Dr. Francis SANWO

Hyperhidrosis is a condition characterized by abnormal increased sweating, in excess of that required for regulation of body temperature. Sweating is a natural response to certain conditions, such as warm weather, physical activity, stress, and feelings of fear or anger. With hyperhidrosis, you sweat more than usual for no apparent reason.

 Although primarily a physical burden, hyperhidrosis can deteriorate quality of life from a psychological, emotional, and social perspective. This excess of sweat happens even if the person is not engaging in tasks that require muscular effort, and it does not depend on the exposure to heat.

 Common places to sweat can include underarms, face, neck, back, groin, feet, and hands. It has been called by some 'the silent handicap'. Perspiration is a function of a complicated bodily system involving metabolism, temperature regulation, hormonal levels, blood flow on the skin and various other factors. It can also be triggered by medical or emotional issues (So, yes, you're not the only one; other people get the sweats when they're embarrassed, too).

Excessive perspiration can manifest itself in several forms, and make you really understand how many sweat glands are on your body.  It affects men and women equally, and most commonly occurs among people aged 25–64 years, though some may have been affected since early childhood. About 30–50% of people have another family member afflicted, implying a genetic predisposition.

 Hyperhidrosis can have physiological consequences such as cold and clammy hands, dehydration, and skin infections secondary to maceration of the skin. Hyperhidrosis can also have devastating emotional effects on one's individual life.

 Symptoms of excessive sweating include: Excessive sweating that’s occurred for at least six months without an apparent reason, sweat that occurs on both sides of your body in roughly the same amount, incidents of excessive sweating at least once a week  and sweating that interferes with your daily activities (such as work or relationships).

Classification of Hyperhidrosis.

Hyperhidrosis can either be generalized, or localized to specific parts of the body. Hands, feet, armpits, groin, and the facial area are among the most active regions of perspiration due to the high number of sweat glands (eccrine glands in particular) in these areas. Hyperhidrosis can also be classified by onset, either congenital (present at birth) or acquired (beginning later in life). Primary or focal hyperhidrosis usually starts during adolescence or even earlier and seems to be inherited as an autosomal dominant genetic trait. It must be distinguished from secondary hyperhidrosis, which can start at any point in life. Secondary hyperhidrosis may be due to a disorder of the thyroid or pituitary glands, diabetes mellitus, tumors, gout, menopause, certain drugs, or mercury poisoning.     Those with hyperhidrosis may have greater stress levels and more frequent depression.

 Primary Focal Hyperhidrosis.

 When excessive sweating is localized (e.g. palms, soles, face, underarms, scalp) it is referred to as primary hyperhidrosis or focal hyperhidrosis.

This is one of the most common causes of excessive sweating. The "focal" in the name refers to the focal points of the body where sweat shows up naturally, like the underarms, palms and face. It generally manifests as a symmetrical excess of sweat on the body (for instance, both palms, both soles of the feet, or both sides of the groin will produce too much perspiration).

 People who suffer from it don't have more sweat glands, larger ones, or anything else in their sweat-making bits that could cause this malfunction. The current theory is that it's a genetically transferred problem in the nervous system that produces a sweat reaction when it's not actually needed. (It's known as idiopathic, indicating that we don't actually know how it happens yet.) The most common manifestation is armpits.

 Primary or focal hyperhidrosis may be further divided by the area affected, for instance, palmoplantar hyperhidrosis (symptomatic sweating of only the hands or feet) or gustatory hyperhidrosis (sweating of the face or chest a few moments after eating certain foods).

The cause of primary hyperhidrosis is unknown. Anxiety or excitement can exacerbate the condition for many sufferers. A common complaint of patients is they get nervous because they sweat, then sweat more because they are nervous. Other factors can play a role, including certain foods and drinks, nicotine, caffeine, and smells.

Excessive sweating or focal hyperhidrosis of the hands interferes with many routine activities, such as securely grasping objects. Some focal hyperhidrosis sufferers avoid situations where they will come into physical contact with others, such as greeting a person with a handshake. Hiding embarrassing sweat spots under the armpits limits the sufferers' arm movements and pose. In severe cases, shirts must be changed several times during the day and require additional showers both to remove sweat and control body odor issues or microbial problems such as acne, dandruff, or athlete's foot. Additionally, anxiety caused by self-consciousness to the sweating may aggravate the sweating. Excessive sweating of the feet makes it harder for patients to wear slide-on or open-toe shoes, as the feet slide around in the shoe because of sweat.

 

 Generalized or Secondary Hyperhidrosis.

 Excessive sweating involving the whole body is termed generalized hyperhidrosis or secondary hyperhidrosis. It is usually the result of some other, underlying condition.

Similarly, secondary (generalized) hyperhidrosis has many causes including certain types of cancer, disturbances of the endocrine system, infections, and medicat Pregnancy.  During pregnancy, women can experience hormone changes, increased blood flow, and higher metabolism levels, which all result in a little bit more sweat than usual. It's all perfectly normal, though possibly a little unexpected. But know that if you end up constantly mopping your brow during your baby shower, not to worry.

 Thyroid diseases. This is another potential cause of excess sweat among pregnant women: Pregnancy kicks the thyroids of some women into overactivity, which is associated with high sweat levels. It can do the same to the non-pregnant too, though. Hyperthyroidism — the medical term for an overactive thyroid — means that the thyroid gland, which plays a large role in manipulating your body's metabolic rate, goes into overdrive, producing excess levels of the metabolic hormones thyroxine (T4) and tri-iodothyronine (T3). Your body's reaction to these hormone levels will be to speed up in basically all senses of the word: all your systems will be driven to work incredibly hard.

People with hyperthyroidism often also find the condition is accompanied by rapid weight loss, jitteriness, tremors, fatigue and a quick heartbeat, as your body tries to cope with the hormonal "push." It may also be accompanied by an enlarged thyroid, or a goiter, on your neck. If you feel like you're experiencing any of these symptoms, see your doctor.

 Perimenopause.  The period of time just before the female body enters menopause and stops having a menstrual cycle — causes sweating for much the same reason as pregnancy: the body reacts to shifting hormonal levels. The hot flashes of perimenopause, however, are more widely known than the pregnancy sopping-wet-underarms. Shifts in estrogen have a direct effect on the body's temperature control settings, and some people may be more prone to flushed skin and the need to cool core body temperature.

 Diabetes Mellitus. There are three ways in which people with diabetes mellitus may experience excess sweating: One in response to low blood sugar, one in relation to food, and one solely occurring at night. The first is such an established symptom that diabetics are warned to check for sweat as a marker that their blood sugar has started to fall to unacceptable levels; the nervous system's trigger for sweating is signaled by low blood sugar levels. The second is rarer, and is called "gustatory sweating" because of its exclusive relationship with food; it's associated with serious diabetics who may have suffered nerve damage, happens exclusively around food, and is confined to the head and neck.

The third is the dreaded "night sweats," or nocturnal hyperhidrosis. And it's not purely related to diabetes. Night sweats is also tie to sleep apnea, infections or hormone problems, amongst other possibilities. But it's definitely an issue for diabetics, and tends to be a signal of low blood sugar due to the body's insulin regulation at night.

 Medication Sweats. If you're on certain medications, they may be at the root of your sweating mystery. There's a class of medications known as diaphoretics, meaning that they cause excessive sweating in some people. The list includes some pain medications, blood pressure and cardiovascular drugs, chemotherapy, hormonal treatments, anything targeting the endocrine system, some antibiotics, and many more. Use of selective serotonin reuptake inhibitors (e.g., sertraline) is a common cause of medication-induced secondary hyperhidrosis. Other medications associated with secondary hyperhidrosis include tricyclic antidepressants, stimulants, opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), glyburide, insulin, anxiolytic agents, adrenergic agonists, and cholinergic agonists.

 Anxiety. When you get anxious, you sweat; the body's panic response is installed to produce excess perspiration in the event that something threatens us.

Stress hormones makes the body ready for immediate action by changing how the body functions when danger is perceived. Part of this change includes increasing perspiration so the body’s water can be eliminated through the skin rather than through the kidneys — so that you don’t have to stop to urinate in the midst of defending yourself from or escaping harm. Another part of the stress response’s actions cause an increase in respiration and heart rate to shunt blood to the parts more necessary for emergency action and away from those that aren’t. This increased respiration and shunting action causes the body's temperature to increase. A second reason for increased perspiration is to help cool the body.

Cancer. A variety of cancers have been associated with the development of secondary hyperhidrosis including lymphoma, pheochromocytoma, carcinoid tumors (resulting in carcinoid syndrome), and tumors within the thoracic cavity.

Diagnosis. Symmetry of excessive sweating in hyperhidrosis is most consistent with primary hyperhidrosis. Excessive sweating affecting only one side of the body is more suggestive of secondary hyperhidrosis and further investigation for a neurologic cause is recommended.

Treatment. There are several systemic, topical, surgical and electrical treatments available for hyperhidrosis. Topical agents for hyperhidrosis therapy include formaldehyde lotion, topical anticholinergics etc. These agents reduce perspiration by denaturing keratin, in turn occluding the pores of the sweat glands. They have a short-lasting effect. For peripheral hyperhidrosis, some chronic sufferers have found relief by simply ingesting crushed ice water. Ice water helps to cool excessive body heat during its transport through the blood vessels to the extremities, effectively lowering overall body temperature to normal levels within ten to thirty minutes. For further treatment options, see your doctor.

 Complications. If hyperhidrosis is not treated, it can lead to complications like: Nail infections especially toenail infections, warts, skin growths caused by the HPV (human papillomavirus), bacterial infections: especially around hair follicles and between the toes, heat rash (prickly heat, miliaria): An itchy, red skin rash that often causes a stinging or prickling sensation. It develops when sweat ducts become blocked and perspiration is trapped under the skin.

Psychological impact: Excessive sweating can affect the patient’s self-confidence, job, and relationships. Some individuals may become anxious, emotionally stressed, socially withdrawn, and even depressed.

On average, a person with hyperhidrosis seeks medical help after living with the condition for 9 years. It is important to spread the word that the symptoms of excessive sweating can be effectively treated.