Hyperhidrosis
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Excessive sweating (hyperhidrosis, hyperhidrosis) is a disorder characterized by excessive secretion of sweat that exceeds the body's physiological needs related to body temperature regulation. The problem may affect individual areas, such as the armpits, hands, feet, or face, or cover larger areas of the skin. Excessive sweating is not always a symptom of a disease, but in some patients it is a consequence of systemic conditions, hormonal disorders, or medications taken. Excessive sweating significantly affects the quality of life, makes daily activities difficult, limits professional and social activity, and increases the risk of skin infections. Modern diagnostics allow distinguishing the primary form from the secondary one, and treatment includes both causal therapy and methods limiting the activity of sweat glands.
Hyperhidrosis - what is it
Sweating is a natural physiological mechanism, the main function of which is to maintain normal body temperature. Sweat production is primarily the responsibility of eccrine sweat glands, of which humans possess about 2-4 million. Their highest density occurs on the palms, feet, forehead, and in the armpit area.
Hyperhidrosis is referred to when the amount of sweat secreted is disproportionately large in relation to the body's needs, occurs independently of ambient temperature or physical exertion, and causes difficulties in daily functioning.
The most common symptoms include:
- constantly damp hands or feet,
- wet stains on clothing,
- the need to change clothes multiple times a day,
- difficulty holding objects in the hand,
- an unpleasant odor resulting from the proliferation of bacteria on damp skin,
- increased susceptibility to skin irritation and infections.
It is worth emphasizing that sweat itself is practically odorless. The characteristic odor appears only as a result of the breakdown of its components by bacteria living on the surface of the skin.
Hyperhidrosis can begin as early as childhood or adolescence, but it can also develop in adulthood as a symptom of other diseases.
Hyperhidrosis - primary and secondary - differences
From a medical point of view, hyperhidrosis is divided into primary (idiopathic) and secondary.
Primary hyperhidrosis
It accounts for about 90% of all cases.
Its characteristic features are:
- it most frequently appears before the age of 25,
- it usually affects both sides of the body symmetrically,
- it involves the armpits, hands, feet, or face,
- it does not occur during sleep,
- it often has a familial basis,
- it results from overactivity of the sympathetic nervous system.
At the same time, no disease responsible for increased sweat secretion is identified.
Secondary hyperhidrosis
It develops as a symptom of another medical condition or the effect of external factors.
It may accompany, among others:
- hyperthyroidism,
- diabetes,
- obesity,
- menopause,
- neurological diseases,
- chronic infections,
- neoplasms,
- Parkinson's disease,
- hypoglycemia,
- hormonal disorders,
- taking certain medications (e.g., antidepressants, antipyretics, or opioids).
Particular attention is drawn to the sudden onset of generalized hyperhidrosis in an adult, especially if it is accompanied by night sweats, weight loss, or fever. Such a situation requires internal medicine diagnostics, as it may be a symptom of a serious illness.
Hyperhidrosis of underarms, hands, feet - why different locations require a different approach
Although the mechanism of hyperhidrosis development is similar, individual body areas differ in skin structure, the number of sweat glands, and their impact on daily functioning. For this reason, the selection of treatment should be individualized.
Axillary hyperhidrosis
This is the most common form of focal hyperhidrosis.
It causes:
- persistent dampness of clothing,
- discoloration on clothing,
- unpleasant odor,
- skin irritation.
The underarm area responds well to topical treatment and botulinum toxin therapy.
Palmar hyperhidrosis
It is particularly troublesome professionally and socially.
It can cause:
- difficulty writing,
- problems operating electronic devices,
- slipping of tools,
- discomfort when shaking hands.
The skin on the hands contains an exceptionally large number of sweat glands, therefore treatment can be more demanding.
Plantar hyperhidrosis
Constant moisture leads to:
- maceration of the epidermis,
- fungal infections,
- bacterial superinfections,
- unpleasant odor,
- painful abrasions.
In therapy, in addition to limiting sweat secretion, proper skin care and the use of breathable footwear are of significant importance.
Hyperhidrosis of the face and head
Although it occurs less frequently, it often causes the greatest psychological discomfort. Excessive facial sweating can make it difficult to perform work requiring contact with people and negatively affect self-esteem.
Each location requires an individual assessment by a doctor, as both the effectiveness of individual treatment methods and the risk of side effects vary.
Hyperhidrosis - when is it worth reaching for botulinum toxin
Botulinum toxin type A is currently among the best-documented methods of treating primary focal hyperhidrosis, especially in the underarms. Its efficacy has been confirmed in numerous clinical trials and guidelines of international dermatological societies.
The mechanism of action consists in the temporary blocking of acetylcholine release, a neurotransmitter responsible for stimulating sweat glands. As a result, sweat secretion is significantly reduced without damaging the glands themselves.
Treatment is worth considering when:
- antiperspirants with a high concentration of aluminum salts do not bring improvement,
- hyperhidrosis hinders professional work or social contacts,
- the problem causes chronic skin irritation,
- recurrent bacterial or fungal infections occur,
- the quality of life is significantly deteriorated.
The most important advantages of the therapy include:
- high effectiveness,
- rapid onset of effects,
- the possibility of treating various body areas,
- reversibility of action,
- low invasiveness.
The treatment effect usually appears after a few days, reaches its maximum after about 2 weeks, and lasts on average from 4 to 9 months, after which the procedure can be safely repeated. The best results are achieved in the treatment of underarm hyperhidrosis, while the therapy of hands and feet is also effective, although it may be associated with greater discomfort during injections.
Other methods are also used in the treatment of hyperhidrosis, such as iontophoresis, anticholinergic drugs, microwave thermolysis of sweat glands, laser treatments, microneedle radiofrequency, and, in selected cases, surgical treatment. The choice of therapy depends on the location of the problem, its severity, the patient's age, and the presence of coexisting diseases.
