Hello, it’s your health buddy! Let’s feel better together. Today, I’m here to share some symptom insights and helpful tips about Hyperhidrosis. Let’s dive in!
Sweaty Hands and Feet? Let’s Talk About Hyperhidrosis!
Hyperhidrosis is a condition where the body produces excessive sweat beyond what is needed for temperature regulation. Normally, when body temperature rises, sweat glands are stimulated to release sweat onto the skin, which then evaporates to cool the body down. However, in hyperhidrosis, excessive sweating occurs in areas like the hands, feet, underarms, and head, leading to social, professional, and daily life discomfort.
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Types of Hyperhidrosis
Hyperhidrosis is categorized into localized hyperhidrosis and generalized hyperhidrosis, depending on the affected area:
- Generalized Hyperhidrosis: Occurs all over the body and is usually associated with underlying medical conditions.
- Localized Hyperhidrosis: Affects specific areas, most commonly the palms, soles, underarms, and face. Most patients seek treatment for localized hyperhidrosis.
There are various treatment options available, but each comes with its own pros and cons. Patients should consult a specialist to determine the most suitable treatment. If considering surgical intervention, it's crucial to be aware of potential side effects, such as compensatory sweating (excessive sweating in other areas after surgery).
Causes of Hyperhidrosis
Primary Hyperhidrosis
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The exact cause of primary hyperhidrosis is not well understood. It often begins in childhood, worsens during puberty, and gradually improves with age. Unlike some other conditions, primary hyperhidrosis does not typically cause excessive sweating at night.
- It affects both men and women.
- Family history is present in about 25–50% of cases.
- It is triggered by heat, emotional stress, and is controlled by the sympathetic nervous system.
Secondary Hyperhidrosis
Secondary hyperhidrosis occurs due to underlying medical conditions. Some common causes include:
- Tuberculosis (TB): Can cause night sweats.
- Endocrine disorders (e.g., hyperthyroidism, diabetes): Can lead to excessive sweating.
Prevalence of Hyperhidrosis
Although exact diagnostic criteria are still being established, studies estimate that 0.6% to 4.6% of the global population experiences hyperhidrosis, with slightly higher rates in Asia.
- Palmar Hyperhidrosis (Sweaty Hands): Often begins in childhood or adolescence.
- Axillary Hyperhidrosis (Excessive Underarm Sweating): Usually starts around puberty or early 20s.
The human body contains 1.5 to 4 million sweat glands, of which about 3 million are eccrine sweat glands, primarily responsible for hyperhidrosis. These glands are densely located in the palms and soles and can produce up to 10 liters of sweat per day under extreme heat conditions.
Another type, apocrine sweat glands, is found in areas like the armpits and groin. These glands release thicker, odor-causing sweat, but they play a minimal role in hyperhidrosis. A newly identified type of gland, called apo-eccrine sweat glands, is believed to contribute significantly to underarm hyperhidrosis.
How Does the Nervous System Affect Hyperhidrosis?
Primary hyperhidrosis is thought to be linked to an overactive autonomic nervous system, specifically excessive stimulation of eccrine sweat glands. Emotional stress can trigger sudden and intense sweating, particularly in social settings. This can lead to social anxiety or avoidance, particularly in individuals who experience facial flushing and excessive sweating together.
Although the sweat glands themselves do not show structural abnormalities, functional overactivity of the sympathetic nervous system is suspected. Recent studies suggest that genetic factors (chromosome 14) may play a role, with around 50% of cases having a family history.
Hyperhidrosis most commonly affects:
- Hands and feet
- Hands and underarms together
- Underarms alone
- Face and scalp
Diagnosis of Hyperhidrosis
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Before deciding on a treatment, it's important to diagnose hyperhidrosis and assess its severity. Doctors distinguish between primary and secondary hyperhidrosis by evaluating the following criteria:
Primary hyperhidrosis is diagnosed if excessive sweating occurs for at least six months without any apparent cause and meets at least two of the following criteria:
- Bilateral (affects both sides) and relatively symmetrical sweating
- Occurs at least once per week
- Interferes with daily activities
- Onset before age 25
- Family history of hyperhidrosis
- No excessive sweating during sleep
A diagnostic test using iodine and starch can help identify excessive sweating areas by turning them dark purple. Sweat volume can also be measured using a gravimetric test, but it is not commonly used in clinical practice. Instead, most doctors rely on patient-reported symptoms to assess severity.
Treatment Options for Hyperhidrosis
Since hyperhidrosis can affect daily life, social interactions, and even career choices, appropriate treatment is essential. Some individuals struggle with slippery hands when handling objects, while others working in electric, metal, or textile industries find sweating particularly disruptive. Students taking written exams may also struggle with sweat-soaked answer sheets.
Additionally, hyperhidrosis can lead to skin issues such as eczema, dermatitis, or fungal infections (e.g., athlete’s foot) due to prolonged moisture exposure.
Non-Surgical Treatments
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Topical Medications
- Aluminum chloride (AlCl3-6H2O) is the most widely used and effective topical treatment.
- Works by blocking sweat gland openings.
- Best applied before bedtime when sweating is minimal.
- May cause skin irritation in about 20% of users.
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Oral Medications
- Anticholinergic drugs such as glycopyrrolate, oxybutynin, and propantheline can help.
- More effective for generalized hyperhidrosis.
- Potential side effects include blurred vision, drowsiness, dizziness, dry mouth, and increased heart rate.
- Not recommended for individuals with myasthenia gravis, glaucoma, or bladder outlet obstruction.
Surgical Treatments
Surgical intervention is considered a last resort due to potential complications. The most common procedure is endoscopic thoracic sympathectomy (ETS), which targets sympathetic nerves controlling sweat production.
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ETS Surgery Details:
- Originally, a large incision was needed, but now minimally invasive endoscopic techniques are available.
- Small 3–5mm incisions are made in the chest area.
- Patients can return to daily life on the same day.
- The procedure can involve cutting, burning, or clamping the nerves.
However, ETS surgery has potential side effects, including:
- Compensatory sweating: Increased sweating in other areas of the body.
- Horner’s Syndrome: Drooping eyelids if nerves affecting facial muscles are damaged.
- Pneumothorax (collapsed lung): Air leakage into the chest cavity.
- Nerve damage: Rare but possible.
While ETS surgery can be effective, it’s crucial to weigh the benefits and risks carefully before proceeding.
Stay informed and take control of your health!
