Excessive sweating

By: | Tags: | Comments: 0 | September 3rd, 2020

Doctor do you have a treatment  for sweaty Palms and feet , My girlfriend is really bothered , am worried I might loose her ?

What is Excessive sweating ?

Excessive sweating also known as Hyperhidrosis is the secretion of sweat in amounts greater than physiologically needed for thermoregulation.

Hyperhidrosis prevalence estimates range from 1 to 5 percent of the population.

It is most commonly a chronic idiopathic (primary) condition; however, secondary medical conditions or medications should also be excluded. Idiopathic hyperhidrosis localized to certain areas of the body is called primary focal hyperhidrosis.

Primary focal hyperhidrosis usually affects the axillae, palms, and soles. The condition may also affect other sites, such as the face, scalp, inguinal, and inframammary areas.

Diagnosis is made by having  Focal, visible, excessive sweating of at least six months duration without apparent cause plus at least two of the following  which include ‘:

  1. Bilateral and relatively symmetric
  2. Impairs daily activities
  3. At least one episode per week
  4. Onset before age 25
  5. Family history of idiopathic hyperhidrosis
  6. Focal sweating stops during sleep

Symptoms

Patients with primary focal hyperhidrosis generally develop symptoms in childhood or adolescence that persist throughout life.

Patients may have focal symptoms most often localized to the palms, soles, and axillae . Less commonly, primary focal hyperhidrosis may affect the scalp and face, or other sites .While primary focal hyperhidrosis is made worse by heat or emotional stimuli, it is not considered a psychological disorder.

Patients with axillary hyperhidrosis report skin maceration/ staining  and staining of clothes.

Palmar hyperhidrosis often leads to a fear of shaking hands and soiling of papers, and patients may have difficulty with work or recreational tasks that require a dry grip.

Patients report that hyperhidrosis often results in social problems on both a private and professional level.

Hyperhidrosis is associated with an increased incidence of other cutaneous/skin disorders.

In a retrospective case-control study involving 387 patients with primary focal hyperhidrosis, patients with hyperhidrosis were more likely to suffer from:

  • dermatophytosis,
  • Pitted keratolysis
  • Viral warts at the sites of hyperhidrosis .
  •  Atopic dermatitis
  •  Eczematous dermatitis were present at a greater frequency in subjects with hyperhidrosis.

The reason for this association is unknown; one theory is that hyperhidrosis is an exacerbating factor for dermatitis.

Sweating assists thermoregulation, skin hydration, and fluid and electrolyte balance.

Three types of sweat glands,

  1. Eccrine,
  2. Apocrine,
  3. Apoeccrine glands have been described in humans.

Eccrine sweat glands are responsible for hyperhidrosis, although Apoeccrine glands might play a role in axillary hyperhidrosis.

The primary function of eccrine sweat glands is thermoregulation, with cooling resulting from evaporation of eccrine sweat.

Eccrine sweat glands are located throughout the body, but they are found in greatest quantity in the:

  • Palms,
  • Soles,
  •  Axillae.

Sweating on the face, chest, and back is generally due to heat stimuli, while sweating of the palms and soles is due to emotional stress.

The axillae have Eccrine, Apocrine, and Apoeccrine glands.

Thermal sweating can occur throughout the day, but emotional sweating (palms, soles, and to some degree axillae) stops while sleeping.

Treatment

Selection of the appropriate approach to treatment begins with consideration of the location of involvement i.e.,

  • axillary,
  • palmar,
  • plantar,
  • craniofacial location).

Additional factors, such as the patient’s goals, expectations, and preferences, as well as safety concerns, disease severity, cost, and treatment availability also impact treatment selection.

Axillary hyperhidrosis — The major therapeutic options for axillary hyperhidrosis include:

  1. Antiperspirants,
  2. Botulinum toxin,
  3. Microwave thermolysis,
  4. Topical glycopyrronium, oral medications, a
  5. Surgery.

First-line therapy — Topical antiperspirants are the preferred initial treatment for axillary hyperhidrosis because they are widely available, inexpensive, and well-tolerated therapies.

Topical glycopyrronium is an alternative first-line treatment and an option for patients who present with a history of poor responses to prescription antiperspirants.

Antiperspirants — Most commercially available nonprescription antiperspirants contain a low-dose metal salt (usually aluminum) that physically obstructs the opening of sweat gland ducts. Nonprescription products are only successful in treating patients with very mild hyperhidrosis.

Treatment with prescription antiperspirants, such as 20% aluminum chloride hexahydrate or 6.25% aluminum chloride hexahydrate, may provide adequate therapy for patients with axillary hyperhidrosis that fails to respond to nonprescription antiperspirants.

Efficacy – The mechanism through which aluminum salts are thought to improve hyperhidrosis involves precipitation of the metal ions with mucopolysaccharides after application to the skin, leading to damage of epithelial cells within of the lumina of sweat ducts and the formation of plugs that occlude the ducts.

Administration – Prescription strength antiperspirants should be applied nightly to the area of hyperhidrosis until improvement is noted; significant improvement may be noted within one week.

The interval between applications then can be gradually lengthened. Once-weekly applications are typically needed for maintenance therapy .

Unfortunately, treatment with strong antiperspirants is often limited by skin irritation, especially in the axillary region. Low-potency corticosteroid creams (such as 2.5% hydrocortisone cream) can help alleviate axillary irritation.

To reduce the risk of irritation, these products should be applied to dry skin between episodes of sweating. Ideally, aluminum chloride hexahydrate should be applied at bedtime when hyperhidrosis is at a minimum, allowed to remain in place for six to eight hours, and washed off in the morning .

Others have recommended using a hair dryer to quickly dry the skin before application and immediately after application, or to use baking soda powder in the morning to neutralize any remaining aluminum chloride .

We do not instruct patients to occlude treated areas with plastic wrap or other occlusive materials after the application of prescription antiperspirants. Occlusion is not necessary and may increase risk for irritation.

Use of an additional antiperspirant product during the daytime also is not necessary. Patients who desire to use a fragranced product may apply a nonmedicated deodorant to the axillae in the morning after bathing .

Back to the question the patient posted, I had a lengthy discussion with the patient  and offered treatment that worked for this patient, patient was happy with the outcome and girlfriend stayed .

 The encounter  with this patient inspired me to write about this condition using this as an avenue to educate as many as possible as that might be suffering from this condition .

Visit us at our Allen Location ,

We are always ready to listen , always with  listening ears, you can always count on us , we are willing to work with you .

Dr Joseph Taiwo

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