What is hyperhidrosis?
Hyperhidrosis is characterised by unusually excessive sweating in many different areas of the body to a degree that is socially debilitating. Hyperhidrosis is considered a widespread disease which many people suffer from. Some associate hyperhidrosis with a rare illness as many of those suffering from it hide it well and suffer in silence. Primary hyperhidrosis usually begins in childhood or in the teenage years.
What are the symptoms of hyperhidrosis?
Hyperhidrosis is characterised by an unusually high sweat production which is inconsistent with the affected individual’s actions – sweat production is far greater in very small activities, compared to those not affected by the disease. The sweat is dripping despite no physical or emotional activity. Hyperhidrosis can be divided into:
Local hyperhidrosis: evenly increased sweating on both sides, located in the armpits, groin, hands and feet.
Universal hyperhidrosis: increased sweating all over the body, under which the face may also be affected.
What are the causes of hyperhidrosis?
People suffering from hyperhidrosis generally do not have more sweat glands than those without the disease, but their sweat glands are overactive. Their response to sweat-stimulating factors is greater than necessary, and this causes a higher sweat production than needed. Hyperhidrosis is categorised as a skin disease, but the nervous system is also involved. Hyperhidrosis is divided into primary and secondary hyperhidrosis:
Primary hyperhidrosis is not caused by a different underlying disease and is not a consequence of i.e. drug side effects. This is a congenital condition, inherited from the parents. If it is local hyperhidrosis, the disease is usually caused by a disturbance in the nervous system, which stimulates the sweat glands, or a disturbance in the sweat glands themselves. Universal hyperhidrosis is often caused by excessive activity in the nervous system that stimulates the sweat glands.
Secondary hyperhidrosis is caused by a different underlying medical condition or treatment. It can be due to elevated metabolism, diabetes mellitus, cancer or certain drugs, i.e. tricyclic antidepressants that cause the sweat glands to become overactive.
What are the treatments for hyperhidrosis?
Hyperhidrosis can be treated using several different preparations. Antiperspirants with aluminium chloride inhibits the sweat production from the gland cells, which reduces sweating, obnoxious smells and sweat stains. Aluminium chloride forms a lump in the excretory ducts of the sweat glands, which prevents the sweat from reaching the skin surface. Antiperspirants come as creams and sprays in varying strengths; some work for hours, others for days.
There are also various different medical preparations which are taken orally. They work by inhibiting the stimulation and activation of the production of sweat in the sweat glands, whereby sweating is reduced. Some of the frequently used drugs are anticholinergics.
These prevent the nervous system’s activation of the sweat glands by inhibiting the line of nerve impulses being sent to the sweat glands. An issue, however, is that it will often affect other functions of these nerve paths as well by triggering side effects, such as dry mouth, fatigue and headache. Examples of anticholinergics against hyperhidrosis include ‘Ercoril’ and ‘Ditropan’.
Hyperhidrosis can also be treated with botulinum toxin (Botox ®), which is injected into the areas with excessive sweat production, thus preventing the nerves from signalling and activating the gland cells. The treatment takes place under anaesthesia, which means it is completely painless, and the effect lasts for 3-6 months, after which the treatment is repeated.
In addition, there are various different permanent treatment options in the form of surgery. One of them is to attempt to remove the sweat glands in i.e. the armpit. However, to ensure that all sweat glands are removed, it usually requires several operations to achieve a good result. There is also a risk of major scarring, infections and sensory disturbances in the area following an operation. Another treatment is to try to reduce palmar sweat and facial blushing by severing some of these nerves, thereby inhibiting the signalling to the gland cells permanently. An issue with this is that 80-95 % of the patients experience that the body’s other areas begin to produce more sweat in order to compensate. This can be areas that were previously unaffected by excessive sweating, and it is therefore debatable, whether such a procedure is beneficial or not.
There is also the option of ‘iontophoresis’ – a type of treatment where a mild current is sent through the skin surface via a water bath, temporarily shutting down the excretory ducts of the sweat glands. To achieve a good and consistent effect, repeated treatments are required.