3% of The Population
Hyperhidrosis refers to excessive sweating and most commonly affects the Underarms, Hands and Face.
Effective Treatments Are Available.
What Is Hyperhidrosis?
Hyperhidrosis simply means a condition which causes excessive sweating. This excessive sweating can occur in different areas of the body. When excessive sweating is limited to one part of the body more than other parts of the body, this is called Focal hyperhidrosis. When hyperhidrosis occurs throughout the entire body this is then call Generalised hyperhidrosis. In general terms focal hyperhidrosis is not associated with specific disease processes, whereas generalised hyperhidrosis needs to be investigated and treated.
Focal hyperhidrosis is also called essential hyperhidrosis or primary hyperhidrosis because there is usually no causative factor (the medical term for this is idiopathic). Primary hyperhidrosis can be further classified according to the specific area which it affects.
Axillary hyperhidrosis refers to sweating which affects the armpits. The largest proportion of patients over 50% suffer from excessive sweating from the armpits.
Palmar hyperhidrosis refers to excessive sweating which is restricted to the Hands. Hyperhidrosis which affects the hands of accounts for up to a quarter of patients.
Craniofacial hyperhidrosis refers to excessive sweating which affects the face especially the scalp and the forehead. At our clinic this accounts for between 10 to 20% of our patients.
Plantar Hyperhidrosis refers to sweating which is restricted to the feet. Excessive sweating on the feet is particularly hard to treat as it involves very large area, as a result injection therapy is limited.
It is not uncommon for patients to have more than one area being affected with excessive sweating in combination. For example they may sweat excessively from their underarms and their hands together.
Pathophysiology or causes of Hyperhidrosis
Hyperhidrosis is generally considered to be the result of inherited characteristics which cause the sympathetic nervous system to become more reactive to the environment then is normal. So that even a small amount of perceived threat or anxiety causes a overstimulation of that part of the brain which controls sweating. The sympathetic nervous system then relays this message to the sweat glands to produce increased amounts of sweat. It is possible other parts of the brain are also involved in hyperhidrosis including the hypothalamus and specific parts of the cerebral cortex.
Hyperhidrosis Diagnosis and Symptoms
The diagnosis of hyperhidrosis is different for every patient And this makes the diagnosis of hyperhidrosis difficult. This is because each patient is affected in a different way by the excessive sweating. Some people may only have a minor amount of sweating but still feel very troubled by this. Many patients are not aware that treatment is available for hyperhidrosis.
To assist us in the diagnosis of hyperhidrosis there is a standardised scale which can be used to help diagnose hyperhidrosis.
This is called the Hyperhidrosis Severity Scale. Click here to read more.
Here is a list of questions that Doctor may ask to determine if you have hyperhidrosis.
When did you're sweating begin?
Where are you most affected by sweating, Does it just affect one or two areas or does it affect your whole body?
What treatments have you already tried including both topical or medications prescribed by other doctors? How successful was the treatment?
Any other family members suffer from excessive sweating?
When do you sweat most, under what conditions or stresses cause you to sweat?
To what extent does your sweating interfere with your life?
Are they any specific triggers to your sweating?
Do you suffer from depression or anxiety?
Do you avoid shaking hands?
Do you have difficulty forming relationships and do you avoid social functions or interactions as a result of your sweaty?
Do you need to change your clothes often?
Statistics and Risk Factors
As already mentioned hyperhidrosis is a inherited genetic condition and that there is a much stronger prevalence amongst family members. The chances of having another family member also suffering hyperhidrosis is generally quoted in the order of of 20 to 30%.
Hyperhidrosis can start in any age. However in general most people can remember sweating excessively from primary school to early high school. This is particularly true for both hand and underarm sweating . Facial sweating on the other hand often presents later in life usually after the age of 25 years.
Hyperhidrosis is a common condition and estimates suggest it can affect between 3-5% of the population in western countries. Estimates suggest up to 15% of adolescents but it is usually self limiting and does not interfere in later life. In our experience,the majority of people we see are between 18-35, however,generally we believe the impact and the prevalence of hyperhidrosis declines after the age of 50 years.
During your consultation process a medical examination is necessary to be carried out. This usually is a simple process of examining the areas where you sweat most. In cases of generalised hyperhidrosis a more thorough examination is necessary to exclude secondary causes. It may also require blood tests to be performed to rule out causes such as thyroid and other endocrine diseases.
The most common way to identify areas of excessive sweating is by performing the Minors Iodine Starch test. This is a very simple procedure of using iodine commonly in the form of betadeine being applied to the area where you sweat followed by using cornstarch. The cornstarch will turn a dark brown black colour when it is mixed with your perspiration.
There are other tests which can also be done to assess excessive sweating. These include
Gravimetric Testing which involves the use of assessing how much sweat is absorbed by a piece of paper.
Thermoregulatory Sweating Test and the Quantitative Sudomotor Axon Reflex Test.
All of the above testing methods are generally not practical in clinical practice to assess whether or not someone has hyperhidrosis.
Hyperhidrosis Treatment Options
The treatment of hyperhidrosis is determined by the area you are trying to stop sweating. Treatment is always commenced with the least invasive and mildest treatment that controls sweating. In the majority of cases this will involve the use of topical antipersiprant such as those that are commercially available from the supermarket or more concentrated formulations such as aluminium chloride which is available from the chemist. When this fails, the doctor usually prescribes either a trial of oral medication or recommends the use neurotoxin injections. The table below is a useful guide i giving you some treatment options.
Topical Agents and Antipersirants
Antiperspirants are best for mild sweating. They can be used for underarms, hands, face and feet. The stronger antiperspirants are more likely to cause skin irritation in some people. The strongest antiperspirants contain aluminium chloride such as Dri Chlor and this should be tried before seeking professional help. If you have any doubts discuss this with your doctor.
Antiperspirants work differently from deodorants. Deodorants simply cover the smell. Antiperspirants, on the other hand, contain aluminium chloride and work by chemically reducing the amount of sweat produced. The one down side to products such as Dri Chlor is that they cause skin irritation in a high percentage of people .
Several oral medications are available for the management of hyperhidrosis. These medications include Ditrpan and Probanthine. These medications work by restricting the electrical nerve signal reaching the sweat gland. For these medications to be effective they must be taken regularly up to 4 times per day and in high doses. Because these drugs stimulate the parasympathetic nervous system, they produce significant unwanted side-effects such as dry mouth, blurred vision and constipation. Nevertheless for some people these medications work and in general they are safe and a cheaper alternative to other forms of treatment. The choice to use oral medications is always a individual one, based on how much a person can tolerate side-effects.
Injection Treatments With Neurotoxin Muscle Relaxants
Injection therapy with neurotoxin muscle relaxants is a well established treatment for hyperhidrosis. The first published article describing its use was in 1998 by a Austrian neurologist (Dr Naumann). When neurotoxins are injected under the skin they act by blocking neurotransmitters which are necessary for the signal from the nerve to reach the sweat gland. The effect of these injections starts within four days and can last in general at least six months and upto 9-12 moths for the face and underarms.On the hands the effect lasts is between six and seven months. Unfortunately neurotoxin muscle relaxants do not have a lasting effect on the feet, lasting only 3 to 4 months.
The procedure of injecting neurotoxin injections is simple, quick and relatively painless. This is because we either use a anaesthetic to numb the or use light sedation during the procedure especially when injecting the hands.
We have had many years of experience using this product and the effectiveness of these injections can be repeated over many years. Some doctors believe there is a theoretical risk of develping auto-antibodies to this product which may cause it to lose it's effectiveness. Clinical experience however suggest that this is very rare.
The only contraindication to using this product is if there is a proven history of allergy or if there is a history of neuromuscular disease or if you are pregnant or breastfeeding.
Iontophoresis refers to the introduction of electrons to the area where you want to stop sweating. By doing so, this disrupts the flow of important ions involved in the transmission of a nerve impulse to the sweat gland.
Iontophoresis has to be performed with the use of an electrical device. These devices can cost up to $1000 and in general they are better purchased and the best one are available from outside Australia.
Iontophoresis has to be performed at least on a daily basis for 45-60 mins which makes them a less attractive alternative form of treatment. It is primarily used for hand sweating and feet sweating.
Not only is iontophoresis time consuming it can also irritate the skin and cannot be used if pregnant or if you have a pacemaker.