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Sweating Also known as perspiration, sweating is the production of salty liquid (water and various dissolved solids) excreted by the sweat glands in the skin of mammals. It is an essential function, and one of the ways we regulate our body temperature as humans rely on the evaporation of sweat to protect the body against a hot environment. It also helps to keep the skin moist. Sweating is controlled by parts of the brain, which send signals along the nerves to the small sweat glands in the skin. Types of hyperhidrosis

Hyperhidrosis can be broadly categorised into 2 types: primary and secondary hyperhidrosis.

Primary hyperhidrosis

Also known as focal hyperhidrosis, this type of excessive sweating has an unknown cause. It is localised to different areas of the body including but not limited to,

The underarms (axillary hyperhidrosis)
The hands (palmar hyperhidrosis)
The feet (plantar hyperhidrosis)
The face (facial hyperhidrosis)

This form of hyperhidrosis is thought to be related to over activity of the central nervous system leading to an overactive stimulation of local sweat glands. It typically starts during childhood, gradually worsening during puberty and persists for the rest of the life of the sufferer.

Axillary hyperhidrosis involves extreme, dripping sweat in the underarms, accompanied by a constant odour resistant to all deodorants. Sufferers of this type of hyperhidrosis avoid wearing certain fabrics and colours as the sweat causes staining and rotting of clothes.It can occur alone, or in conjunction with any or all other types of hyperhidrosis, and is typically resistant to all the types of deodorants and other odor controlling medication.

Palmar hyperhidrosis , also known as excessive sweating on the palms is usually profound and dramatic, affecting all aspects of the sufferer’s life, including work, daily living and interpersonal social interactions. It can be triggered by nervousness, emotional distress and stressful conditions, as well the application of even the smallest amount of lotion to the hands. In some cases, the condition is so severe that sweat can be seen literally dripping down from the individual’s hands. Most individuals suffering from palmar hyperhidrosis will also have plantar hyperhidrosis.

Plantar hyperhidrosis is severe or excessive sweating of the feet and it typically occurs with palmar hyperhidrosis. It is usually presented with bad foot odour, blisters, infection and athlete’s foot.Individuals suffering from this form of hyperhidrosis find that they have to purchase new regular shoes frequently as moisture tends to ruin shoes.Driving also becomes uncomfortable and dangerous when there is profuse sweating of the feet.

Facial hyperhidrosis can occur on the scalp as well as the face, causing sufferers to sweat profusely to a point where sweat is dripping off the face. It affects both men and women and is thought to be a genetic condition.When the scalp is affected by excessive sweating, the hair may look oily and dirty, amd can cause bad hair odour.

Secondary hyperhidrosis

Also known as generalised hyperhidrosis, this form of hyperhidrosis is thought to be caused by a number of other underlying conditions, or a side effect of a medication. This form of sweating is characterised by sweating, which occurs all over the body, during the day and at night.

Certain medical conditions are thought to cause secondary hyperhidrosis, including but not limited to diabetes, menopause, angina or other cardiovascular problems, hypoglycaemia, diabetes, neurological diseases, and most chronic infections.

Treatment of hyperhidrosis

Hyperhidrosis, particularly primary hyperhidrosis, can be treated using aluminium chloride solution or antiperspirant in situations where normal antiperspirants have ceased to combat it. These can be applied on the armpits, palms and soles, and the face (whilst avoiding the area around the eyes). However, some individuals cannot tolerate the irritation caused by aluminium solution.

Other treatment methods include,

Botulinum toxin (Botox) injections administered under the skin around the affected area helping to stop the nerves controlling the sweat glands from working. This form of treatment is required every few months so as to stop the condition from returning.

Surgery (sweat gland suction) , which is a technique adapted from liposuction. The sweat glands are permanently removed in a gentle, non-aggressive way with local anaesthetic applied to the affected area. This is done by softening the sweat glands after which they are removed in a method similar to liposuction. The operation takes between 60 to 90 minutes and is on an out-patient basis. The success of sweat gland suction depends greatly on the type of surgery and the location of sweating. It is thought to be 75 to 80% effective for axillary hyperhidrosis, and about 95 to 98% effective palmar hyperhidrosis.

However, side effects and complications are known to plague the treatment of hyperhidrosis with surgery as they are almost constant and unavoidable. These side effects are often the price patients pay for treating hyperhidrosis with surgery.

One common side effect of hyperhidrosis is what is known as compensatory sweating , that is, excessive sweating shifts from the area where surgery has been performed to another part of the body such as the abdomen and groin area. This side effect occurs in almost every patient who undergoes surgery.

Other side effects include,

•  Gustatory sweating which is facial sweating occurring after eating or smelling food.

•  Horner’s Syndrome , which is a condition that occurs on one side of the face. This could include droopy eyelids and constricted pupils. This side effect occurs in about 1% of patients and it is known to sometimes correct on its own.

•  Intercostal neuralgia , which is nerve pain that can result from mild nerve damage during the surgery. This is however thought to subside in 3 to 6 weeks after surgery.

Patients with other underlying conditions may find that they have side effects relating to the condition they already have.

Oral medication , mainly anticholinergics drugs are also available to help reduce excessive sweating. However, most of these drugs are not effective enough to reduce excessive sweating whilst some have uncomfortable side effects associated with them.

Iontophoresis , which involves the application of low intensity electrical current to the affected areas, particularly the hands, feet, and armpit. It uses water to conduct this electrical current through the skin’s surface and although it is not entirely understood how it works, it is thought that the electric current and mineral particles in the water work collectively to thicken the outer layer of the skin microscopically. The treatment is said to be effective in about 85% of individuals; hence, it is a safe treatment option.

Complete cessation of sweating occurs after the initial phase of treatment with Iontophoresis and can last from a few days to one month depending on the individual. After initial treatment, hyperhidrosis can then be controlled by regular maintenance treatment. These maintenance treatments can be done in the comfort of the home as Iontophoresis machines are now available for home use.

The use of iontophoresis in the treatment of hyperhidrosis holds many advantages, the most important being that the risk of infection is greatly reduced as it is a non-invasive mode of treatment. For individuals who are unwilling or unable to receive injections, iontophoresis is a relatively pain free option to consider. Treatment is also administered directly to the areas affected without any disadvantages of injections or oral medication.

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