Hyperhidrosis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]
Overview
Primary hyperhidrosis is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature. There is controversy regarding the definition of hyperhidrosis, because any sweat that drips off of the body is in excess of that required for thermoregulation. Almost all people will drip sweat off of the body during heavy exercise.
Classification
- Primary hyperhidrosis must be distinguished from secondary hyperhidrosis, which can start at any point in life. For some, it can seem to come on unexpectedly. The latter form may be due to a disorder of the thyroid or pituitary gland, diabetes mellitus, tumors, gout, menopause, certain drugs, or mercury poisoning[1]. Such secondary forms may have more serious consequences than just hyperhidrosis, making medical consultation advisable.
- Hyperhidrosis can also be classified as focal or generalised.
- Focal hyperhidrosis is most commonly seen during emotional outbursts like sweating of palms, axillae, face etc. Generalised hyperhidrosis affects the entire body and can be triggered by emotion or exertion/heat for thermoregulation.
Pathophysiology
- Primary hyperhidrosis affects about 0.6-0.1% of the general population.
- Onset of symptoms occurs during puberty, seen as excess sweating of face, palms, soles and axillae, and symptoms usually resolve with age. [2]
Physiology
- Sweat is a hypotonic solution produced by eccrine glands and apocrine glands which are distributed all over the body.
- Most of the body's sweat is produced by the eccrine glands. Eccrine glands have the highest concentration in the axillae. These glands play an important role in thermoregulation. [3]
- Apocrine sweat glands are seen in the axillae and urogenital region. [4]
- Sweating is caused by two broad impulses- thermoregulation and emotion. The thermoregulatory centre of sweating is located in the hypothalamus and is triggered by increased body temperature (eg., fever) and the emotion centre of sweating is located in the limbic system and is triggered by extreme emotional states like anxiety, fear etc.
Pathology
- It is not known what causes primary hyperhidrosis. One theory is that hyperhidrosis results from an overactive sympathetic nervous system, but this hyperactivity may in turn be caused by abnormal brain function. [5]
- Some patients afflicted with the condition experience a certain degree of reduction in their quality of life, depending on how severe their condition is. [6]
- Sufferers feel at a loss of control because perspiration takes place independent of temperature and emotional state. However, anxiety can exacerbate the situation for many sufferers. A common complaint of patients is that they get nervous because they sweat, then sweat more because they are nervous.
- Other factors can play a role; certain foods & drinks, nicotine[7], caffeine, and smells can trigger a response (see also diaphoresis).
- Primary focal hyperhidrosis is the most common type and is seen during puberty in the axillae and face. [8]
- Secondary focal hyperhidrosis is a disorder of defective thermoregulation and is seen in neuropathy affecting peripheral nerves like diabetic neuropathy[9]</ref>, spinal cord disease[10]</ref> etc.
- Generalised primary and secondary hyperhidrosis involve the whole body. Secondary general hyperhidrosis is seen in disorders of thermoregulation like fever, hyperthyroidism etc. [11]
- Some forms of primary Hyperhidrosis are genetically transmitted in either autosomal dominant or recessive pattern.[12]
Causes
- The cause of primary hyperhidrosis is unknown, although some surgeons claim it is caused by sympathetic over-activity.
- Nervousness or excitement can exacerbate the situation for many sufferers.
- Other factors can play a role; certain foods and drinks, nicotine, caffeine, withdrawal from alcohol[13], and smells can trigger a response.
- One form of congenital hyperhidrosis is seen in Riley-Day syndrome, seen among Ashkenazi Jews. Affected children have hyperhidrosis, decreased pain sensitivity, areflexia.[14]
- A common complaint of patients is they get nervous because they sweat, then sweat more because they are nervous. [15]
| Primary focal hyperhidrosis | Secondary focal hyperhidrosis | Secondary general hyperhidrosis |
|---|---|---|
| Puberty | Neuropathy | Thyrotoxicosis |
| Social stress | Complex regional pain syndrome[16] |
Diagnosis
History and Symptoms
- Hyperhidrosis can either be generalized or localized to specific parts of the body.
- Hands, feet, axillae, and the groin area are among the most active regions of perspiration due to the relatively high concentration of sweat glands; however, any part of the body may be affected.
- Patients often feel embarrassed in social situations because shaking hands is difficult for people with sweaty palms.
- Patients also reports a degree of disability in writing or holding objects.
The following are diagnostic tools used to diagnose hyperhidrosis.
- Iodine starch test is the most common initial diagnostic tool used to diagnose hyperhidrosis. To perform the test, iodine is applied to the affected skin and starch powder is applied over it. If there is sweat on the skin, the starch and iodine react and a violet colour is seen. This test is helpful to identify focal hyperhidrosis. </ref>
- The amount of sweat can be quantified by using quantitative sudometry. This test stimulates sweat production with acetylcholine electrophoresis. The sweat produced is detected by passing dehumidified nitrogen gas over the required area of skin enclosed in a chamber. The humidity and perspiration is then plotted on a chart and compared. </ref>
- Gravimetry is another method to diagnose hyperhidrosis. Filter paper is applied over affected areas (palms, soles, axillae) and after a defined period of time weight of filter paper before and after is measured</ref>. Hyperhidrosis is diagnosed as axillary sweating of >136 mg/min/m2, palmar sweating sweating of >50 mg/min/m2.
Treatment
Medical Therapy
Hyperhidrosis can usually be very effectively controlled, but there is no known permanent cure because little is known about the cause behind excessive sweating.
References
- ↑ Schlereth T, Dieterich M, Birklein F (2009). "Hyperhidrosis--causes and treatment of enhanced sweating". Dtsch Arztebl Int. 106 (3): 32–7. doi:10.3238/arztebl.2009.0032. PMC 2695293. PMID 19564960.
- ↑ Vlahovic TC (2016). "Plantar Hyperhidrosis: An Overview". Clin Podiatr Med Surg. 33 (3): 441–51. doi:10.1016/j.cpm.2016.02.010. PMID 27215162.
- ↑ Sato K, Kang WH, Saga K, Sato KT (1989). "Biology of sweat glands and their disorders. I. Normal sweat gland function". J Am Acad Dermatol. 20 (4): 537–63. doi:10.1016/s0190-9622(89)70063-3. PMID 2654204.
- ↑ Sato K, Leidal R, Sato F (1987). "Morphology and development of an apoeccrine sweat gland in human axillae". Am J Physiol. 252 (1 Pt 2): R166–80. doi:10.1152/ajpregu.1987.252.1.R166. PMID 3812728.
- ↑ <ref name="pmid22150061">Fernandez-Ortega JF, Prieto-Palomino MA, Garcia-Caballero M, Galeas-Lopez JL, Quesada-Garcia G, Baguley IJ (2012). "Paroxysmal sympathetic hyperactivity after traumatic brain injury: clinical and prognostic implications". J Neurotrauma. 29 (7): 1364–70. doi:10.1089/neu.2011.2033. PMID 22150061.
- ↑ <ref name="pmid30589248">Lenefsky M, Rice ZP (2018). "Hyperhidrosis and its impact on those living with it". Am J Manag Care. 24 (23 Suppl): S491–S495. PMID 30589248.
- ↑ Molin S, Ruzicka T, Herzinger T (2015). "Smoking is associated with combined allergic and irritant hand eczema, contact allergies and hyperhidrosis". J Eur Acad Dermatol Venereol. 29 (12): 2483–6. doi:10.1111/jdv.12846. PMID 25405274.
- ↑ <ref name="pmid15280843">Strutton DR, Kowalski JW, Glaser DA, Stang PE (2004). "US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey". J Am Acad Dermatol. 51 (2): 241–8. doi:10.1016/j.jaad.2003.12.040. PMID 15280843.
- ↑ <ref name="pmid30859595">Amano M, Namiki T, Munetsugu T, Nakamura M, Hashimoto T, Fujimoto T; et al. (2019). "Dyshidrosis associated with diabetes mellitus: Hypohidrosis associated with diabetic neuropathy and compensated hyperhidrosis". J Dermatol. 46 (8): e292–e293. doi:10.1111/1346-8138.14840. PMID 30859595.
- ↑ <ref name="pmid19222501">Kocyigit P, Akay BN, Saral S, Akbostanci C, Bostanci S (2009). "Unilateral hyperhidrosis with accompanying contralateral anhidrosis". Clin Exp Dermatol. 34 (8): e544–6. doi:10.1111/j.1365-2230.2008.03070.x. PMID 19222501.
- ↑ <ref name="pmid30710604">Nawrocki S, Cha J (2019). "The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Etiology and clinical work-up". J Am Acad Dermatol. 81 (3): 657–666. doi:10.1016/j.jaad.2018.12.071. PMID 30710604.
- ↑ Henning MA, Pedersen OB, Jemec GB (2019). "Genetic disposition to primary hyperhidrosis: a review of literature". Arch Dermatol Res. 311 (10): 735–740. doi:10.1007/s00403-019-01966-1. PMID 31435740.
- ↑ <ref name="pmid15280843">Strutton DR, Kowalski JW, Glaser DA, Stang PE (2004). "US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey". J Am Acad Dermatol. 51 (2): 241–8. doi:10.1016/j.jaad.2003.12.040. PMID 15280843.
- ↑ Norcliffe-Kaufmann L, Kaufmann H (2012). "Familial dysautonomia (Riley-Day syndrome): when baroreceptor feedback fails". Auton Neurosci. 172 (1–2): 26–30. doi:10.1016/j.autneu.2012.10.012. PMID 23178195.
- ↑ <ref name="pmid18557586">Shargall Y, Spratt E, Zeldin RA (2008). "Hyperhidrosis: what is it and why does it occur?". Thorac Surg Clin. 18 (2): 125–32, v. doi:10.1016/j.thorsurg.2008.01.001. PMID 18557586.
- ↑ <ref name="pmid32174618">Alkali NH, Al-Tahan AM, Al-Majed M, Al-Tahan H (2020). "Complex regional pain syndrome: A case report and review of the literature". Ann Afr Med. 19 (1): 68–70. doi:10.4103/aam.aam_23_19. PMC 7189882 Check
|pmc=value (help). PMID 32174618 Check|pmid=value (help).