Hyperhidrosis

Hyperhidrosis: Excerpt from Handbook of Diseases

The excessive secretion of sweat from the eccrine glands, hyperhidrosis usually occurs in the axillae (typically after puberty) and on the palms and soles (commonly starting during infancy or childhood).

Causes

Possible causes of hyperhidrosis include the following:

❑ Genetic factors may contribute to the development of hyperhidrosis and, in susceptible individuals, emotional stress appears to be the most common cause. Increased central nervous system (CNS) impulses may provoke excessive release of acetylcholine, producing a heightened sweat response.

❑ Exercise and a hot climate can cause profuse sweating in these patients.

❑ Certain drugs, such as antipyretics, emetics, meperidine, and anticholin-esterase, can increase sweating.

❑ In addition, hyperhidrosis may occur as a clinical manifestation of an underlying disorder. Infections and chronic diseases, such as tuberculosis, malaria, and lymphoma, may cause excessive nighttime sweating. Diabetic patients commonly demonstrate hyperhidrosis during a hypoglycemic crisis.

❑ Other predisposing conditions include pheochromocytomas; cardiovascular disorders, such as shock and heart failure; CNS disturbances (most commonly lesions of the hypothalamus); withdrawal from drugs or alcohol; menopause; and Graves’disease.

Signs and symptoms

Axillary hyperhidrosis commonly produces such extreme sweating that patients usually ruin their clothes in 1 day and develop contact dermatitis from clothing dyes; similarly, hyperhidrosis of the soles can easily damage a pair of shoes.

Profuse sweating from both the soles and the palms hinders the patient’s ability to work and interact socially. Patients with this condition typically report increased emotional strain.

Diagnosis

Clinical observations and the patient history confirm hyperhidrosis.

Treatment

The treatment of choice is the application of 20% aluminum chloride in absolute ethanol. (Most antiperspirants contain a 5% solution.) Formaldehyde may also be used but may lead to allergic contact sensitization.

Glutaraldehyde produces less contact sensitivity than formaldehyde but stains the skin; it’s used more commonly on the feet than on the hands as a soak or applied directly several times per week and then weekly as needed. Therapy sometimes includes anticholinergics, except in patients with glaucoma or benign prostatic hyperplasia.

Severe hyperhidrosis unresponsive to conservative therapy may require local axillary removal of sweat glands or, as a last resort, a cervicothoracic or lumbar sympathectomy.

Clinical tip  Another form of effective treatment involves iontophoresis of water into involved areas of skin by a device that may be purchased by the patient.

Special considerations

❑ Provide support and reassurance because hyperhidrosis may be socially embarrassing.

❑ Tell the patient to apply aluminum chloride in absolute ethanol nightly to dry axillae, soles, or palms. The area should be covered with plastic wrap for 6 to 8 hours, preferably overnight, and then washed with soap and water. Repeat this procedure for several nights until profuse daytime sweating subsides. Frequency of treatments can then be reduced.

❑ Advise the patient with hyperhidrosis of the soles to wear leather sandals and white or colorfast cotton socks.

Book Source Details

• Book Title: Handbook of Diseases
• Author(s): Springhouse
• Year of Publication: 2003
• Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.

More About Hyperhidrosis

• Back to disease: Hyperhidrosis: Introduction
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5

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