Hyperhidrosis/ sweaty palms&feet
What is Hyperhidrosis?
Hyperhidrosis means excessive sweating that is required for normal thermoregulation of the body. It can be localized affecting commonly over the palms, soles and axilla. Localized hyperhidrosis usually starts during childhood and adolescence period. It can also be generalized all over the body.
What causes hyperhidrosis?
The exact etiology if hyperhidrosis is unknown. Hyperhidrosis can be primary cause (idiopathic) or secondary caused by medications, fever conditions, malignancy and metabolic diseases (diabetes mellitus, hyperthyroidism, and hyperpituitarism).
Generalized hyperhidrosis is a consequence of disruption in the autonomic thermoregulation. Localized hyperhidrosis can be caused by excessive sympathetic activity or localized abnormality in distribution/number of sweat glands resulting in increased sweat production.
Hyperhidrosis involving the palms and soles (sweaty palms/feet) may be inherited in autosomal dominant manner. Essential hyperhidrosis is a skin and neurological disorder whereby there is an excessive sweating of the eccrine sweat glands.
Clinical presentation of Hyperhidrosis
Patient will either complain of generalized sweating of localized sweating involving the palms, axilla or feet areas. Sweaty feet and axilla may also result in unpleasant odor. It may also predispose to dermatitis and Tineainfection.
Diagnostic tests for hyperhidrosis
1.Iodine starch test: spraying the areas affected with iodine starch; areas that produce sweat will turn purplish black.
2.Blood tests: Thyroid tests to exclude thyroid diseases, blood glucose level to exclude diabetes or hypoglycaemia, uric acids to exclude gout, urinary catecholamines to exclude pheochromocytoma and also purified protein derivative (PDD) test to screen for tuberculosis.
3.Chest x-ray to exclude tuberculosis or cancer causes of hyperhidrosis.
Diagnosis of Hyperhidrosis
Diagnosis of hyperhidrosis includes excessive sweating for at least 6 months with 4 or more of the following:
-bilateral and symmetric distribution
-at sites with dense sweat glands like the palms, soles, axilla and craniofacial areas
-does not occur at night
-episodes occur at least weekly
-positive family history
-start at age 25 years old or younger
-impairs daily life activities
Management of Hyperhidrosis
General measures include wear loose garments that absorb sweat and do not stain. Change socks regularly, put insoles into soles may also help. Avoiding foods that contain caffeine e.g. tea, coffee, chocolate and cola drinks may also help.
Topical antiperspirants that contain Aluminum salts lead to obstruction of the distal sweat gland ducts. It comes in roll-ons, wipes, sticks or sprays form. It should be used on dry skin at night after shower and wash off in the morning to reduce irritation from the chemical. Dusting powder that contains diphemanil 2% can be applied over feet area.
Iontophoresis: The affected area is immersed in the electrolyte solution with an electric current passing through the skin surface for about 20 minutes daily. This process is repeated over weeks to reduce sweat production. It can be used for areas like armpits, hands and soles.
Systemic medications like anti-cholinergics (propantheline, glycopyrronium bromide, oxybutynin, and benztropine) work by blocking sympathetic stimulation of eccrine sweat glands. However it can cause side effects like dry mouth, urinary retention, constipation, and visual disturbances. Other drugs that may have some benefit include tranquilizers, indomethacin, sedatives and calcium channel blockers.
Botulinum toxin injections: It has anti-cholinergic effect on the neuromuscular junction and sweat glands hence reducing sweat production. Local anesthesia should be given at injection sites to reduce pain. Contraindications to injections include neuromuscular junction disease (myasthenia gravis, Lambert-Eaton disease), peripheral motor neuron disease (amyotrophic lateral sclerosis), pregnancy, and lactation.
Sympathectomy surgery: Endoscopic Thoracic Sympathectomy (ETS) is a procedure done in hospital setting which involves surgical destruction of spinal sympathetic nerve ganglion. It is effective in up to 95% cases but the condition may recur in up to 15% cases. For facial sweating, the second thoracic T2 ganglion is cut out. For hand and armpit sweating, the third thoracic ganglion T3 is cut out.
Side effects include compensatory hyperhidrosis (excess sweating in the chest, back, thighs and abdomen areas), gustatory hyperhidrosis (excess sweating during eating), Horner’s syndrome (unilateral drooping of eyelid, pupil constriction and reduce facial sweating), persistent pain, pneumonia and pneumothorax post-surgery.
Local surgical procedure: This involves excision of localized sweat glands over the axilla areas to reduce sweating.