Hyperhidrosis(Excessive Sweating) Treatment in Delhi, India

Hyperhidrosis is a condition characterised by excessive sweating beyond what is necessary for thermoregulation. People with hyperhidrosis experience sweating that is disproportionate to the environmental conditions or physical exertion they are engaged in. It can affect various parts of the body, including the palms of the hands, soles of the feet, underarms, face, and other areas.

Types

There are two primary types of hyperhidrosis:

• Primary Hyperhidrosis: This type of hyperhidrosis is idiopathic, meaning it does not have an underlying medical cause. It typically starts during childhood or adolescence and affects specific areas of the body, such as the hands, feet, or underarms.
• Secondary Hyperhidrosis: It is caused by an underlying medical condition or due to the side effects of certain medications. It usually affects larger areas of the body and can occur at any time during a person's life. Medical conditions associated with secondary hyperhidrosis include hormonal imbalances, neurological disorders, infections, metabolic disorders, and certain types of cancer.

Symptoms

The most significant symptom of hyperhidrosis is excessive sweating that goes beyond what is necessary for normal thermoregulation. The sweating associated with hyperhidrosis is typically unrelated to physical activity or environmental temperature and can occur at any time, even during periods of rest or relaxation. The severity of sweating can vary from mild to severe, and it can significantly affect an individual's daily activities, emotional well-being, and social interactions.

The symptoms of hyperhidrosis may include:

• Visible sweating: Excessive sweating can be visibly apparent, leading to wet patches on clothing, especially in the underarms, palms, or soles of the feet. This can cause embarrassment and self-consciousness.
• Persistent sweating: Sweating can occur persistently or intermittently without an obvious trigger or relief. It may continue for prolonged periods, often interfering with daily tasks and social interactions.
• Skin maceration: Prolonged moisture on the skin due to excessive sweating can lead to skin maceration, which is characterised by softening, whitening, or wrinkling of the skin.
• Cold and clammy hands or feet: Excessive sweating in the palms and soles of the feet can make them feel cold, clammy, and uncomfortable.
• Social and emotional impact: Hyperhidrosis can have a significant impact on an individual's emotional well-being and social life. It may lead to feelings of embarrassment, self-consciousness, and anxiety.

Causes

The causes of hyperhidrosis can vary depending on whether it is primary or secondary hyperhidrosis.

Primary Hyperhidrosis

It may be caused by genetic and environmental factors. It often starts during childhood or adolescence and tends to run in families.

Primary hyperhidrosis is thought to involve overactivity of the sympathetic nervous system, which regulates involuntary bodily functions, including sweating. The overactive sweat glands produce more sweat than necessary for thermoregulation, leading to excessive sweating. The specific reasons behind this overactivity are still under investigation.

Secondary Hyperhidrosis

Secondary hyperhidrosis occurs as a result of an underlying medical condition or as a side effect of certain medications. Some common causes of secondary hyperhidrosis include:

• Hormonal imbalances: Conditions such as menopause, hyperthyroidism (overactive thyroid gland), or pheochromocytoma (adrenal gland tumour) can disrupt the body's hormone levels and trigger excessive sweating.
• Neurological disorders: Neurological conditions like Parkinson's disease, multiple sclerosis, autonomic neuropathy (nerve damage affecting involuntary functions), or spinal cord injuries can affect the nerves that control sweating and lead to hyperhidrosis.
• Infections: Certain infections, such as tuberculosis or HIV/AIDS, can cause secondary hyperhidrosis as the body's immune response triggers excessive sweating.
• Metabolic disorders: Metabolic conditions like diabetes, gout, or an overactive metabolism (hypermetabolism) can contribute to secondary hyperhidrosis.
• Medications: Some antidepressants, antipsychotics, antipyretics (fever-reducing drugs), or hormonal treatments may have excessive sweating as a side effect.
• Cancer: Some types of cancer, particularly lymphoma and leukaemia, can cause secondary hyperhidrosis due to the body's immune response or the cancer cells' impact on the nervous system.

Identifying and addressing the underlying cause of secondary hyperhidrosis is essential to manage excessive sweating effectively.

Risk factors

Common risk factors associated with hyperhidrosis are as follows:

• Family history: Primary hyperhidrosis often runs in families, suggesting a genetic predisposition. If a close family member, such as a parent or sibling, has hyperhidrosis, the risk of developing the condition may be higher.
• Age: Hyperhidrosis can occur at any age, but it often starts during childhood or adolescence, particularly in cases of primary hyperhidrosis. It may persist throughout adulthood if left untreated.
• Gender: Both males and females can develop hyperhidrosis. However, some studies suggest that primary hyperhidrosis may be slightly more prevalent in males, especially when it affects the palms and soles of the feet.
• Medical conditions: Certain medical conditions or disorders can increase the risk of secondary hyperhidrosis. These may include hormonal imbalances (e.g., menopause, hyperthyroidism), neurological disorders (e.g., Parkinson's disease, multiple sclerosis), infections (e.g., tuberculosis, HIV/AIDS), metabolic disorders (e.g., diabetes, gout), or certain types of cancer.
• Medications: Some medications have been associated with excessive sweating as a side effect. These may include certain antidepressants, antipsychotics, antipyretics (fever-reducing drugs), or hormonal treatments. However, it's important to note that not everyone who takes these medications will develop hyperhidrosis.
• Stress and anxiety: Emotional stress, anxiety, or heightened emotional states can trigger or worsen hyperhidrosis symptoms. Stress-induced sweating is particularly common in individuals with primary hyperhidrosis.

Diagnosis

The diagnosis of hyperhidrosis involves a thorough evaluation of an individual's medical history, a physical examination, and sometimes additional tests to determine the underlying cause and differentiate between primary and secondary hyperhidrosis. Here's an overview of the diagnostic process for hyperhidrosis:

• Medical history: The healthcare professional will begin by discussing your symptoms and medical history. They may ask questions about the pattern of sweating, areas affected, triggers, and any associated symptoms. They will also inquire about any relevant medical conditions, medications, or family history of hyperhidrosis.
• Physical examination: This will be conducted to assess the areas of excessive sweating and to check for any underlying conditions or signs that may contribute to hyperhidrosis. The healthcare professional will examine the skin, take note of sweat patterns, and look for any associated factors.
• Diagnostic tests: In most cases, the diagnosis of hyperhidrosis can be made based on the medical history and physical examination. However, in some instances, additional tests may be recommended to identify the underlying cause or rule out other conditions.
• Sweat test: It measures the amount of sweat produced by the body. It can help determine the severity and distribution of sweating. One common method is the iodine-starch test, where an iodine solution is applied to the skin, followed by starch. Excessive sweating causes the starch to turn dark blue.
• Blood tests: They may be conducted to assess hormone levels, check for metabolic disorders, or detect any underlying medical conditions associated with secondary hyperhidrosis.
• Imaging or nerve function tests: In certain cases, MRI, CT scans or nerve function tests (like electromyography or nerve conduction studies) may be ordered to evaluate the nervous system and rule out neurological causes of hyperhidrosis.

Treatment

The treatment options for hyperhidrosis aim to manage and reduce excessive sweating, improve quality of life, and minimise the associated physical and emotional discomfort. Here are some common treatment approaches

• Antiperspirants: Over-the-counter or prescription-strength antiperspirants containing aluminium chloride hexahydrate can be applied to the affected areas to reduce sweating. These antiperspirants work by temporarily blocking the sweat ducts. They are often the first line of treatment for mild cases of hyperhidrosis.
• Topical treatments: Prescription creams or lotions containing anticholinergic agents, such as glycopyrrolate, can be applied to the affected areas to reduce sweating. These medications work by inhibiting the activation of sweat glands.
• Oral medications: In cases of severe primary or secondary hyperhidrosis, oral medications may be prescribed. Anticholinergic medications, such as glycopyrrolate or oxybutynin, can help reduce sweating. However, they may have potential side effects, such as dry mouth and blurred vision.
• Botulinum toxin (Botox) injections: Botulinum toxin injections, commonly known as Botox, can be effective in reducing sweating. The toxin is injected into the affected areas, such as the underarms, palms, or soles of the feet, and works by blocking the nerve signals that stimulate sweat production. The effects typically last for several months before repeat injections are needed.
• Iontophoresis: It involves using a device that delivers a low-level electrical current to the affected areas, such as the hands or feet, while they are immersed in water or placed on wet pads.
• Surgical procedures: In severe cases of primary hyperhidrosis, surgical options may be considered. One common procedure is sympathectomy, where the sympathetic nerves responsible for sweating are surgically interrupted.

Hyperhidrosis Surgery – What is it?

Hyperhidrosis surgery, also known as Sympathectomy, is a surgical procedure that involves cutting or clamping the sympathetic nerves that control sweating. This is typically done through small incisions in the chest or armpit. It can be performed under general or local anaesthesia, and patients can usually go home the same day or the next day.

There are two main types of hyperhidrosis surgery:

• Endoscopic thoracic sympathectomy (ETS): This involves using a small camera and instruments to access the sympathetic nerves. The nerves are then cut, depending on the patient's needs. This is a form of Video Assisted Thoracoscopic Surgery (VATS). The real meaning of the term "sympathectomy" includes the dissection and surgical removal of a specific segment of the sympathetic trunk and ganglia.
• Open sympathectomy: This involves making a larger incision in the chest or armpit and directly accessing the sympathetic nerves. This procedure is less common than ETS and is usually reserved for more severe cases. This approach is almost obsolete now.

Whatever technique is used, the most important consideration is to correctly define in which level (or levels) the sympathetic trunk shall be interrupted. This decision has to be based on the patient's symptoms localisation, in balance with the risks of postoperative Compensatory Hyperhidrosis (CH).

For palmar hyperhidrosis, the interruption at the R3 and R4 levels will provide the most curative scenario, marked by completely dry hands but with a higher risk of CH. For patients who prefer a lower risk of CH at the expense of less dry hands, the interruption can be done only at the R4 level.

Benefits of Hyperhidrosis Surgery

Hyperhidrosis surgery is a highly effective treatment for sweaty hands and other types of hyperhidrosis. Some of the benefits of surgery include:

• Long-lasting results: Unlike non-surgical treatments, hyperhidrosis surgery provides long-lasting relief from excessive sweating.
• Improved quality of life: For many people, hyperhidrosis surgery can significantly improve their quality of life by reducing feelings of embarrassment, anxiety, and frustration.
• Increased confidence: People who have undergone hyperhidrosis surgery often report feeling more confident in social situations and at work.
• Minimal scarring: Hyperhidrosis surgery is minimally invasive, which means there is usually only a small scar at the incision site.
• Quick recovery time: Most patients can resume their normal activities within a few days.

Complication

The excessive sweating associated with hyperhidrosis can have both physical and emotional consequences. Some potential complications that can arise are:

• Skin infections: Prolonged moisture on the skin can create an environment conducive to bacterial or fungal growth, increasing the risk of skin infections. Common infections include athlete's foot, fungal nail infections, and bacterial infections.
• Skin irritation and discomfort: The constant presence of sweat and moisture can lead to skin maceration, which is characterised by softening, whitening, or wrinkling of the skin. This can cause skin irritation, itching, and discomfort.
• Social and emotional impact: Hyperhidrosis can significantly impact a person's emotional well-being and social life. Excessive sweating can lead to embarrassment, self-consciousness, and social anxiety. Individuals with hyperhidrosis may avoid social situations or activities that can trigger sweating, which can impact their quality of life and overall psychological health.
• Occupational and functional limitations: Depending on the severity of hyperhidrosis, it can interfere with daily activities and occupational performance. Professions that require frequent physical contact, such as handshake-based interactions or handling delicate equipment, may be particularly challenging for individuals with excessive sweating.
• Decreased confidence and self-esteem: The visible signs of sweating and the challenges it presents can lead to decreased self-confidence and self-esteem. Hyperhidrosis may affect personal relationships and professional interactions, leading to a negative impact on overall well-being.

Prevention

While there is no surefire way to prevent hyperhidrosis, there are some strategies that can help manage and minimise excessive sweating. Here are some preventive measures that can be helpful:

• Good hygiene practices: Maintaining good hygiene is essential for managing excessive sweating. Regularly bathing or showering can help keep the skin clean and prevent the buildup of sweat and bacteria. Use antibacterial soaps or cleansers to minimise the risk of skin infections.
• Wear breathable clothing: Choose lightweight, loose-fitting clothing made from natural fabrics like cotton or linen, as they allow better air circulation and help wick away moisture from the skin. Avoid tight or synthetic clothing, as they can trap sweat and contribute to increased sweating.
• Use absorbent materials: To manage excessive sweating, consider using absorbent materials such as sweat-absorbing pads or undershirts that can help soak up sweat and keep it away from your clothing.
• Apply antiperspirants: Over-the-counter or prescription-strength antiperspirants can be applied to the affected areas, such as the underarms, palms, or soles of the feet, to reduce sweating. Apply them as directed and consider using clinical-strength antiperspirants for better efficacy.
• Manage stress: Emotional stress and anxiety can trigger or exacerbate sweating. Learning stress management techniques, such as deep breathing exercises, meditation, or engaging in relaxation activities, may help reduce stress levels and potentially minimise sweating episodes.
• Avoid triggers: Pay attention to factors that may trigger excessive sweating in your case. These triggers can vary from person to person and may include certain foods, caffeine, spicy foods, or hot beverages. By identifying and avoiding your specific triggers, you may be able to minimise sweating episodes.

If you suspect you have hyperhidrosis or are experiencing excessive sweating that interferes with your daily life, it's important to consult your doctor. They can provide a proper diagnosis, discuss treatment options, and offer guidance on managing the condition effectively.

Review

Reviewed by Dr. Kamran Ali, Principal Consultant, Thoracic Surgery.