Summer... high temperatures... increased sweating... great discomfort for many Greeks. True, what is hyperhidrosis, where is it caused, what are its effects and how is it treated?
The hyperhidrosis is a pathological condition characterized by excessive sweat secretion from the εκκρινείς sweat glands, in addition to the amount required for thermoregulation. It is not usually accompanied by malodour (bromidrosis), which is caused by Responsive sweat glands that produce a type of sweat rich in organic substances. The breakdown of these substances by the bacteria in the area results in the characteristic unpleasant odour.
The hyperhidrosis is not a rare situation. According to an American study it affects about 3% of the general population, mainly people between 18 and 54 years old. Depending on its etiology, the hyperhidrosis can be primary or secondary and, depending on its extent, focal or generalised.
Primary or idiopathic hyperhidrosis is considered a result of hyperreactivity of the sympathetic nervous system to thermal or mental stimuli. It is first manifested in childhood or adolescence. It is usually focal and involves areas rich in secretory sweat glands, such as the armpits, palms, soles, face and scalp. In 34-65% there is an inherited predisposition.
Secondary hyperhidrosis is associated with several underlying conditions such as infections, endocrine, metabolic, neurological, cardiovascular and respiratory disorders, malignant diseases, drugs, anxiety, stress. It can occur at any age, is usually generalized throughout the body and there is no hereditary predisposition.
The hyperhidrosis has serious professional, economic, social and psychological consequences that negatively affect the quality of life of patients. It also increases the likelihood of microbial infections, fungal infections, sweating, and can lead to dehydration and heat stroke. Sweat can stain and eventually damage clothing and shoes. Large sums are spent on cleaning and replacing them, as well as buying deodorants and antiperspirant products.
The treatment of hyperhidrosis is not is an easy case. In principle, the case of secondary hyperhidrosis, which can only be treated by identifying and treating the underlying condition, must be excluded. Patient information is of great importance. General measures such as weight loss, light clothing, frequent changes of clothes, a cool environment, good hygiene, avoidance of triggers, replacement of lost fluids and electrolytes have beneficial effects.
The local treatment includes the use of deodorants and antiperspirant products in the form of soaps, sprays, lotions, roll-ons, sticks, gels, creams, etc., and are recommended in mild and moderate forms of hyperhidrosis. In particular, aluminium salts have the property of clogging the excretory sweat glands, reducing perspiration. In addition, they exert antimicrobial actions and are useful in controlling bromide. More recently, topical anticholinergics with glycopyrrolate as the main representative, which antagonises acetylcholine receptors in the sweat glands, have been applied with excellent results in the treatment of focal hyperhidrosis. Glycopyrrolate is used at a concentration of 2% in the form of a cream or spray. Also, oxybutynin, another anticholinergic at concentrations of 3% and 10% has started to be used with great success. The side effects of these substances are rare, mild and reversible.
Systemic oral treatment of hyperhidrosis with oxybutynin, glycopyrrolate and methanetheline which are anticholinergic substances, have very good efficacy reaching 90% in all types of hyperhidrosis. The application of oxybutynin transdermally in patch form is effective and safe and is considered a promising treatment. The most common side effect of these products is dryness of the oral cavity.
Iontophoresis is a method based on passing a low-power electric current through a water bath and introducing ions into the skin, causing the sweat glands to clog. It is indicated as a second-line treatment for mild to moderate palmar or plantar hyperhidrosis. It is applied daily for 15′-20′ until a result is obtained and then less frequently. It has minimal side effects, but requires special equipment and is time-consuming.
The intradermal injection of botulinum toxin (Botox, Dysport) is very popular nowadays and is applied in moderate and severe forms of focal hyperhidrosis. The drug causes temporary chemoattraction of the secretory sweat glands and stops sweat secretion. It is indicated for all localized hyperhidrosis with results up to 95% and a duration of 3-19 months depending on the site and patient. Injection is performed at multiple sites 2 cm apart, after a starch-iodine test to map the area of intense sweating. The most common adverse event, mainly affecting the palms at a rate of 5-77%, is muscle weakness that resolves after 2-5 weeks and reflux hyperhidrosis in other parts of the body at a rate of approximately 5%.
Surgical treatment is recommended in moderate or severe cases of hyperhidrosis that cannot be treated with available conservative treatments. For axillary hyperhidrosis, removal or destruction of the sweat glands by surgical skin excision, liposuction or lasers is used, while for palmar and plantar hyperhidrosis, endoscopic sympathectomy, i.e. invasive destruction of the sympathetic ganglia responsible for hyperhidrosis in the thoracic and groin region, is used.
Recently, several energy-emitting medical devices are available for the treatment of focal hyperhidrosis, such as various types of lasers, radiofrequency, microwaves and focused ultrasound. These are minimally invasive treatments that cause permanent thermal destruction of the sweat glands and significantly reduce hyperhidrosis and bromhidrosis. The results are long-lasting, complications are minimal and the improvement in patients' quality of life is significant. However, these treatments are costly and only involve the axillary region.
Conclusion, the hyperhidrosis is an extremely unpleasant condition that significantly burdens the daily life of patients, especially in the summer months. Patient evaluation by a dermatologist who has the knowledge and experience is essential for the best therapeutic outcome with minimal side effects.
Source : www.edae.gr
