Hyperhidrosis
Hyperhidrosis: Excerpt from Professional Guide to Diseases (Eighth Edition)
Hyperhidrosis is the excessive secretion of sweat from the eccrine glands. It usually occurs in the axillae (typically after puberty) and on the palms and soles (often starting during infancy or childhood). Abnormal and excessive heat loss can occur, causing most patients to have body temperatures less than 98.6° F (37° C).
Causes and incidence
Genetic factors may contribute to the development of hyperhidrosis and, in susceptible individuals, emotional stress appears to be the most prominent cause, although most patients aren’t anxious. 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 anticholinesterases) and certain foods (such as tomato sauce, chocolate, coffee, and spicy foods) have been known to increase sweating.
In addition, hyperhidrosis commonly occurs as a clinical manifestation of an underlying disorder. Infections and chronic diseases, such as tuberculosis, malaria, or lymphoma, may cause excessive nighttime sweating. A person with diabetes commonly demonstrates hyperhidrosis during a hypoglycemic crisis. Other predisposing conditions include hyperthyroidism, pheochromocytomas; cardiovascular disorders, such as shock or heart failure; CNS disturbances (generally lesions of the hypothalamus); withdrawal from drugs or alcohol; menopause; and Graves’disease.
Hyperhidrosis occurs in up to 1% of the U.S. population.
Signs and symptoms
Axillary hyperhidrosis frequently produces such extreme sweating that patients often 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 palms hinders the patient’s ability to work and interact socially. Patients with this condition often report increased emotional strain.
Diagnosis
CONFIRMING DIAGNOSIS Clinical observations and patient history confirm hyperhidrosis.
Treatment
The treatment of choice is 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 often on the feet than on the hands, as a soak or applied directly several times a week and then weekly as needed.
Iontophoresis (low-level electric current applied locally to skin surfaces) reduces sweat secretion at the site. Repeated treatments will be necessary for sustained relief.
Therapy sometimes includes anticholinergics, except in patients with glaucoma or prostatic hypertrophy. Severe hyperhidrosis unresponsive to conservative therapy may require local axillary removal of sweat glands or, as a last resort, a cervicothoracic or lumbar sympathectomy.
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, then washed with soap and water. Tell him to 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: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
More About Hyperhidrosis
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- Diaphoresis
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Skin, clammy
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Night Sweats
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- Skin, clammy
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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- Diaphoresis
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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- Sweating
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Diaphoresis (Professional Guide to Signs & Symptoms (Fifth Edition))
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