperhidrosis locus maps to 14q11.2-q13". American Journal of Medical Genetics Part A 140A (6): 567–72. doi:10.1002/ajmg.a.31127. PMID 16470694.