HYPERHYDROSIS: CAUSES AND EFFECTS

MAY, 2012

TABLE OF CONTENTINTRODUCTIONMECHANISM OF SWEATINGDEFINITIONCLASSIFICATIONGENETICSCAUSES OF HYPERHYDROSISSOCIAL EFFECTDIAGNOSISTREATMENTCONCLUSIONREFERENCES

INTRODUCTIONSweating is a normal bodily function, but for some people, it can be an embarrassing or traumatic experience. They find themselves changing clothes several times a day; they sweat even when the weather is cool and when they are not doing any strenuous work.A number of these people do not realize they are suffering from a disorder called hyperhydrosis, or the condition can be treated.

The human body has about 2-5 million sweat glands. The two main ones are; eccrine and apocrine.

Eccrine Sweat Glands

Approximately 3 million eccrine sweat glands

Secrete a clear, odorless fluid

Aid in regulating body temperature

Areas of concentration:Facial, plantar, and

axillae

Apocrine Sweat GlandsInactive until pubertyProduce thick fluidSecretions come in

contact with bacteria on the skin and produce characteristic “body odor”

Found in axillary and genital areas

MECHANISM OF SWEATINGHypothalamus serve as the thermoregulatory centre. It controls both blood flow and sweat output to the skin’s surface. It is triggered by exercise, temperature change, hormones and stress. Once trigger send message to the spinal cord via neurotransmitters (acetylcholine an catecholamine). These neurotransmitters travel down to ganglion to nerves innervating the skin’s surface

Photo used with permission: The Whiteley Clinic,2007

DEFINITION

Hyperhydrosis is a state of excessive sweating of the axilla, palms, soles, or face that interferes with daily activities. It is a condition characterized by abnormally increased perspiration in excess of that required for thermal regulation.

University of Miami Cosmetic Center, 2007

CLASSIFICATIONHyperhydrosis is classified into primary

and secondary types.• Primary type: is associated with hyperactivity of

the sympathetic nervous system and can affect one or several areas of the body (Strutton et al(2004), Hornberger et. al (2004)), starts during childhood or adolescence.

• Secondary type: is caused by other factors mainly disorders.

GENETICSHyperhydrosis appear to be inherited in a

dorminant fashion. It was thought to be autosomal recessive genetic potential.

A new UCLA (University of California-Los Angeles) study published in the journal of vascular surgery shows strong evidence that sweaty palms syndrome is genetic (Champeau,2002).It is caused by dorminant gene, indicating that family members of those who have the disorder may suffer from it more than has been previously reported.

It has been found by the Department of Human Genetics of UCLA that as much as 5% of the population maybe at risk for some form of hyperhydrosis, commonly known as sweaty ‘palms syndrome’. Also according to research carried out by UCLA, it was found that 65% of the patients reported family recurrence of the disorder.

CAUSESExcessive sweating affects a great

number and there are various factors, this include;

heart attack: Infections: eg T.B those living with it.Malignancy: eg LymphomaObesity Neurologic and endocrine disorder (eg

hyperthyroidism, diabetes)Others; (anxiety, hypoglycemia,

menopause, stress) (Clinic, 2011)

SOCIAL EFFECTThis pose a lot of problem on individuals

with this disorder, such as;Low esteem and self confidenceEmbarrassmentRule out a career such as being a chefWorkplace limitations such as low output,

time management, mental and interpersonal tasks.

Social isolationDaily activities impacted

DIAGNOSISDiagnosis involve two types i.e. Patient’s examination (include history)

(Hornberger et. al, 2004).Clinical test could include; i. Minor starch

iodine test: this delineates the area of sweating by use of iodine solution in 3.5% of alcohol.

ii Thermoregulatory sweat Test (TST): This delineate the distribution response to a controlled heat and humidity stimulus (Fealey, 1997).

Photo used with permission: Eisenach, Atkinson, & Fealey, 2005

Treatment Option ReviewHYPERHYDROSIS

AXILLARY PALMOPLANTARTOPICAL TREATMENT

BOTOX IONTOPHORESIS

IONTOPHORESIS

LOCAL EXCISION

BOTOX

ETS

TREATMENTTreatment depends on the outcome of the

diagnosis and the area affected. Topical treatment: use of

Antiperspirants eg. Aluminum chloride hexahydrate, block sweat pore and reduce sweat, and also eliminate odour

Systemic treatment: use of Anticholinergics, has sympathetic inhibitory action.

Iontophoresis: block sweat duct by directing a mild electrical current through the skin (Hornberger et. al, 2003).

Treatment cont’n

Botox: use of Botulin toxin injection, inhibit nerve impulse (Heckman, 2001, Naumann and Lowe, 2001, lowe et. al, 2003).

Surgery: can be done for severe cases. It is of two types; (i) Local Excision (ii) Endoscopic Thoracic Sympathectomy.

Endoscopic thoracic sympathectomy (ETS) is the most effective of all. It also have some side effects.

CONCLUSIONHyperhydrosis is an embarrassing

disorder that even today is misconceived as rare and untreatable. It is aggravated during emotional stress and the pathophysiological mechanism appears to be hyperfunctioning of the gland.

Hyperhydrosis does not have to be a problem of epic proportion. By acknowledging the condition and by getting help from the right sources, you can minimize its impact on the quality of your life.

REFERENCES Fealey R.D (1997): Thermoregulatory sweat test. In:

low PA, ed. Clinical Autonomic Disorders. 2nd ed. Philadelphia, pa: Lippincott-Raven; 245-257

Hamm, H., Naumann, M., & Kowalski, J. (2006). Primary focal hyperhydrosis: Disease characteristics and functional impairment. Dermatology, 212. 343-353.

Heckmann M, Ceballos-Baumann A.O, Plewig G (2001): Hyperhydrosis study Group, Botulinum toxin A for axillary

hyperhydrosis; 344:111- 117. Hornberger J, Grimes K, Naumann M, et al. (2004 Aug):Multi- Specialty

Working Group on the Recognition, Diagnosis, and Treatment of Primary Focal Hyperhydrosis. Recognition, diagnosis, and treatment of

primary focal hyperhydrosis. JAmAcad Derm. 51(2):274-286,

•Mayo Clinic (2011): What causes excessive sweating, Article reviewed by M.J Ingram,

•Rachel Champeau (2002); Evidence that 'sweaty palms' syndrome’ is genetic , UCLA issues of the journal of vascular surgery• Reisfeld R, Berliner K (2008): Evidence based review of the nonsurgical management of hyperhydrosis, thorac surg clin 18(2); 157-166• Strutton DR, Kowalski JW, Glaser DA, Stang PE.(2004 Aug.): US prevalence

of hyperhydrosis and impact on individuals with axillary hyperhydrosis: results from a national survey. J Am Acad Derm. 51(2):241-8,