Hyperhidrosis
"A patient with hyperhidrosis has to be evaluated by a dermatologist. This will indicate a treatment with botulinum toxin or anticholinergic drugs, or will be inclined to a surgical solution or other procedures".
DR. AGUSTÍN ESPAÑA
DIRECTOR. DERMATOLOGY DEPARTMENT
What is hyperhidrosis?
Hyperhidrosis is a disease characterised by excessive sweating in certain areas of the body, resulting from an increase in the secretion of the sweat glands.
This increased sweating is usually due to an overactivity of these glands due to nervous hyperstimulation, caused by situations involving emotional tension or stress, by the action of pharmacological substances or for thermal reasons.
Despite the control of body temperature by the hypothalamus that occurs in normal situations, in hyperhidrosis, the sweat glands in the palms of the hands, soles of the feet, armpits and craniofacial region are particularly sensitive to emotional or thermal stimuli, producing more intense sweating to regulate temperature and counteract the rise in temperature.
Hyperhidrosis can cause work and social disability and affects about 1% of the population, of which almost half of the cases are hereditary.
Symptoms of hyperhidrosis
In severe cases, sweat soaks clothes, wets work tools and even drips onto the floor. The most common symptoms of hyperhidrosis:
- Excessive sweating: Sweat production is disproportionate even at rest or in cool climates, mainly affecting the armpits, hands, feet and face.
- Bad odour (bromhidrosis): The accumulation of sweat favours the growth of bacteria, generating an unpleasant odour that is difficult to control.
- Skin over-infection: In damp areas such as the feet, bacterial infections can occur.
- Skin problems on the hands: Sweating on the palms can lead to dyshidrosis (small, itchy blisters), contact dermatitis and even cold, bluish hands (cyanosis).
Do you have any of these symptoms?
If you suspect that you have any of the above symptoms,
you should consult a medical specialist for a diagnosis.
Causas de la hiperhidrosis
Excessive sweating is mainly due to thermal and emotional stimuli, which activate the sympathetic nervous system and provoke an exaggerated response in the sweat glands.
- Emotional factors: Situations such as public speaking, fear of being observed or social interaction can trigger excessive sweating.
- Thermal factors: Increased body or environmental temperature can intensify sweat production.
- Drugs: Some drugs, such as antidepressants, can cause hyperhidrosis as a side effect.
Tipos de hiperhidrosis
Depending on its location, hyperhidrosis is classified as follows:
- Generalised: It affects the whole body.
- Localised: concentrated in specific areas, such as the armpits, hands, feet or face.
According to its cause:
- Idiopathic or essential: Of unknown origin, it is the most common. It starts in childhood or adolescence and affects between 0.6% and 1% of the population. It usually improves with age and has a family history.
- Secondary or pathological: It is associated with diseases such as infections, neurological disorders, lymphomas, diabetes or alcohol intoxication. It may also be an adverse effect of certain medications.
Treatment of hyperhidrosis
Pathological facial flushing and hyperhidrosis are approached from a multidisciplinary perspective involving different types and intensities of treatment.
Facilitating appropriate treatment is essential for hyperhidrosis, as it can lead to occupational and social disability.
Pharmacological treatment
Some cases of hyperhidrosis can be corrected with drug treatments.
Initial treatment of excessive sweating is topical, with anticholinergic drugs, such as glycopyrronium bromide, and astringent and tanning preparations, such as aluminium chloride, glutaraldehyde or salicylic acid. The mechanism of action is the occlusion of the sweat gland duct. They should be applied at night and when the skin is dry.
A second pharmacological option in some types of hyperhidrosis are systemic treatments: propantheline bromide, tranquillisers and sedatives, such as clonazepam or diazepam, and calcium antagonists, such as diltiazem.
Botulinum toxin
Indicated for certain cases of severe sweating of the hands or armpits.
The administration of this drug produces a selective blockage in the action of acetylcholine on the eccrine glands, reducing the production of sweat.
First, a test is carried out to find out which areas sweat the most and thus act more selectively, avoiding systemic side effects.
Hyperhidrosis surgery is effective and definitive in more than 80% of cases of hyperhidrosis of the hands, feet, armpits and face.
It is indicated for the most severe cases, in which the rest of the procedures have failed. It should always be dictated by the surgeon, since it is not effective for all patients.
The operation for hyperhidrosis is performed on an outpatient basis with a very low complication rate. It lasts approximately one hour, with very satisfactory results for the patient from the first days.
Hyperhidrosis surgery is a minimally invasive treatment called videothoracoscopic thoracic sympathectomy. It consists of making a small incision of only 5 mm, on each side of the thorax to locate and section or compress by means of clips, in a specific point, the sympathetic chain, which is the one that controls the sweating and facial blushing.
Our team of experts in hyperhidrosis
IN NAVARRE AND MADRID
Dermatology Team
