WHAT IS HYPERHIDROSIS?Hyperhidrosis is excessive sweating or perspiration. Sweating is a normal bodily function that removes excess heat from the body. Evaporation of sweat cools the skin. Sweating increases during physical exertion, emotional states, or when eating spicy foods. In some people, sweat production is so high that it interferes with daily life. It can even hinder social interactions, for example, making it difficult to shake hands. Excessive sweating can occur all over the body, but it is usually limited to certain parts. The areas where hyperhidrosis most commonly occurs are the armpits, face, palms, and soles of the feet.HOW DOES HYPERHIDROSIS DEVELOP?The cause of hyperhidrosis is usually unknown. This is called idiopathic hyperhidrosis. The impulse to sweat likely originates in the brain. There is a significant hereditary component: in 30-50% of people with hyperhidrosis, it runs in the family.
When all sweat glands throughout the body are overactive, the cause is usually an underlying problem. This could be obesity, menopause, a (chronic) infection such as tuberculosis, hormonal diseases such as an overactive thyroid, cancer, or the use of certain medications. Hyperhidrosis can develop due to psychological factors.
It usually begins during puberty and the symptoms persist for several decades.WHAT ARE THE PHENOMENA?With hyperhidrosis, certain areas of the body are frequently very moist due to excessive sweat production. This can occur on the palms of the hands, in the armpits, on the scalp and face, on the torso, in the groin, or on the soles of the feet. Excessive perspiration can be accompanied by an unpleasant odor. This odor is caused by an increase in bacteria and the release of an odor. The unpleasant odor of sweaty feet is often a major problem. With sweaty feet, the skin is easily infected by fungi and bacteria.
Excessive sweating in the armpits results in clothing that is constantly wet. People who suffer from sweaty armpits have to change their clothes several times a day. Often, this is alleviated by wearing dark-colored, loose-fitting clothing.
With hyperhidrosis of the hands, the palms are moist or even very wet. This leads to difficulties shaking hands. Writing on paper can also be difficult, as the paper becomes saturated with moisture. Sometimes, the skin softens, becoming pale and wrinkled, as if one has been immersed in water for too long.
Hyperhidrosis of the forehead and scalp causes sweat to drip down the face. This can be disruptive to social interactions.
Excessive perspiration can lead to emotional and psychosocial problems, including low self-confidence, social isolation, and depression. Besides the psychological consequences, excessive sweating can also cause skin irritation, for example, in the groin.HOW IS THE DIAGNOSIS MADE?It's possible to get an idea of sweat secretion with the iodine-starch test. The skin is thoroughly dried and rubbed with an iodine solution. Starch is then sprinkled over the skin. Starch reacts with iodine in the presence of sweat, resulting in a dark blue or black discoloration. However, such a test is usually unnecessary.HOW IS IT TREATED?Aluminum chloride:
Topical treatment with an aluminum chloride solution can be effective in reducing excessive perspiration on the hands, feet, and armpits. Applying aluminum chloride to the skin blocks the sweat gland ducts.
The solution should be applied at night after washing the affected areas with soap and water. The skin must be completely dry before applying the aluminum chloride solution. After application, the skin can also be dried with a cold air dryer to prevent the aluminum chloride from sweating off. The following morning, the same areas should be washed thoroughly again. Once the excessive perspiration has stopped, maintenance treatment can be applied once a week or once every two weeks. Treatment with aluminum chloride can cause skin irritation.
Axhidrox:
Axhidrox is a cream containing glycopyrronium. This agent inhibits the activity of the nerves that stimulate the sweat glands. The cream should be applied once a day in the evening for four weeks, then less frequently, if possible twice a week.
Iontophoresis
Iontophoresis can produce good results. This method involves immersing the hands and feet in water through which a weak electric charge is passed. Iontophoresis can be performed with two fluid containers, but also with moist, sponge-like applicators. Specially designed sponge-like applicators can be used for the armpits, face, and back.
The treatment takes 15 to 20 minutes and should be performed three times a week until excessive perspiration has stopped. After that, treatments can be reduced to less frequent intervals, for example, once a week. The treatment is sometimes initiated under the supervision of a physiotherapist. If effective, a device can then be purchased for home use.
The way iontophoresis works is not well understood. Sweat production may be inhibited by disrupting the transport of ions in the sweat glands. It is particularly suitable for the hands and feet. However, for severe cases, this therapy is not always sufficient. Iontophoresis treatment is harmless. Side effects may include skin irritation and pain.
Botulinum injections (Botox)
A relatively new treatment option is blocking sweat secretion using botulinum toxin. This toxin is produced by the bacterium Clostridium botulinum. This protein blocks the transmission of impulses at the transition from nerve to muscle and at the transition from nerve to sweat gland. The nerve block causes the sweat glands to stop producing sweat. Botulinum toxin is injected into the skin with small injections at the sites of hyperhidrosis (see below: treating hyperhidrosis with Botox ).
The effect is often exceptionally good, but the block is only temporary. After 3 to 6 months, nerve impulse conduction recovers, and the hyperhidrosis returns. Therefore, the treatment will have to be repeated regularly.
Botulinum toxin injections are painful, especially in the hands. Hands can only be treated with botulinum toxin under regional anesthesia. There is a risk of paralyzing the hand muscles for several weeks to months.
Botox vials are very expensive, and the amount reimbursed by health insurance is insufficient to cover the treatment. Therefore, most hospitals no longer offer this treatment. Or you may have to pay extra.
Anticholinergics:
Anticholinergics are medications that suppress sweat gland activity via the nerves. Anticholinergics are administered in tablet form. In the Netherlands, oxybutynin and glycopyrronium can be prescribed. These medications can have side effects, such as dry mouth, insomnia, and poor bowel movements.
MiraDry:
The MiraDry is a device that destroys sweat glands using heat via the microwave principle. The skin is first anesthetized with injections. The handpiece of the MiraDry device creates a vacuum on the skin and delivers controlled electromagnetic energy to the armpits. The energy generates heat, which destroys the sweat glands. At the same time, the overlying skin is protected from overheating by a continuously operating cooling system. The miraDry treatment is offered in several dermatological treatment centers. A treatment costs approximately 1500 euros and is not reimbursed by the health insurer.
Operations
A much more invasive procedure is a sympathectomy. In this procedure, several nerve nodes (ganglia) or nerve pathways are blocked or severed. Blocking is often performed first. This has only a temporary effect of one to two years. If the results are good, the nerve pathways can then be severed, which will have a lasting effect. The results are reasonable, with a significant decrease in sweating in the majority of people with hyperhidrosis. However, there is a risk of complications from the treatment. Moreover, increased perspiration can occur elsewhere on the body. Another option is to excise an area of skin containing the sweat glands in the armpits, or to remove the sweat glands (liposuction). Excision can have side effects, such as painful and unsightly scars. Liposuction of the armpits produces good results, but the long-term effects are not yet known.WHAT CAN YOU STILL DO YOURSELF?If you have hyperhidrosis of the armpits and groin, wear airy, cool cotton clothing whenever possible.
If you have hyperhidrosis of the feet, wear open shoes whenever possible (see sweaty feet ).
Wash your armpits and use deodorant or other antiperspirant.
Keep the room temperature cool and ensure good ventilation.
Avoid foods that cause perspiration, such as spicy dishes.
Avoid stress and practice relaxation exercises if necessary.WHAT ARE THE OUTLOOK?The condition usually persists for several years, sometimes lifelong. When all sweat glands throughout the body are overactive, it usually disappears once the underlying cause can be addressed. Treating sweaty armpits has improved with the advent of MiraDry. Treating sweaty hands and feet is still very difficult. |
