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Definition
Hyperhidrosis is sweating more than would be expected in the temperature of
the environment.
Description
This condition is characterized by constitutional hyperactivity of the
eccrine sweat glands. The disorder may be generalized, consisting of excessive
body sweating, or localized, with sweating confined to the palms, soles,
armpits, groin, and under the breasts. As a rule, onset is in childhood or
during puberty. Patients experience a heightened reaction to sweating stimuli
such as anxiety, pain, exercise, tension, caffeine, and nicotine. The
sweat-prone areas may be localized or generalized. When the palms and soles are
involved, the skin may appear pink or blue-white, and may even macerate, crack,
or scale, particularly on the feet. Patients often experience spontaneous relief
in adult life.
Causes
The cause is unknown. In very rare cases, hyperhidrosis of the palms and
soles is thought to be inherited as an autosomal dominant genetic trait. One
must distinguish between idiopathic hyperhidrosis from excess sweating due to
malfunction of the thyroid or pituitary gland, infection, diabetes mellitus,
tumors, gout, and menopause. The disorder affects males and females in equal
numbers.
Treatment
Before treating generalized hyperhidrosis, a possible primary disorder must
be ruled out. For patients with palmar-plantar-type hyperhidrosis, cotton socks
and shoes that promote the circulation of air prevent overheating of the feet.
Alternating footwear is helpful. Applications of medicated powder formulated to
hamper bacterial growth is useful. For refractory cases, topical agents such as
aluminum chloride in ethyl alcohol may be indicated for axillary sweating but is
often useless for sweating hands. Short-term courses of anticholinergic drugs
are also useful in severely afflicted patients but the side effects of dry
mouth, drowsiness and constipation frequently occur. Super-antiperspirants may
be of some help. These are essentially superstrength formulas of regular
underarm antiperspirants. The active ingredient, aluminum chloride, actually
reduces the sweat output (unlike deodorants, which just deal with odor).
Heavyweight formulas are available over the counter in concentrations up to 12
percent, compared with 4 to 6 percent in regular antiperspirants. Even stronger
concentrations are available with a prescription. The trick is to use them
correctly. They work only when applied to dry skin. Do not apply them to broken
skin or freshly shaved underarms. To increase their effectiveness, apply them at
night before bed, since the nervous system is less active during sleep. In the
morning, shower as usual, then apply regular antiperspirant to the underarms.
Two or three applications of this combined treatment should keep one dry for
another three days. One approach to treatment is to control stress. Whether or
not emotional stress is the instigator, stress does make the sweating worse.
Stress management therapists take three main approaches to help a patient calm
overactive sweat glands. First is the daily use of relaxation tapes or
meditation. Second is biofeedback training; and third is traditional
psychotherapy that investigates and aims to remove the causes of stress. Surgery
is available in extreme cases in which sweat glands are removed from underarms,
or the nerves that trigger the sweat glands in the hands can be cut.
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