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Hyperhidrosis Treatment

Why Do People Sweat?

Sweating is a physiological reaction necessary to adjust the body temperature. It is perfectly normal and necessary for people to sweat to some extent. In case of a physical temperature increase or emotional stress in human body, receptors on the skin transfers the information to the front hypothalamus-preoptic area in the brain. This area stimulates the sweat glands on the skin, which results in sweat, a salty white liquid. Evaporation of sweat on the skin helps reduce the body temperature. Human body regulates its temperature through sweating. Although emotional stress-related sweating occurs on the palm of the hands, soles and forehead, the physical temperature causes sweating overall the body.

It is quite usual for almost all mammals to sweat; however, horses happen to have a sweating mechanism similar to humans. Since dogs cannot sweat, they dehydrate through mouth breathing and therefore regulate their body temperatures.

Amount of sweat that people can produce may vary from one person to another. Genetics plays an important role in sweating. Physical activities, diseases, taking medications and emotional state are the main factors to determine the amount of sweating. Hyperhidrosis may also be a symptom of a serious disease. In case of hyperhidrosis, people should immediately see a doctor.

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Why Does Sweat Stink?

In fact, sweat is made up of water and resolved solids (chlorides). Apart from that, it contains odorizes (2-methylphenol and 4-methylphenol) and urea. However, the main reason of the odor is not the sweat itself, but the bacteria which can exist in sweaty areas.

What is Hyperhidrosis?

Hyperhidrosis can be defined as the over-sweating than necessary in order to adjust the body temperature. Hyperhidrosis may affect the whole body or some body parts. Hands, feet, armpits and genitals sweat the most. Although emotional stress-related sweating occurs on the palm of the hands, soles and forehead, the physical temperature causes sweating overall the body.

Primary Hyperhidrosis

Generally, it starts during or before adolescence. It is common between family members. Secondary hyperhidrosis may occur in any period of life. Secondary hyperhidrosis may be caused by thyroid or hypophysis diseases, diabetes, tumors, gout, menopause, various medications or mercury poisoning. Hyperhidrosis may also result from various neurological diseases, brain lesions, obesity or psychological diseases.

Sweating more than necessary may be disturbing, cause boredom and stress, embarrass the patient and damage the skin, which prevents personal communication and might negatively affect career choices, mental health, personal appearances and living standards.

Can Hyperhidrosis Be Treated Through Medications?

There are creams available for armpits which are made of chlorides and methyl alcohol. There are also creams available for foot sweating which contain glutaraldehyde. These medications have limited success in treating the disease and may cause damage on the skin.

Various anticholinergic medications (Oxybutynin, Glycopyrrolate, Benztropine, Propantheline bromide) are used to treat hyperhidrosis. However, they may cause costiveness, tachycardia or hazy sight and are not effective. They do not successfully treat the disease and they should be permanently used.

Beta-blockers, in fact, are used for the treatment of cardiovascular diseases. They might be effective for stress-related sweating. Antidepressant and anxiolytic drugs may treat sweating caused by psychological issues.

Do B*t*x Injections Successfully Treat Hyperhidrosis?

B*t*x (botulin toxin type-A) is a bacterial toxin. They temporarily stop sweat occurrence since they temporarily block the nerves connected to the sweat glands. B*t*x Injections are the most preferable option when the patient does not consider surgical operation. Although mostly used for armpit sweating, they are also used to treat hand and foot sweating. They last 3 to 9 months. They are not effective for facial sweating. Patients who receive B*t*x injections during spring season expect to have a trouble-free summer. Since these injections may cause pain, injections to hands and soles are performed in a surgery room.

Perkütan sempatektomi, lumbar sempatektomi, endoskopik torakal sempatektomi (ETS) gibi yöntemlerde diğer bir çözüm olup, sempatik sinir sistemi hücrelerini tahrip ederek ter bezlerinin çalışmasını durdurur. Ancak bu tedavilerin etkisi de geçicidir.

What is Iontophoresis?

Iontophoresis is the application of a small amount of electric current to hands and feet, which causes the sweat glands to get blocked. The treatment is performed once a week and required for a lifetime. It is not effective in armpit sweating. Its results are temporary.

What are the Surgical Options to Treat Hyperhidrosis?

One of the surgical options is to removal or destruction of sweat glands for the treatment of armpit sweating. Retro dermal curettage, liposuction, VASER or laser treatment may serve the purpose. The success rate is quite high.

Another option is the destruction of cells in sympathetic nervous system that regulate the operation of sweat glands. Percutaneous sympathatectomy, lumbar sympathatectomy, endoscopical thoracic sympathatectomy (ETS) are the operations for the treatment of armpit sweating. In percutaneous sympathatectomy, the nerves are blocked via phenol injections. It provides a temporary decrease in sweating.

Endoscopical thoracic sympathatectomy (ETS)

It is a standard and effective treatment for hyperhidrosis and hectic flushing. It is the removal of sympathetic nerve which is located in thoracic cavity and affect hands, armpits and face. The removal of the nerve does not cause any loss of function. The nerve segment to be removed is decided according to the sweating part of the body. The greatest complication is that an increase in sweating is observed in areas which do not sweat before the operation. This situation may be disturbing for 20-80% of the patients. There is also a risk for dry hands, Horner’s syndrome, an increase in overall sweating.

Lumbar sympathatectomy is recommended for the patients with foot sweating who have not benefitted from EST treatment. It has a 97% rate of success. However, it must be applied to the patients on whom ETS treatment has not been effective.