Hyperhidrosis
Einstein Health Glossary
ICD 10 - R61
What is hyperhidrosis?
Hyperhidrosis is excessive sweating—more than what is necessary for regulating body temperature. It is usually a primary condition (not a symptom of another disease) and occurs in certain parts of the body. It typically affects the armpits, palms of the hands, and soles of the feet, but it can also occur on the scalp, under the breasts, in the groin area, or on the face.
Types
Hyperhidrosis can be primary and idiopathic (with no defined cause), meaning it is not related to any other disease, and it is usually focal, affecting areas such as the face, scalp, armpits, feet, and hands. Generalized excessive sweating, which occurs all over the body, tends to appear later in life, does not go away during sleep, and may be associated with infections, tumors, spinal cord injuries, and other less common conditions.
Causes
Hyperhidrosis affects about 1% to 5% of the population and appears to have a genetic or familial component. The sweat glands responsible for hyperhidrosis are the eccrine glands, which are most commonly found on the palms of the hands, soles of the feet, and armpits. Sweating observed on the face, trunk, and back is usually related to physical exertion, while sweating on the palms and soles is triggered by emotional stimuli and typically does not occur during sleep. Hyperhidrosis seems to result from an exaggerated brain response to emotional or affective stimuli.
Symptoms
Patients with primary hyperhidrosis experience localized symptoms on the palms of the hands, soles of the feet, and armpits, which begin in childhood or adolescence and persist into adulthood. The scalp, breasts, and face are less commonly affected. It is important to note that although symptoms may worsen with heat or emotional stimuli, hyperhidrosis is not considered a psychological disorder. Patients often have moist skin and complain about staining clothes, avoiding handshakes, and refraining from work or leisure activities that require a dry grip, which can lead to social difficulties in both professional and personal life.
Diagnosis
Suggested diagnostic criteria for primary focal hyperhidrosis include:
- excessive, focal sweating lasting at least 6 months with no apparent cause
- plus at least two of the following characteristics:
- occurs symmetrically on both sides of the body
- interferes with daily activities
- occurs at least once per week
- begins before the age of 25
- family history of hyperhidrosis
- stops during sleep
Treatment
Sweat production can be temporarily reduced by blocking the release of acetylcholine, through the use of Botulinum Toxin Type A, which acts on the autonomic nervous system. For axillary hyperhidrosis, treatment response may begin within 2 to 3 days after application, and the duration of effect varies, often increasing with repeated treatments. The average duration of effect for axillary treatment is 5 to 8 months after repeated sessions.
For palmar and plantar hyperhidrosis (hands and feet), results may begin to appear within 1 week, lasting approximately 6 months. Before application, the ideal area in the armpit can be identified using the iodine-starch test. The dosage is typically 50 to 100 units per armpit, hand, or foot. Side effects of palmar treatment may include mild, temporary weakness in some hand muscles and bruising, as the procedure involves needle injections.
Scalp applications usually begin to take effect around the fourth day and last about 6 months, with no significant side effects. The dosage ranges from 100 to 200 units, depending on the treated area. Other treatment options include, Aluminum salt-based antiperspirants for axillary hyperhidrosis, Oral medications and Sympathectomy (surgical nerve interruption) for palmar and plantar hyperhidrosis. These alternatives, like botulinum toxin treatment, should be evaluated in terms of risks, costs, and benefits for managing this condition.