Discover the causes and solutions for excessive sweating. Navigate Hyperhidrosis with insights from Meri Sehat. Stay dry, stay informed.

Hyperhidrosis

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Overview

Hyperhidrosis is excessive sweating that exceeds the body&#39;s physiological needs for thermoregulation. 
&nbsp;

According to studies, 1-1.6% of people in the UK and US have hyperhidrosis. While people of both sexes and all ages can have hyperhidrosis, it typically begins in childhood or adolescence.<a href="#accordion">[9]</a>

Also known as sudorrhea or polyhidrosis, the condition may affect any site on the body but generally presents at the soles, palms, armpits, and groin. Data suggests that multifocal hyperhidrosis is a common occurrence; 81% of patients report at least three sites affected by hyperhidrosis[10]. Also, it affects both sides of the body equally, like both hands or both feet.<a href="#accordion">[11]</a> 
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According to estimates, nearly 2-3% of Americans experience palmoplantar hyperhidrosis and axillary hyperhidrosis.<a href="#accordion">[12]</a>More than 90% of cases are primary, and more than one-half of these cases affect the axillae<a href="#accordion">[13]</a>.

Approximately, 3 in every 100 Australians have excessive sweating.<a href="#accordion">[14]</a>.Another study showed that the prevalence of primary hyperhidrosis in Sweden was 5.5% whereas14.8% of the study population suffered from secondary hyperhidrosis.<a href="#accordion">[10]</a>

However, it is believed that these figures may be misleading because many individuals don&rsquo;t seek proper treatment for various reasons. 
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There are two types of hyperhidrosis:

<ul>
	<li>
	<h5>Primary Focal Hyperhidrosis</h5>
	</li>
</ul>

Excessive sweating occurs in specific areas, like the palms, feet, underarms, or face, without any apparent reason. Focal hyperhidrosis is due to a genetic mutation. It is a chronic form of the condition that tends to affect both sides of the body and is more common than the other type. It often begins before 25, i.e., in childhood or adolescence.

Depending on the area affected, primary hyperhidrosis is further categorized into palmar hyperhidrosis (sweaty hands), craniofacial hyperhidrosis (sweaty head or face), axillary hyperhidrosis (sweaty underarms), and plantar hyperhidrosis (sweaty feet). 
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<ul>
	<li>
	<h5>Secondary Generalized Hyperhidrosis</h5>
	</li>
</ul>

Excessive sweating occurs all over the body, usually at night. It may be a symptom of another medical condition, including endocrine disorders, neurological conditions, diabetes, and certain cancers. It may also be a side effect of medication, like antidepressants or substance use. The condition tends to affect the whole body later in life. 
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Sign and Symptoms

There is no singular criteria for what counts as &ldquo;normal&rdquo; sweating. However, hyperhidrosis is identifiable if the person seems to sweat more than is necessary, to the extent that it interferes with everyday activities.

Excessive sweating can be defined as sweating more than usual at least once a week, for a continuous period of six months while being awake, in a comfortable or cool setting, or even during periods of rest, i.e. sweating occurs even when the person is not in a hot environment, anxious, stressed out, or exercising. 
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Symptoms include:

<ul>
	<li>Damp clothing</li>
	<li>Clammy or wet soles or palms</li>
	<li>Body odor</li>
	<li>Itching and inflammation</li>
	<li>Cracked skin</li>
	<li>Social withdrawal</li>
</ul>

The symptoms range in severity. Minor symptoms may come and go, or they can be constant. 
&nbsp;

Causes

Primary hyperhidrosis has no obvious medical cause. However, secondary hyperhidrosis can be triggered by:

<ul>
	<li>Infections (e.g.,Malaria,HIV,TB)</li>
	<li>Pregnancy or menopause</li>
	<li>Overactive thyroid gland</li>
	<li>Low blood sugar</li>
	<li>Spinal cord injury</li>
	<li>Anxiety 
	&nbsp;</li>
</ul>

Diagnosis

The medical history of the patient is important to make a thorough diagnosis.The healthcare practitioner will ask the patient about the symptoms, which parts of their body are affected by sweating, how often sweating occurs, and whether it happens during sleeping hours.

They may order blood and urine tests to rule out infection or other underlying conditions like hypoglycemia and hyperthyroidism.

Sweat tests, including the thermoregulatory test, paper test, and iodine-starch test, help doctors evaluate the body&rsquo;s sweating pattern and the severity of the condition. Also, imaging tests may be ordered if the doctor suspects a tumor. 
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Treatment

The condition is quite challenging to treat. The healthcare provider may begin with the least invasive modality and then proceed accordingly<a href="#accordion">[15]</a>.

<ul>
	<li>Prescription antiperspirants with aluminum chloride</li>
	<li>Prescription wipes and creams</li>
	<li>Oral medications (e.g., nerve-blocking pills and antidepressants)</li>
	<li>Botulinum toxin injections or Botox</li>
	<li>Surgical interventions and other procedures (e.g., microwave therapy, iontophoresis, sweat gland removal, and endoscopic thoracic sympathectomy) 
	&nbsp;</li>
</ul>

Even though the condition is not life-threatening, it can significantly impact the quality of life, causing both physical discomfort and emotional distress<a href="#accordion">[11]</a>.

<ul>
	<li>Avoiding participation or having little interest in any sort of activity due to embarrassment</li>
	<li>Emotional and psychological distress</li>
	<li>Fungal infections, especially on the feet (e.g., athlete&rsquo;s foot and fungal nail infections)</li>
	<li>Skin conditions, like boils, warts, and heat rash 
	&nbsp;</li>
</ul>

These include:

<ul>
	<li>Lifestyle factors, like eating spicy food, caffeine intake, and wearing synthetic fabrics, tight clothes, and enclosed shoes</li>
	<li>Family history of excessive sweating</li>
	<li>Age, with young adults being more vulnerable</li>
	<li>Hereditary predisposition to medical conditions that cause sweating 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Hyperhidrosis is excessive sweating beyond physiological needs.</li>
	<li>It can be primary or secondary.</li>
	<li>Treatment options range from antiperspirants to surgical interventions.</li>
	<li>Complications include skin infections and psychological distress.</li>
	<li>Preventive measures include avoiding trigger foods and stress management.</li>
</ul>

[1] Doolittle, J., Walker, P., Mills, T., & Thurston, J. (2016). Hyperhidrosis: an update on prevalence and severity in the United States. Archives of Dermatological Research, 308(10), 743–749.

[2] Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). American Academy of Dermatology, Inc.

[3] Kim, W. O., Kil, H. K., Yoon, D. M., & Yoon, K. B. (2010). Botulinum toxin A for the hyperhidrosis. Pain Research and Management, 15(5), 324–328.

[4] Bahar, R., Zhou, P., Liu, Y., Huang, Y., Phillips, A., Lee, T. K., ... & Lio, P. A. (2016). The prevalence of anxiety and depression in patients with or without hyperhidrosis (HH). Journal of the American Academy of Dermatology, 75(6), 1126–1133.

[5] Wade, R., Rice, S., Llewellyn, A., Moloney, E., Jones-Diette, J., Stoniute, J., … & Woolacott, N. (2017). Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis. Health Technology Assessment, 21(80), 1-280.

[6] Felisberto, G., Cataneo, A., & Cataneo, D. (2021). Thoracic sympathectomy for the treatment of primary axillary hyperhidrosis: systematic review and proportional meta-analysis. Annals of Medicine, 53(1), 1217-1227.

[7] Hong, S. (2023). Cosmetic treatment using botulinum toxin in the oral and maxillofacial area: a narrative review of esthetic techniques. Toxins, 15(2), 82.

[8] Dobosz, Ł., Cwalina, N., & Stefaniak, T. (2017). Influence of body mass index on compensatory sweating in patients after thoracic sympathectomy due to palmar hyperhidrosis. The Thoracic and Cardiovascular Surgeon, 65(06), 497-502.