Hyperhidrosis

Hyperhidrosis is excessive sweating. Sweating is necessary to keep the body cool; however, it should not interfere with a person’s ability to interact and function. Hyperhidrosis affects quality of life. May cause embarrassment and frustration. It can impact one’s ability to carry out routine chores and may be an occupational hazard. There are three types of hyperhidrosis: primary focal, generalized idiopathic, and secondary generalized

Primary focal hyperhidrosis is a true medical condition not caused by medication or another medical problem. It occurs on specific areas of the body, usually appearing on both sides equally. The most commonly affected areas are the feet, hands, under arms, head, and face. Primary focal hyperhidrosis frequently begins in childhood or adolescence, often starting with excessive sweating on the hands and feet that occurs at least once a week while the person is awake.  There may be a hereditary component.

Secondary generalized hyperhidrosis may be caused by a medical condition, such as menopause, overactive thyroid, diabetes, or stroke. Medications (antihypertensives or antidepressants), exercise, and heat also called secondary generalized hyperhidrosis. Unlike primary hyperhidrosis, sweating involves large areas of the body and may occur during sleep. This condition must be investigated by dermatologist for proper diagnosis and treatment.

Primary hyperhidrosis may affect a person’s quality of life, interfering with their work and social activities. It causes emotional embarrassment and isolates people. It is psychologically unsettling and may be associated with depression and anxiety. Also physically debilitating, it may cause discomfort in skin irritation, which can lead to bacterial and fungal infections.

The first step in the evaluation of hyperhidrosis is to differentiate between generalized and focal hyperhidrosis. Generalized hyperhidrosis is usually part of some other underlying condition, such as infective or malignant disease or a hormonal disorder, and focal or primary idiopathic hyperhidrosis occurs in otherwise healthy people There are numerous topical medications and procedures that are effective for treating and controlling hyperhidrosis.  These include the following:

            Antiperspirants – available by prescription and nonprescription, these topical sprays, gel’s, roll-on’s, and lotions decrease sweating. The most common ingredient is aluminum chloride. Antiperspirants should be applied at bedtime on dry skin, covering the hair bearing areas of the under arm and wash off in the morning.

Topical glycopyrronium (Qbrexa) – a new prescription treatment that comes in a towelette that you wipe onto the sweaty areas at nighttime before bed.  In hyperhidrosis, glycopyrronium inhibits the action of acetylcholine on sweat glands, reducing sweating.

Possible side effects include dry mouth and urinary retention.

            Iontophoresis – used to treat sweaty hands and feet, this treatment requires the patient to immerse the hands or feet in a shallow pan filled with water. A medical device sends a low voltage current through the water. This process is used every other day for about 6 to 10 treatments until sweating decreases. Repeat treatments are necessary to maintain results. The patient administers the treatments at home and a prescription is necessary for the machine.

            Botulinum toxin type A (Botox) – is a dilute concentration of this neurotoxin is injected by a dermatologist into the under arms, palms, or souls to decrease sweating. Neurotoxins block the release of a neurotransmitter open parentheses acetylcholine) and is an effective treatment that may last 4 to 8 months. Retreatment is necessary

Oral medication – taken by mouth, the medication glycopyrrolate and propantheline bromide are used to prevent stimulation of sweat glands. They block open parentheses cholinergic) receptors in the gland and other areas of the body, such a smooth muscle and heart muscle. Since these medications have potential side effects, the benefit should outweigh the potential risk

MiraDry – uses a non-invasive handheld device to deliver precisely controlled electromagnetic energy beneath the underarm skin to the specific area where sweat glands are located, resulting in thermolysis (decomposition by heat) of the sweat glands.