Hyperhidrosis is a condition characterized by an abnormally increasing sweating, more than is necessary for the regulation of body temperature. Although primarily a physical burden, hyperhidrosis can degrade the quality of life from a psychological, emotional, and social perspective. It has been called by some 'silent flaw'.
Both diaphoresis and hydrosis words can mean sweat (where their meaning is synonymous with sweating) or excessive sweat, in which case they are specific, narrowly defined, disorder clinical.
Video Hyperhidrosis
Classification
Hyperhidrosis can be common , or localized to a particular body part. The hands, feet, armpits, groin, and face area are the most active part of the sweat due to the high number of sweat glands (especially eccrine glands) in this area. When excessive sweating is localized (eg palms, soles of feet, face, armpits, scalp) this is referred to as primary hyperhidrosis or focal hyperhidrosis. Excessive sweating involving the whole body is called general hyperhidrosis or secondary hyperhidrosis. Usually this is the result of some other underlying conditions.
Primary hyperhidrosis or focal may be further subdivided by the affected area, such as palmoplantar hyperhidrosis (symptomatic sweating only on the hands or feet) or gustatory hyperhidrosis (sweating on the face or chest shortly after a certain meal).
Hyperhidrosis can also be classified based on onset, either congenital (present at birth) or acquired (starting later). Primary or focal hyperhidrosis usually begins during adolescence or even earlier and appears to be inherited as an autosomal dominant genetic trait. It must be distinguished from secondary hyperhidrosis, which can begin at any point in life. Secondary hyperhidrosis may be caused by a disorder of the thyroid or pituitary gland, diabetes mellitus, tumor, gout, menopause, certain medications, or mercury poisoning.
One classification scheme uses the amount of skin affected. In this scheme, excessive sweating in an area of ​​100 centimeters square (16 inches square) or more is distinguished from sweating which affects only a small area.
Other classification schemes are based on the possible causes of hyperhidrosis.
Maps Hyperhidrosis
Cause
The cause of primary hyperhidrosis is unknown, although some doctors claim it is caused by excessive activity of the sympathetic nervous system. Anxiety or excitement can worsen the condition of many sufferers. A common complaint of patients is that they feel nervous with sweat, then more sweat because they are nervous. Other factors can play a role, including certain foods and beverages, nicotine, caffeine, and odors.
Primary hyperhidrosis
Primary hyperhidrosis (focal) has many causes.
- Unilateral unilateral hyperidrosis limited
- Relationships reported with:
- Blue rubber bleb nevus
- Glomus Tumor
- POEMS syndrome
- Burning foot syndrome (Goplan's)
- The trench leg
- Kausalgia
- Pachydermoperiostosis
- Myxedema pretibial
- Excessive sweating associated with:
- Encephalitis
- Syringomyelia
- Diabetic neuropathy
- Herpes zoster (shingles)
- Parotitis
- Parotid abscess
- thoracic sympathectomy
- Auriculotemporal or Frey's syndrome
- Miscellaneous
- Deep sweat (due to postganglionic sympathetic deficits, often seen in Raeder syndrome)
- Harlequin's Syndrome
- Emotional hyperhidrosis
Secondary hyperhidrosis
Similarly, secondary hyperhidrosis (common) has many causes including certain types of cancer, endocrine system disorders, infections, and drugs.
Cancer
Various cancers have been linked to the development of secondary hyperhidrosis including lymphoma, pheochromocytoma, carcinoid tumors (resulting in carcinoid syndrome), and tumors in the thoracic cavity.
Endocrine
Certain endocrine conditions are also known to cause secondary hyperhidrosis including diabetes mellitus (especially when low blood sugar), acromegaly, hyperpituitarism, and various forms of thyroid disease.
Drugs
The use of selective serotonin reuptake inhibitors (eg, sertraline) is a common cause of secondary hyperhidrosis due to treatment. Other drugs associated with secondary hyperhidrosis include tricyclic antidepressants, opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), glyburide, insulin, anxiolytic agents, adrenergic agonists, and cholinergic agonists.
Miscellaneous
- In people with a history of spinal injuries in the past
- Autonomous dysfunction
- Orthostatic hypotension
- Syringomyelia post-trauma
- Associated with peripheral neuropathy
- Familial familiarization (Riley-Day syndrome)
- Congenital autonomous dysfunction with loss of universal pain
- Cold exposure, especially related to cold induced sweat syndrome
- Associated with possible brain lesions
- Episodic with hypothermia (Hines and Bannick syndrome)
- Episodic without hypothermia
- olfaction
- Related to systemic medical problems
- Parkinson's disease
- Fibromyalgia
- Congestive heart failure
- Anxiety
- The state of menopause
- Overnight
- Compensation
- Infantile acrodynia caused by chronic low-dose mercury exposure, which causes an increase in catecholamine accumulation and produces a clinical picture resembling pheochromocytoma.
Diagnosis
The symmetry of excessive sweating in hyperhidrosis is most consistent with primary hyperhidrosis. Excessive sweating affects only one side of the body is more suggestive of secondary hyperhidrosis and further investigation for the neurological reasons is recommended.
Treatment
There are several systemic, topical, surgical and electrical treatments available for Hyperhidrosis. Topical agents for hyperhidrosis therapy include Formaldehyde lotion, topical anticholinergics, etc. These medications reduce sweat by denaturing keratin, which in turn clogs the pores of the sweat glands. They have short-term effects. Formaldehyde is classified as a human carcinogen that may be inhaled continuously day by day, year after year, has been linked to cancer of the nose and brain, and possibly leukemia. Contact sensitization increases, especially with formalin.
Drugs
Aluminum chlorohydrate is used in regular antiperspirants. However, hyperhidrosis requires a solution or gel with a much higher concentration. This antiperspirant or hyperhidrosis gel solution is very effective for the treatment of the axillary or armpit area. It usually takes about three to five days to see improvement. The most common side effect is skin irritation. For severe case of plantar and palmar hyperhidrosis, there are some successes with conservative measures such as higher strength aluminum chloride antiperspirant. The treatment algorithm for hyperhidrosis recommends topical antiperspirants as first-line therapy for hyperhidrosis. Both the International Hyperhidrosis Society and the Canadian Hyperhidrosis Advisory Committee have published treatment guidelines for evidence-based hyperhidrosis that are said to be evidence-based.
Prescription drugs called anticholinergics, taken, are sometimes used in the treatment of generalized and focal hyperhidrosis. Anticholinergics used for hyperhidrosis include propantheline, glycopyrronium bromide or glycopyrrolate, oxybutynin, methantheline, and benzatropine. The use of these drugs can be restricted, however, by side effects, including dry mouth, urinary retention, constipation, and visual disturbances such as midriasis (pupil dilation) and cycloplegia. For people who feel hyperhidrosis they are exacerbated by anxiety-triggering situations (public speaking, stage shows, special events such as weddings, etc.), Taking anticholinergic drugs before the event can help.
Some anticholinergic drugs can reduce hyperhidrosis. Oxybutynin (brand name Ditropan ) is one that promises, although it can have side effects, such as drowsiness, visual symptoms and dryness of the mouth and other mucous membranes. Glycopyrrolate is another drug that is sometimes used. It is said to be almost as effective as oxybutynin, but has similar side effects. Other anticholinergic agents have tried to include propantheline bromide and benztropine.
For peripheral hyperhidrosis, some chronic sufferers feel relieved simply by ingesting the destroyed ice water. Ice water helps cool excessive body heat during transport through blood vessels to the extremities, effectively lowering overall body temperature to normal levels within ten to thirty minutes.
Procedures
Botulinum type A toxin injections can be used to block the control of sweat gland nerves. The effect can last from 3-9 months depending on the injection site. This use has been approved by the US Food and Drug Administration (FDA). The duration of beneficial effects on primary palmar hyperhidrosis has been found to increase with repeated injections. Botox injections tend to be painful. Various steps have been tried to minimize pain, one of which is the application of ice.
BTX-A has since been approved for the treatment of severe primary axillary hyperhidrosis (excessive underarm sweating due to unknown cause), which can not be managed by topical agents.
Microwave-based devices have been tried to extract excessive underarm sweat and seem to show promise.
Tap water Iontophoresis as a treatment for palmoplantar hyperhidrosis was originally described in the 1950s. Studies show positive results and good safety with tap water angiophthesis. One experiment found it reduced sweating by about 80%. The US Food and Drug Administration (FDA) has approved a water tap iontophoresis device for the treatment of hyperhidrosis.
Surgery
Removal or sweating of sweat glands is one of the surgical options available for axillary hyperhidrosis (excessive underarm sweat). There are several methods to remove or destroy the sweat glands, such as sweat gland suction, retrodermal coils, and armpit suction, Vaser, or Laser Sweat Ablation. Suction of sweat glands is a customized technique for liposuction.
Another major surgical option is the thoracic sympathectomy (ETS) endoscope, which cuts, burns, or clamps the thoracic ganglion on the main sympathetic chain that extends along the spine. Clamping is intended to enable the reversal of the procedure. ETS is generally considered a "safe, reproducible, and effective procedure and most patients are satisfied with the results of surgery". Satisfaction rates above 80% have been reported, and are higher for children. This procedure provides relief from excessive hand sweating in about 85-95% of patients. ETS may be helpful in treating axillary hyperhidrosis, flushed face and sweating faces, but failure rates in patients with reddened facial and/or excessive facial sweating are higher and such patients may be more likely to experience unwanted side effects.
ETS side effects have been described as ranging from trivial to destructive. The most common side effect of ETS is sweating compensation (sweating in different areas than before surgery). The main problem with sweating compensation is seen in 20-80% of patients undergoing surgery. Most people find sweating compensation to be tolerated while 1-51% claim that their quality of life decreases as a result of sweating compensation. "Total body sweat in response to heat has been reported to increase after sympathectomy.Native sweating problems can recur, due to nerve regeneration, sometimes as early as 6 months after the procedure.
Other possible side effects include Horner's Syndrome (about 1%), sweating (less than 25% sweating) and excessive palm dryness (sandpaper hands). Some patients have experienced cardiac sympathetic denervation, which can result in a 10% reduction in heart rate both at rest and during exercise, thus reducing exercise tolerance.
Percutaneous percatectomy is a minimally invasive procedure similar to the botulinum method, in which the nerve is blocked by a phenol injection. This procedure provides temporary relief in many cases. Some doctors recommend trying this more conservative procedure before switching to surgical sympathectomy, the effect is usually irreversible.
Prognosis
Hyperhidrosis can have physiological consequences such as cold and moist hands, dehydration, and secondary skin infections due to skin maceration. Hyperhidrosis can also have devastating emotional effects on one's individual life.
Those with hyperhidrosis may have greater stress levels and more often depression.
Excessive sweating or focal hyperhidrosis of the hand interferes with many routine activities, such as objects that hold tightly. Some hyperhidrosis patients focus on avoiding situations where they will have physical contact with others, such as greeting someone with a handshake. Hiding the embarrassing sweat dots under the armpits restricts arm movement and pose the sufferer. In severe cases, shirts should be changed several times during the day and require additional good shower to remove sweat and control the problem of body odor or microbial problems such as acne, dandruff, or athlete's feet. In addition, anxiety caused by self-awareness of sweat can aggravate sweat. Excessive sweating on the feet makes it more difficult for the patient to wear slippery shoes or open legs, because the feet slide around the shoes due to sweat.
Some careers present a challenge for people with hyperhidrosis. For example, careers that require the use of a knife may not be safe by people with excessive sweat on the hands. The risk of dehydration may limit the ability of some to function in very hot conditions (especially if it is also humid). Even playing a musical instrument can be uncomfortable or difficult because the hands are sweating.
Epidemiology
It is estimated that the incidence of focal hyperhidrosis may be as high as 2.8% of the US population. It affects men and women alike, and is most common among people aged 25-64, although some may have been affected since early childhood. Approximately 30-50% of people have other family members who are stricken, which implies genetic predisposition.
In 2006, researchers at Saga University in Japan reported that the primary palmar hyperhidrosis map to the 14q11.2-q13 gene locus.
References
External links
Source of the article : Wikipedia
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