Hyperhidrosis

What it is?

• Hyperhidrosis simply means a condition which causes excessive sweating. This excessive sweating can occur in different areas of the body. When excessive sweating   is limited to one part of the body more than other parts, this is called Focal hyperhidrosis. When hyperhidrosis occurs throughout the entire this is then call Generalised hyperhidrosis. In general  terms focal hyperhidrosis is not associated with specific disease processes, whereas generalised hyperhidrosis needs to be investigated and treated.
• Focal hyperhidrosis is also called essential hyperhidrosis or primary hyperhidrosis because there is usually no causative factor (the medical term for this is idiopathic). Primary hyperhidrosis  can be further classified according to the specific area which it affects.
• ​Axillary hyperhidrosis refers to sweating which affects the armpits.  The largest proportion of patients over 50% suffer from excessive sweating from the armpits.
• Palmar hyperhidrosis refers to excessive sweating which is restricted to the Hands.  Hyperhidrosis which affects the hands of accounts for up to a quarter of patients. 
• Craniofacial hyperhidrosis refers to excessive sweating which affects the face especially the scalp and the forehead.  At our clinic this accounts for between 10 to 20% of our patients. 
• Plantar  Hyperhidrosis refers to sweating which is restricted to the feet. excessive sweating on the feet is particularly hard to treat as it involves very large area as meaning injection therapy and the treatment effect is limited.
• It is not uncommon for patients to have more than one area being affected with excessive sweating in combination. For example they may sweat excessively from their underarms and their hands together.  excessive sweating treatment.

Causes

Pathophysiology of Hyperhidrosis
Hyperhidrosis is generally considered to be the result of inherited characteristics which cause the sympathetic nervous system to become more reactive to the environment then is normal. So that even a small amount of perceived threat or anxiety causes overstimulation of that part of the brain which controls sweating. The sympathetic nervous system then relays this message to the sweat glands to produce increased amounts of sweat. It is possible other parts of the brain are also involved in hyperhidrosis including the hypothalamus and specific parts of the cerebral cortex.

Treatment

– Iontophoresis
About Treatment
Iontophosesis refers to the introduction of electrons to the area where you want to stop sweating. By doing so, this disrupts the flow of important ions involved in the transmission of a nerve impulse to the sweat gland.

Ionotophoresis has to be performed with the use of an electrical device. These devices can cost up to $1000 and in general they are better purchased and the best one is available from outside Australia.

Iontophosesis has to be performed at least on a daily basis for 45-60mins which makes them a less attractive alternative form of treatment. It is primarily used for hand sweating and feet sweating.

One of the biggest problems of iontophoresis besides the time-consuming nature of the treatment is that it also causes skin irritation and should not be used by pregnant women or those with pacemakers.

Treatment used for
The treatment of hyperhidrosis is determined by the area you are trying to stop sweating. Treatment is always commenced with the least invasive and mildest treatment that controls sweating. In the majority of cases, this will involve the use of topical antipersiprant such as those that are commercially available from the supermarket or more concentrated formulations such as aluminium chloride which is available from the chemist. When this fails, the doctor usually prescribes either a trial of oral medication or recommends the use neurotoxin injections. The table below is a useful guide i giving you some treatment options.

– Oral Medications
About Treatment
Several oral medications are available for the management of hyperhidrosis. These medications include Ditrpan and Probanthine. These medications work by restricting the electrical nerve signal reaching the sweat gland. For these medications to be affected they must be taken regularly up to 4 times per day and in high doses. Because these drugs stimulate the parasympathetic nervous system, they produce significant unwanted side-effects such as dry mouth, blurred vision and constipation. Nevertheless, for some people these medications work and in general they are safe and a cheaper alternative to other forms of treatment. The choice to use oral medications is always an individual one, based on how much a person can tolerate side-effects.

– Topical Agents and Antipersirants
About Treatment
Antiperspirants are best for mild sweating.  They can be used for underarms, hands, face and feet. The stronger antiperspirants are more likely to cause skin irritation in some people. The strongest antiperspirants contain aluminium chloride such as Dri Chlor and this should be tried before seeking professional help. If you have any doubts discuss this with your doctor.

Antiperspirants work differently from deadrants. Deodrants simply cover the smell. Antiperspirants, on the other hand, contain aluminium chloride which draws water into the sweat gland by the process of osmosis this then causes the sweat gland to swell and hence blocks the entrance of the sweat gland and by this process, the flow of sweat is reduced. The one downside to products such as Dri Chlor is that they cause skin irritation in a high percentage of people.

– Injection Treatments With Neurotoxin Muscle Relaxants
About Treatment
Injection therapy with neurotoxin muscle relaxants is a well-established treatment for hyperhidrosis. The first published article describing its use was in 1998 by an Austrian neurologist (Dr Naumann). When neurotoxins are injected under the skin they act by blocking neurotransmitters which are necessary for the signal from the nerve to reach the sweat gland. The effect of these injections starts within four days and can last in general at least six months and up to 9-12 months for the face and underarms. On the hands the effect lasts is between six and seven months. Unfortunately, neurotoxin muscle relaxants do not have a lasting effect on the feet, lasting only 3 to 4 months.

The procedure of injecting neurotoxin injections is simple, quick and relatively painless. This is because we either use an anaesthetic to numb the or use light sedation during the procedure especially when injecting the hands.

We have had many years of experience using this product and the effectiveness of these injections can be repeated over many years.  Some doctors believe there is a theoretical risk of developing auto-antibodies to this product which may cause it to lose it’s effectiveness. Clinical experience however suggests that this is very rare.

The only contraindication to using this product is if there is a proven history of allergy or if there is a history of neuromuscular disease or if you are pregnant or breastfeeding.