Perspiration is a natural process of our organism. There are 2-3 million of sweat glands on the human body, on average, 300 glands per one square centimetre. A human produces from a few millilitres up to a few litres of sweat every day. If he didn’t sweat, his body would overheat. Thermoregulatory functions of sweat glands are controlled by sympathetic nervous system by means of supplying glands by postsynaptic cholinergic nerves..
Reasons for hyperhidrosis
- hot climate, high humidity
- physical effort
- emotions, stress
- ingestion of some spices, strong coffee, tea, chocolate, obesity
- hormonal imbalance (hyperthyroidism, diabetes),
- neurological diseases (Ross syndrome, Frey’s syndrome, neuropathy)
- infections with high fever e.g. tuberculosis
- menopause and andropause
- some tumours e.g. Adrenocortical carcinoma characterized by hypersecretion of catecholamines
- idiopathic – about 60%
Hyperhidrosis can be whether local and related to only armpits, palms , feet or can concern the hole body.
Taking into consideration all abovementioned examples, it’s clear that we have got an influence on some types of sweating, but there are conditions which can’t be eliminated or cured. Local sweating is one of them, which is idiopathic. Fortunately, medicine has found the solution – blocking sweat glands activity with botulinum toxin, which is regarded as the most effective and low-risk treatment. Thanks to only one treatment we can eliminate the discomfort of excessive sweating for a few months. The disadvantage of this method is the fact that this is not a cure for the cause but it only eliminates the symptoms. However, as we do not have any other alternative method, this one seems to be the best.
Problems related to hyperhydrosis
Despite the fact that perspiration is a natural process of our organism, yet excessive sweating can be extremely embarrassing. This problem can be related to sense of shame, and embarrassment, which can lead to limiting contacts with other people. Sometimes it even happens that hyperhydrosis can preclude from following some professions (e.g. in laboratories with reagents). People suffering from excessive sweating know how it can be oppressive in everyday life, especially when it is associated with unpleasant smell, which is caused by bacteria resolving the sweat. Washing the body and using deodorants remove the problem only for a moment.
As a general rule, accurate anamnesis seems to be enough to diagnose the patient. Anamnesis not only helps to assess the scale of the problem but also set possible contraindications for the treatment.
There are several methods of sweating assessment (i.a. gravimetry, hydrometric, colorimetric), however, in practice Minor test (starch–iodine test)is used most frequently. The test consists in applying iodine solution to the excessively sweating places on the skin and dusted them with cornstarch (potato flour). It causes a colour change into dark colour allowing the sweat production to be visualized, which confirms recognition. The test is completely painless, however, sometimes anamnesis and short observation are sufficient to skip the test and start the treatment.
- 1. General recommendations:
- hygiene, palms and feet herbal baths (oak bark, mint, walnut leaves, sage, chamomile, birch bark) – two times a week soak for 30 minutes
- wearing natural fibre clothes with loose cut
- frequent change of clothing/ footwear
- avoiding coffee, alcohol and strong spices
- stress, tension and fear
- frequent airing of your workplace
- Antiperspirants containing aluminium chloride – temporally block pores of sweat glands.
- 1. General recommendations:
They are applied at night, initially every day, then it is limited to one application every 2-3 weeks. Effectiveness is 90%, unfortunately they can cause skin irritation with time.
- General treatment:
- sedatives, anticholinergic pharmaceuticals (e.g. Bellergot)
- herbal brews e.g. sage tea, herbal drops
- homoeopathic pharmaceuticals
- Non-surgical topical treatment – intradermal injection of botulinum toxin (Botox, Dysport):
- General treatment:
After injecting a small portion of botulinum toxin type A – produced by the bacterium Clostridium botulinum – the activity of nerves, which supply exocrine glands, is blocked. This action prevents sweat secretion. Blockade of nerve endings sustains for 6-12 months, then new nerve endings are developed and replace the blocked ones. This means that treatment effect is visible for few months and then it fades away. Nowadays, it is the most widely used and recommended method. According to statistics 80% of patients respond to the treatment well, however, there are people who do not experience expected effects or the effects are unsatisfactory. It happens with 20% of the patients who have to apply antiperspirants or other remaining abovementioned methods.
Course of treatment:
Before the treatment the area of excessive sweating should be carefully determined. Most frequently the areas where botulinum should be injected are visibly covered with beads of sweat. Sometimes precise identification of those areas is extremely difficult. Therefore, a starch–iodine test ( so-called Minor test) is applied. The test consists in applying iodine solution to the excessively sweating places on the skin and dusted them with cornstarch(potato flour). After a few or dozen minutes desired areas start to darken. Identified places of excessive sweating are divided into squares 1.5 x 1.5 centimeter with solution of gentian violet. The treatment consists in giving shallow intradermal injections of a small dose of botulinum toxin into each square. For the majority of people the treatment is minimally painful, but sensitive people can be anaesthetized. As a general rule the treatment carried out on palms or feet requires anesthesia. The treatments itself lasts a few or dozen minutes and after that the patient can get back to his/her daily routine. The effect is visible after a few or dozen days and lasts a few months and can maintain even for a year (armpits). Then it needs to be repeated.
- sometimes local painfulness can remain for few hours
- after armpit sweating treatment no complications were observed, apart from possible slight itchiness around armpits which disappears without treatment after 1-2 weeks
- compensatory sweating was observed in other areas, which also disappeared after a few weeks
- after palm sweating treatment, within a few days after the treatment, temporary muscle weakness was observed, which consisted in inability of the movement of the fifth finger, seldom pulling the thumb away from the hand and difficulty in gripping. These symptoms, however, were not disturbing in everyday life. Nonetheless, such a condition can turn out to be unacceptable for e.g. a pianist
- there is a slight risk of flu-like symptoms (tiredness, a small increase in body temperature, muscle pains) – these ailments disappear within few days – ailments disappear within few days
- absolute contraindications:
- neuromuscular junction disease (myasthenia gravis, Lambert–Eaton myasthenic syndrome)
- hypersensitivity to preparation components (human albumins)
- taking the following medicines or the period of one week after discontinuation of taking medicines:
- aminoglycosides (streptomycin, gentamicin, amikacin, kanamycin etc.)
- aminoquinolines (chloroquine, hydroxychloroquine)
- D-penicillamine (Cuprenil)
- tubocurarine, pancuronium, gallamine
- lincomycin, tetracycline, polymyxin
- local skin infections
- pregnancy, lactation
- relative contraindications::
- coagulopathy (bleeding disorder)
- taking anticoagulants (e.g. aspirin)
- absolute contraindications:
- Surgical treatment:
- surgical removal of all sweat glands in the armpits, sometimes even the skin removal of this area. Hypodermic fat is always removed from the areas of the armpits. 90% of the results are satisfying, however, it is connected with appearing scars, which can lead to shoulder range of motion limitations. For some people the lack of hairy skin in this area after the procedure can also be inconvenient
- sympathectomy – ganglion removal – at present sporadic
- the armpit area liposuction: with thin cannulas fat tissue is sucked out in a typical way. Skin deprived of fat base is sewn up with a special stitch. If any sweat glands had not been removed during the liposuction, an appearing scar will make them impossible to produce sweat. Hairy skin in this area remains untouched