Hyperhidrosis

Definition

Hyperhidrosis (from Greek “hyper”—excessive, increased, “hydros”—sweat) is commonly understood in medical practice as profuse sweating, which occurs regardless of physical factors: increased motor activity, overheating, high temperature, or others. 

General information

In the body of a healthy person, sweating increases when the ambient temperature rises to 20-25 ° C, as well as when there is physical or psycho-emotional stress. When the ambient temperature rises to 36 ° C and above with the help of sweating, it is thermoregulation of the body, and it is not allowed to overheat. Increased heat dissipation and cooling of the body are promoted by low relative humidity and active physical movement.

On the contrary, in a humid environment with still air, sweat evaporation does not take place, so a prolonged stay in a hot bath or steam room is not recommended. Psycho-emotional excitement stimulates the skin receptors, which react and stimulate the secretion of sweat. Therefore, increased sweating occurs if a person experiences strong emotion, such as excitement, fright, or pain.

Pathological disorders of sweating are expressed in its excessive increase or, conversely, a decrease, as well as in the change in the odor of sweat, which becomes stinky. Increased sweating can be general when profuse sweating occurs on almost the entire body surface and often accompanies functional disorders of the nervous and endocrine systems and several infectious diseases. In cases where sweating is limited to localized areas of the body (soles, palms, axillary areas, elbow, and knee bends), we are talking about local hyperhidrosis due to increased nervous system excitability.

Causes of hyperhidrosis

Sweat is produced by sweat glands located in the subcutaneous fatty tissue. The largest number of sweat glands is located in the armpits, palms, and soles of the feet. By its chemical composition, sweat is 97-99% water with impurities of salts (chlorides, phosphates, sodium, and potassium sulfates) and other complex organic substances. The presence and concentration of these substances in sweat secretion vary from person to person; hence, the individual odor of sweat is inherent in different people. 

Hyperhidrosis can be one of the symptoms of several neuropsychiatric, somatic diseases or a consequence of poor personal hygiene.

Clinically, a distinction is made between primary and secondary hyperhidrosis. Primary hyperhidrosis is more common in adolescence during rapid puberty and occurs in 1% of people. Secondary hyperhidrosis is usually the result of neurologic, endocrine, or somatic disease. The identification of factors causing hyperhidrosis predetermines the program of further examination and treatment of the patient. Thus, in generalized hyperhidrosis, it is necessary, first of all, to exclude tumor, endocrine, and infectious diseases.

Sweat glands form and excrete sweat through pores on the surface of the skin. The normal regulation of sweating in the human body is provided by the autonomic nervous system, which is responsible for metabolism, blood circulation, excretion, and reproduction. The autonomic nervous system is divided into two parts: sympathetic and parasympathetic.

Regulation of the sweating process is carried out by the sympathetic autonomic nervous system. When the sympathetic nervous system is hyperfunctioning, the normal functioning of the sweat glands is altered: at the slightest excitement, the person immediately becomes covered with sweat. 

Treatment

Local surgical treatment of hyperhidrosis

All surgical treatment methods represent a particular risk, so they should be used only after conservative treatment is ineffective and does not bring the expected results. Local surgical methods in treating hyperhidrosis involve surgical intervention in increased sweating, an intermediate stage between conservative treatment and the central surgical method of combating hyperhidrosis (sympathectomy).

Conservative ways to treat and prevent hyperhidrosis include general hygiene of the body and areas of excessive sweating, medication, antiperspirants, Botox injections, and seeing a psychologist.

The disadvantage of conservative treatment of hyperhidrosis is that its effect is short-lived and requires regular treatment procedures: the effect of antiperspirants lasts up to 6 hours, and the effect of Botox injections—up to 6 months.

The surgical treatment of hyperhidrosis is currently being successfully utilized:

• axillary liposuction
• closed axillary curettage
• axillary skin excision.

Using these surgical treatment methods is the safest, gives a permanent positive result, and does not cause fears of side effects. They are minimally traumatic and do not cause cosmetic defects because the procedure is carried out through small punctures measuring only 10 mm. The technique of localized surgery methods involves reducing the number of sweat glands, leading to a reduction in sweating. In 90% of cases, the problem of hyperhidrosis and the unpleasant odor of sweat is eliminated.

The latest techniques for the treatment of hyperhidrosis

The newest word in cosmetology is the laser method of treating hyperhidrosis. This method has been successfully used to treat cellulite. Experts in the field of cosmetology have expanded the range of indications for laser treatment to include hyperhidrosis. The impact of laser heat energy on the sweat gland cells leads to their complete blocking and cessation of function. As a result, there is a complete cure for hyperhidrosis that does not require additional interventions.

Manipulation is performed in outpatient conditions under local anesthesia: a cannula with a laser beam at the end is inserted through a micropuncture into the skin and affects the cells of the gland. The procedure is characterized by low traumatism due to superficial intervention, takes 20-30 minutes, and does not require special preparation and subsequent stay in the clinic.

The risk of complications after laser treatment is virtually nonexistent: tissues are not hyperthermic, hematomas are not present at the puncture site, and laser radiation has an additional bactericidal effect on the area of intervention.

Axillary hyperhidrosis is treated with a neodymium laser that destroys up to 70% of sweat glands. In one session, the condition is completely cured. The procedure removes the sweat gland once and for all. Today, the treatment of hyperhidrosis with laser technology is the latest method. Still, it has not become widespread due to its high cost and insufficient number of trained specialists.

All these treatment options are available in more than 530 hospitals worldwide (https://doctor.global/results/diseases/hyperhidrosis). For example, Endoscopic thoracic sympathectomy (ETS) can be performed in these countries for following approximate prices:

Turkey $3.6 K in 27 clinics

China $8.4 K in 7 clinics

Germany $10.8 K in 26 clinics

Israel $15.1 K in 13 clinics

United States $18.8 K in 11 clinics.