Hyperhidrosis. Sweat and heat, it is known, are also connected due to the fact that it is through sweating that the body regulates its internal temperature

Abnormal sweating (hyperhidrosis), however, can have a strong impact on the life of the person who experiences it, leading to embarrassment on the aesthetic front and perhaps even limiting certain activities such as sports.

What is hyperhidrosis and types

Hyperhidrosis refers to an excessive secretion of sweat by the sweat glands.

Broadly speaking, 2 types can be distinguished:

A) focal (or localised or primary) hyperhidrosis: affecting only 1 or more specific body regions, unilateral or symmetrically on both sides, such as:

• palms of the hands
• soles of the feet;
• armpits;
• face.

B) generalised (or secondary) hyperhidrosis: sweating is spread to various areas of the body.

The causes of focal hyperhidrosis

Focal hyperhidrosis is caused by abnormalities in the regulation of sweat secretion processes, probably due to a neurological dysfunction.

The triggering causes may be

• genetic: familial and genetic predisposition, whereby the condition tends to run in families in 30-50% of cases;
• physical, including trauma/injury or disease affecting the nervous system: much more rarely and particularly if hyperhidrosis is unilateral
• psychological: e.g. stress, anxiety, feelings of discomfort, etc.

The causes of generalised hyperhidrosis

Generalised hyperhidrosis, on the other hand, is a physiological response of the body to certain primary triggering pathologies/conditions such as:

• cardiovascular diseases such as heart failure
• endocrine diseases such as diabetes, hyperthyroidism, etc.;
• trauma and neurological diseases (Parkinson’s disease, ischaemia, multiple sclerosis, spinal cord or peripheral nerve injuries etc.);
• neoplasms, e.g. lymphomas (tumours affecting the lymphatic system) and neuroendocrine tumours (affecting the cells of the neuroendocrine system);
• infections;
• menopause;
• pregnancy;
• obesity;
• taking certain medications (as a side effect).

If generalised hyperhidrosis occurs mainly at night, the presence of the following must be ruled out in particular

• tumours of the lymphatic system (lymphomas);
• hyperthyroidism;
• neuroendocrine tumours;
• diabetes mellitus.

Symptoms of hyperhidrosis

The most obvious clinical manifestation of hyperhidrosis is abnormal sweating that, in the most severe cases, leaves the affected part of the body wet almost as if it had been immersed in water.

Sweating can also lead to an intense odour linked to bacterial infections in cases of:

• lacerations of the skin, as, for example, in focal forms on the feet, where there may be rubbing against the footwear and contact with the bacteria present in it;
• bromhidrosis.
• Excessive sweating and bromhidrosis

When excessive sweating causes a strong, pungent odour, we speak of bromhidrosis: a condition that is pathological in a certain sense as it is caused by an infection by certain bacteria that degrade the sweat molecules present on the skin, causing the stench.

How hyperhidrosis is treated

There are numerous treatments available for hyperhidrosis and the use of one rather than the other varies depending on the severity of the problem.

Deodorants with bactericidal action

Deodorants that combine fragrance with a bactericidal action block the agents responsible for the degradation of perspiration, so they tend to improve the unpleasant olfactory effect as well.

Antiperspirants

Antiperspirants are products that exert an astringent effect, clogging the sweat pores and thus reducing the amount of sweat secreted by approximately 40%.

They are commonly available in various formulations (spray, cream, roll-on) and can be purchased in pharmacies or supermarkets.

The most popular on the market are formulations with aluminium salts that have good anti-perspirant efficacy, with the possibility, however, of side effects such as:

• irritation;
• alteration or fraying of the textile fibres of clothing.

Anti-perspirants are applied daily or, if sweating occurs during sports and particular emotional states, when needed.

Iontophoresis

Iontophoresis is a procedure particularly suitable for the treatment of moderate focal hyperhidrosis, localised in the palms of the hands and feet.

The treatment, which is absolutely painless and carried out in sessions lasting about 20 minutes, consists of passing an electric current of low intensity through the skin of the areas affected by hyperhidrosis that are immersed in water or placed in contact with a sponge soaked in water.

The current generated would appear to act by obstructing the ducts of the sweat glands with a transitory effect over time.

It should be specified that the treatment cannot be performed in the presence of:

• electromedical devices such as pacemakers;
• orthopaedic prostheses or fixators.

Botulinum

Micro-injections of botulinum neurotoxin into the area affected by excessive sweating (localised hyperhidrosis) are another commonly used treatment against hyperhidrosis.

Botulinum inhibits the release of acetylcholine, a substance that transmits the nerve impulse to the sweat glands to secrete sweat.

The treatment, which is performed on an outpatient basis, lasts about 7-8 months, after which it must be repeated.

Endoscopic thoracic sympathectomy and surgical treatment

More serious cases of hyperhidrosis, particularly in the focal form in the hands and armpits, can be approached with surgical treatments such as thoracic sympathectomy, which can be performed percutaneously (i.e. through the skin) or via thoracoscopy.

The procedure, performed under general anaesthesia, physically cuts or inhibits the nerve ganglia, i.e. the nodular nerve structures that carry the sweat secretion impulse to the sweat glands in the area of interest.

It is a procedure with resolving efficacy in almost all cases, but like all surgical procedures, it carries a percentage of risk, so it is generally reserved for the most serious cases.

How to sweat less in summer

High summer temperatures are known to cause a general increase in sweating and, especially for those suffering from hyperhidrosis, there are general lifestyle measures that can help to partially limit the secretion of sweat and possible bad odour, including:

• avoiding the consumption of spicy foods and exciting drinks such as alcohol and coffee;
• not overdoing exposure to the sun, especially in the middle of the day;
• not practising sports during the hottest hours and in the sun;
• wear natural fibres, such as cotton, preferably white, in contact with the skin, or, if you want to conceal the halo, very dark colours, possibly also wearing armpit protectors to protect clothes from sweat stains.

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Source:

GSD