Hyperhidrosis [Sweating - excessive; Perspiration - excessive; Diaphoresis]

Definition

• Excessive sweating palms and soles
• Exacerbated by stress or anxiety
• Only occurs while awake

Differential Diagnosis

• Acromegaly
• Anxiety conditions
• Cancer
• Carcinoid syndrome
• Certain medications and substances of abuse
• Glucose control disorders
• Heart disease
• Hyperthyroidism
• Lung disease
• Menopause
• Parkinson’s disease
• Pheochromocytoma
• Spinal cord injury
• Stroke
• Tuberculosis or other infections
• Exams and Tests

Visible signs of sweating may be noted during a doctor's visit. A number of tests may also be used to diagnose excessive sweating.

Tests include:

Starch-iodine test. An iodine solution is applied to the sweaty area. After it dries, starch is sprinkled on the area. The starch-iodine combination turns a dark blue color wherever there is excess sweat.
Paper test. Special paper is placed on the affected area to absorb the sweat, then weighed. The heavier it weight, the more sweat has accumulated.

The patient may be also be asked details about the sweating.

Other Medical Treatments

Antiperspirants: Aluminum Chloride: Initially a patient may need to use it three to seven times a week.


Medication. Anticholinergics drugs, such as glycopyrrolate (Robinul, Robinul-Forte),

Iontophoresis. It is most effective for sweating of the hands and feet.

Endoscopic thoracic sympathectomy (ETS). In severe cases, a minimally-invasive surgical procedure called sympathectomy may be recommended.

Botulinum toxin type A (Botox) for Hyperhidrosis

Botulinum toxin type A (Botox) was approved by the FDA in 2004 for the treatment of severe underarm sweating, a condition called primary axillary hyperhidrosis. Small doses of purified botulinum toxin injected into the underarm temporarily block the nerves that stimulate sweating.

Side effects include injection-site pain and flu-like symptoms. If you are considering Botox for other areas of excessive sweating talk to your doctor in detail. The effect of a single injection can last up to a 6-17 months. Some patients need additional injections.

Preferred option for axillary hyperhidrosis

• Then 50-200 units of Botulinum toxin are injected intradermally; the dose is divided into 10-15 aliquots injected at spatial intervals of approximately 2 cm
• Injection in the axillae is usually well tolerated without anesthesia.
• Injections in palms and soles can be very painful and are therefore best performed under regional anesthesia (median and ulnar nerve block for palms, sural and posterior tibial nerve block for soles).
• Effect of BTX-A, which can be perceived after 2-4 days.
• Effective in more than 90% of patients,.
• A substantial reduction of the adverse impact of hyperhidrosis.
• Treatment with BTX-A showed marked improvement of unpleasant body odor (bromhidrosis).
• In patients with dyshidrotic hand dermatitis, treatment of the palms with BTX-A may reduce the severity of the eczema, as hyperhidrosis is considered to be a precipitating factor in this condition.
• Duration of effect:  After one treatment, anhidrosis lasts between 3 and 17 months with a median duration of approximately 7 months.

When to Contact a Medical Professional

There is prolonged, excessive, and unexplained sweating.
Sweating is accompanied or followed by chest pain or pressure.
Sweating is accompanied by weight loss or most often occurs during sleep.
If sweating is accompanied by fever, weight loss, chest pain, shortness of breath, or a rapid, pounding heartbeat. These symptoms may indicate an underlying problem, such as hyperthyroidism.

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