Hyper Hydro Sis

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CAUSES AND EFFECTS


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INTRODUCTION

Sweating is a normal bodily function, but forsome people, it can be an embarrassing ortraumatic experience. They find themselves

changing clothes several times a day; they sweateven when the weather is cool and when they arenot doing any strenuous work.

A number of these people do not realize they aresuffering from a disorder called hyperhydrosis,

or the condition can be treated.


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The human body has about 2-5 million sweatglands. The two main ones are; eccrine andapocrine.

Eccrine Sweat Glands

Approximately 3 millioneccrine sweat glands

Secrete a clear, odorless fluidAid in regulating body

temperatureAreas of concentration:Facial, plantar, and axillae

Apocrine Sweat Glands

Inactive until pubertyProduce thick fluidSecretions come in contact

with bacteria on the skinand produce characteristicbodyodor

Found in axillary andgenital areas


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MECHANISM OF SWEATING

Hypothalamus serve as thethermoregulatory centre. Itcontrols both blood flow andsweat output to the skins surface.

It is triggered by exercise,temperature change, hormonesand stress.Once trigger send message to thespinal cord via neurotransmitters

(acetylcholine an catecholamine).These neurotransmitters traveldown to ganglion to nervesinnervating the skins surface

Photo used with permission: The WhiteleyClinic,2007


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DEFINITION

Hyperhydrosis is a state ofexcessive sweating of the

axilla, palms, soles, or facethat interferes with dailyactivities. It is a conditioncharacterized by abnormally

increased perspiration inexcess of that required forthermal regulation.

University of Miami Cosmetic Center, 2007


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CLASSIFICATION Hyperhydrosis is classified into primary and

secondary types.

Primary type: is associated with hyperactivity of thesympathetic nervous system and can affect one or

several areas of the body (Strutton et al(2004),

Hornberger et. al (2004)), starts during childhood or

adolescence. Secondary type: is caused by other factors mainly

disorders.


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GENETICS Hyperhydrosis appear to be inherited in a

dorminant fashion. It was thought to be autosomalrecessive genetic potential.

A new UCLA (University of California-LosAngeles) study published in the journal of vascularsurgery shows strong evidence that sweaty palmssyndrome is genetic (Champeau,2002).

It is caused by dorminant gene, indicating thatfamily members of those who have the disordermay suffer from it more than has been previouslyreported.


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It has been found by the Department of HumanGenetics of UCLA that as much as 5% of thepopulation maybe at risk for some form ofhyperhydrosis, commonly known as sweaty palms

syndrome. Also according to research carried outby UCLA, it was found that 65% of the patientsreported family recurrence of the disorder.


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CAUSES Excessive sweating affects a great number and

there are various factors, this include;

heart attack:

Infections: eg T.B those living with it. Malignancy: eg Lymphoma

Obesity

Neurologic and endocrine disorder (eghyperthyroidism, diabetes)

Others; (anxiety, hypoglycemia, menopause,stress) (Clinic, 2011)


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SOCIAL EFFECT This pose a lot of problem on individuals with

this disorder, such as;

Low esteem and self confidence

Embarrassment Rule out a career such as being a chef

Workplace limitations such as low output, timemanagement, mental and interpersonal tasks.

Social isolation

Daily activities impacted


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DIAGNOSIS Diagnosis involve two types i.e.

Patients examination (includehistory)(Hornberger et. al, 2004).

Clinical test could include; i. Minor starch iodinetest: this delineates the area of sweating by use ofiodine solution in 3.5% of alcohol.

ii Thermoregulatory sweat Test (TST): Thisdelineate the distribution response to a controlledheat and humidity stimulus (Fealey, 1997).


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Photo used with permission:

Eisenach, Atkinson, & Fealey, 2005


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Treatment Option Review

HYPERHYDROSIS

AXILLARY PALMOPLANTAR

TOPICAL TREATMENT

BOTOX IONTOPHORESIS

IONTOPHORESIS

LOCAL EXCISION

BOTOX

ETS


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TREATMENT Treatment depends on the outcome of the

diagnosis and the area affected.

Topical treatment: use of Antiperspirants eg.

Aluminum chloride hexahydrate, block sweat poreand reduce sweat, and also eliminate odour

Systemic treatment: use of Anticholinergics, hassympathetic inhibitory action.

Iontophoresis: block sweat duct by directing amild electrical current through the skin(Hornberger et. al, 2003).


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Treatment contn

Botox: use of Botulin toxin injection, inhibit nerveimpulse (Heckman, 2001, Naumann and Lowe,

2001, lowe et. al, 2003).

Surgery: can be done for severe cases. It is of twotypes; (i) Local Excision (ii) Endoscopic Thoracic

Sympathectomy. Endoscopic thoracic sympathectomy (ETS) is the

most effective of all. It also have some side effects.


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CONCLUSIONHyperhydrosis is an embarrassing disorder

that even today is misconceived as rare anduntreatable. It is aggravated during emotional

stress and the pathophysiological mechanismappears to be hyperfunctioning of the gland.

Hyperhydrosis does not have to be aproblem of epic proportion. By acknowledging

the condition and by getting help from the rightsources, you can minimize its impact on thequality of your life.


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REFERENCES

Fealey R.D (1997): Thermoregulatory sweat test. In: low PA,ed. Clinical Autonomic Disorders. 2nd ed. Philadelphia,pa: Lippincott-Raven; 245-257

Hamm, H., Naumann, M., & Kowalski, J. (2006). Primary focal

hyperhydrosis: Disease characteristics and functionalimpairment. Dermatology, 212. 343-353.

Heckmann M, Ceballos-Baumann A.O, Plewig G (2001): Hyperhydrosisstudy Group, Botulinum toxin A for axillary hyperhydrosis;344:111- 117.

Hornberger J, Grimes K, Naumann M, et al. (2004 Aug):Multi- Specialty

Working Group on the Recognition, Diagnosis, and Treatment of

Primary Focal Hyperhydrosis. Recognition, diagnosis, and

treatment of primary focal hyperhydrosis. JAmAcad Derm.

51(2):274-286,


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Mayo Clinic (2011): What causes excessive sweating, Article reviewed byM.J Ingram,

Rachel Champeau (2002); Evidence that 'sweaty palms' syndromeis genetic , UCLA issues of the journal of vascular surgery

Reisfeld R, Berliner K (2008): Evidence based review of thenonsurgical management of hyperhydrosis, thorac surg

clin 18(2); 157-166 Strutton DR, Kowalski JW, Glaser DA, Stang PE.(2004 Aug.): US prevalence

of hyperhydrosis and impact on individuals with axillary

hyperhydrosis: results from a national survey. J Am Acad

Derm. 51(2):241-8,

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