Hyperhidrosis (from the Greek “hyper” – excessive, elevated, “hidros” – sweat) is profuse sweating that occurs regardless of physical factors: increased motor activity, overheating, high ambient temperature or others. Sweating is a physiological process of the sweat glands secreting a watery secretion (sweat) that constantly occurs in the human body. The process of sweating protects the body from hyperthermia (overheating) and helps to maintain its homeostasis (constancy): evaporating from the skin, sweat thereby cools the surface of the body and lowers its temperature.
In the body of a healthy person, sweating increases with an increase in ambient temperature to 20-25 ° C, as well as with physical or psycho-emotional stress. When the ambient temperature rises to 36 ° C and above, the thermoregulation of the body is carried out with the help of sweating, its overheating is not allowed. Low relative humidity and active physical movement contribute to increased heat transfer and cooling of the body.
On the contrary, in a humid environment with still air, the process of evaporation of sweat does not occur, so it is not recommended to stay in a hot bath or steam room for a long time. Excessive fluid intake dramatically increases sweating, therefore, during intense physical activity or in a room with high air temperature, you should not drink a lot of water. As a result of psychoemotional arousal, skin receptors, reacting, stimulate the release of sweat. Therefore, increased sweating occurs if a person experiences strong emotions, such as excitement, fright or pain.
Pathological disorders of the sweating process are expressed in its excessive increase or, on the contrary, decrease, as well as in a change in the smell of sweat, which becomes fetid. Excessive sweating can be common when profuse sweating occurs on almost the entire surface of the body, and often accompanies functional disorders of the nervous, endocrine system and a number of infectious diseases. In cases where sweating is limited to local areas of the body (soles, palms, axillary areas, elbow and knee bends), we are talking about local hyperhidrosis due to increased excitability of the nervous system.
Excessive sweating or hyperhidrosis often causes serious discomfort to people, negatively affecting their quality of life. Knowing his problem, a person is in constant tension, expecting that this may happen at the most inopportune moment and cause inconvenience to others. This nervous expectation, in turn, further provokes sweating. The circle closes, and it seems impossible to get out of it. The symptoms described above are signs of hyperhidrosis.
Each person reacts to strong emotional shocks in their own way: someone – with a sharp jump in pressure or an attack of colic, and someone with increased sweating.
Local hyperhidrosis is manifested by profuse sweating of the palms, feet, armpits, forehead and other parts of the body, both individually and all together. Generalized hyperhidrosis for no apparent reason requires immediate medical advice, as it can be a symptom of a serious illness.
Causes of hyperhidrosis
Wet palms and soles, wet armpits, an unpleasant pungent smell of sweat do not add to a person’s self-confidence and are negatively perceived by others. In order to understand the factors of hyperhidrosis, it is necessary to understand the physiology of the sweating process as a whole.
Sweating is one of the natural mechanisms that ensure the cooling of the body and the removal of excess fluid, toxic substances, decomposition products and water-salt metabolism from it. It is no coincidence that some medicinal substances, being excreted from the body through the skin, stain sweat in reddish, blue-green, yellowish shades. And wanting to lose weight, we go to the gym – then a significant part of the weight is lost.
Sweat is produced by sweat glands located in subcutaneous fat. The largest number of sweat glands is located in the armpits, on the palms and soles of the feet. By its chemical composition, sweat by 97-99% consists of water with impurities of salts (chlorides, phosphates, sodium and potassium sulfates) and other complex organic substances. The presence and concentration of these substances in the sweat secret varies from person to person, hence the individual smell of sweat inherent in different people. In addition, the secret of the sebaceous glands and bacteria on the surface of the skin are mixed with the composition of sweat.
Physiological sweating is an indispensable condition for cleansing the body of toxins and waste products. Bath, sauna, steam room contribute to the excretion of sweat from the body of these substances and general health improvement. Even in a healthy person, sweating increases with physical exertion, as well as with emotional experiences and nervous overloads.
Hyperhidrosis can be one of the symptoms of a number of neuropsychiatric, somatic diseases or a consequence of non-compliance with the rules of personal hygiene.
Clinically, primary and secondary hyperhidrosis are distinguished. Primary hyperhidrosis is more common in adolescence during the period of rapid puberty and occurs in 1% of people. Secondary hyperhidrosis, as a rule, is a consequence of neurological, endocrine or somatic disease. Identification of the factors causing hyperhidrosis determines the program of further examination and treatment of the patient. So, with generalized hyperhidrosis, it is necessary, first of all, to exclude tumor, endocrine and infectious diseases.
Sweat glands form and secrete sweat through the pores on the surface of the skin, and the normal regulation of sweating in the human body is provided by the autonomic nervous system, which is responsible in the human body for the processes of metabolism, blood circulation, excretion, reproduction. The autonomic nervous system is divided into two parts: sympathetic and parasympathetic.
The regulation of the sweating process is carried out by the sympathetic autonomic nervous system. With hyperfunction of the sympathetic nervous system, there is a change in the normal functioning of the sweat glands: at the slightest excitement, a person immediately sweats. But what is the trigger mechanism of these interrelated processes and what are the causes of hyperhidrosis – modern medical science cannot yet give an exact answer to this question.
Treatment of hyperhidrosis
Non-surgical treatment
Before proceeding to the description of conservative methods of treating hyperhidrosis, it is necessary to give some general recommendations to people suffering from this ailment.
Since sweat is a biological fluid formed in the human body, it is an excellent breeding ground for bacteria, which leads to a violation of the protective functions of the skin and the development of skin diseases: sweating, scuffs and diaper rash, as well as fungal and pustular diseases.
Therefore, the main postulate in the fight against hyperhidrosis should be careful observance of the rules of personal hygiene: you should take a shower every day (and sometimes more than once!), make warm baths for palms and feet (preferably with chamomile or oak bark infusion), do wipes. To eliminate the smell of sweat, it is recommended to use deodorants. It is not recommended to wear clothes, especially underwear and socks, made of synthetic fabrics, because they are airtight. Change underwear, socks, tights should be as often as possible. Shoes should be comfortable, light with special insole inserts, and open in summer. It is necessary to limit, and if possible, exclude from the diet altogether, too hot, spicy food, alcohol, nicotine, coffee. Products such as onions and garlic, spices enhance the unpleasant smell of sweat.
If hyperhidrosis is not a symptom accompanying the underlying disease, then the following types of conservative treatment are widely used in medical practice for its treatment:
- psychotherapeutic methods
- drug therapy
- antiperspirants
- physiotherapy methods
Psychotherapeutic methods of treatment of hyperhidrosis, in particular hypnosis, are aimed at eliminating the psychological problems of the patient. The ability to control their emotions and fears helps some people to cope with the problem of hyperhidrosis.
For drug therapy of hyperhidrosis, different groups of drugs are used, depending on the severity of the disease and contraindications. Preparations of belladonna containing atropine affect the sympathetic nervous system, reducing its excitability and reducing the secretion of sweat glands.
Sedative medications (valerian, motherwort, herbal sedatives, etc.) and tranquilizers are indicated for people with a labile, unstable nervous system. By lowering the excitability of the nervous system, they help to cope with everyday stress as a factor in the occurrence of hyperhidrosis. The selection of the right drug and its dosage should be carried out by a doctor.
Botox injections can be attributed to the modern method of treating hyperhidrosis. The pharmacological effect of this treatment method is based on long-term (up to six months or more) blocking of nerve endings innervating sweat glands and a significant reduction in sweating.
Antiperspirants have a local effect and, due to their chemical composition, including zinc, aluminum salts, formaldehyde, salicylic acid, triclosan, ethyl alcohol, prevent sweating. Causing narrowing or even complete blockage of the excretory ducts of the sweat glands, drugs of this group block the excretion of sweat outside. Among the side effects of their use should be called allergic reactions, dermatitis and even severe swelling at the application sites.
Among the physiotherapeutic methods of treatment, hydrotherapy (coniferous-salt therapeutic baths, contrast shower) is widely used, which has a restorative effect on the nervous system. A beneficial effect on the nervous system is also exerted by an electroson – a therapeutic method of influencing the brain with a low-frequency pulse current. The therapeutic effect of electrosone is based on sedative effect, strengthening of inhibition processes, improving the activity of the autonomic nervous system.
The method of medicinal electrophoresis is based on a combination of direct current and ions of medicinal substances that reduce sweating. Local exposure to the problem area with a constant frequency electric current causes temporary anhidrosis (dehydration) of this area of the skin. At the same time, medicinal substances are deposited in the skin and retain their pharmacological effect for up to 15-20 days.
The combination of a whole complex of conservative methods of treatment (psychotherapy, medications, antiperspirants, physiotherapy), spa treatment can achieve a more stable clinical effect (up to 1-2 months).
However, all conservative methods of combating hyperhidrosis only give a temporary respite in the fight against this ailment, but do not solve the problem cardinally. To get rid of hyperhidrosis once and for all, you can only resort to surgical methods of treatment.
Local surgical treatment of hyperhidrosis
All surgical methods of treatment pose a certain risk, therefore, it is worth resorting to them only after conservative treatment, in the case when it turned out to be ineffective and did not bring the expected results. Local methods of surgery in the treatment of hyperhidrosis involve surgical intervention directly in the area of increased sweating and are an intermediate stage between conservative treatment and the central surgical method of combating hyperhidrosis (sympathectomy).
Conservative methods of treatment and prevention of hyperhidrosis include general hygiene of the body and places of increased sweating, taking medications, using antiperspirants, the use of Botox injections and cosmetics used in blushing syndrome (with vitamins B3 and B5), ontophoresis (ionophoresis), contacting a psychologist.
Often the problem of hyperhidrosis or erythrophobia is contrived by a person and is his psychological problem. In this case, it is worth contacting a psychotherapist for treatment and correction. The disadvantage of conservative treatment of hyperhidrosis is a short-term effect that requires regular medical procedures: the effect of antiperspirants lasts up to 6 hours, the effect of Botox injections lasts up to 6 months.
Currently, in the surgical treatment of hyperhidrosis, the following are successfully used:
- liposuction of the axillary zone
- closed curettage of the axillary zone
- excision of the skin of the axillary zone.
The use of these methods of surgical treatment is the safest, gives a stable positive result, does not cause fears of side effects. They are not traumatic and do not cause cosmetic defects, because the procedure is carried out through small punctures with a size of only 10 mm. The technique of local methods of surgery involves a decrease in the number of sweat glands, leading to a decrease in sweating. In 90% of cases, the problem of hyperhidrosis and the unpleasant smell of sweat is completely removed.
Surgical methods of treatment
Curettage. The operation involves the destruction of nerve endings and the subsequent removal of sweat glands at the site of increased sweating. To more accurately determine the hyperhidrosis zone, an iodine-starch test (Minor test) is performed before the procedure. Surgical manipulations are performed under local anesthesia. A 10-millimeter puncture is made (with severe hyperhidrosis – 2 punctures), resulting in skin detachment. Then “scraping” is carried out from the inside.
Curettage is most often used for hyperhidrosis of the axillary zone. Excessive sweating and unpleasant odor are eliminated. As complications, it may be accompanied by small bleeding and hematoma, easily removable and safe. After several years, during which a persistent positive effect persists, the nerve endings can recover, and the resumption of hyperhidrosis is possible.
Liposuction is indicated for overweight people. The process of sweating in the body is controlled by the autonomic nervous system, of which the sympathetic nervous system is a part. During the operation, the nerves of the sympathetic trunk are destroyed and thus the action of the nerve impulse that causes sweating is suppressed. In the course of operational measures, a Minor test is carried out to determine the hyperhidrosis zone, a puncture is made, a small tube is inserted into it, the nerve endings of the sympathetic trunk are destroyed through it and the axillary tissue is removed. Both the course of the operation and the possible side effects are similar to curettage. There is a slight decrease in skin sensitivity at the site of exposure, hemorrhage, hematomas. If a subcutaneous accumulation of fluid forms, it is removed by puncture.
Excision gives excellent results in the treatment of hyperhidrosis. However, after the procedure, a small scar (about 3 cm) remains at the site of exposure, causing some stiffness of movement. The operation, as in the previous methods, is preceded by the determination of the hyperhidrosis zone using a Minor sample and its further complete excision. Despite all the ambiguity, the high efficiency of this method causes increased interest in it.
All the above methods of local surgical treatment of hyperhidrosis show high efficiency and safety.
Sympathectomy
Hyperhidrosis is a disease that, like any other, reduces the quality of life, causes physical and psychological discomfort. To cure the disease and remove its symptoms, which means to improve a person’s well-being and emotional background, is a task quite possible at the current level of medical development.
Hyperhidrosis can be local, in which there is increased sweating in certain parts of the body (armpits, palms and feet) and general.
Treatment of hyperhidrosis should begin with conservative methods. You should consult a psychologist, keep your body clean, use antiperspirants. In some cases, with a slight increase in sweating, the use of ionophoresis and Botox injections are very effective. In the absence of contraindications, it is possible to use local surgical methods of treatment to reduce sweating and get rid of the unpleasant smell of sweat. Curettage, liposuction and excision of the skin of the axillary zone in most cases give a stable positive result of treatment, do not cause serious side effects.
In the event that these methods did not give the expected result, they resort to the treatment of hyperhidrosis with the help of sympathectomy – a surgical intervention called the central method.
Sympathectomy has been used in the treatment of hyperhidrosis since 1946, and the technique of its implementation is quite well developed. This low-traumatic procedure guarantees a positive result of treatment, which persists for a long time. However, sympathectomy should be resorted to only in cases of extreme necessity with a severe form of hyperhidrosis that cannot be treated by other known methods. Exposure to the body using this method is fraught with such unpleasant consequences as dry skin of the face and palms. In the future, the skin condition is normalized. A serious warning to sympathectomy is the threat of the development of compensatory hyperhidrosis, which cannot be predicted or affected by any treatment methods.
There are several types of sympathectomy:
- thoracic and cervical sympathectomy (routine operations);
- destruction or clipping of the sympathetic trunk (endoscopic sympathectomy);
- chemical blockade or electrodestruction of the sympathetic trunk (percutaneous intervention).
Surgical intervention in all these cases is carried out under general anesthesia. The purpose of the operation is to disrupt the sympathetic trunk by completely or partially destroying it. Traditional sympathectomy, performed through an incision in the neck or chest, has now given way to a more gentle and aesthetic endoscopic method. Endoscopic sympathectomy is performed in one of the following ways: either with the destruction of the sympathetic trunk by high-frequency current, or with the imposition of a special clip on it. Both methods are highly effective, with irreversible positive results in eliminating hyperhidrosis.
There is a risk of bleeding, increased sweating on the face after eating spicy or hot food, drooping eyelid, pupil constriction (Gorner syndrome). It is currently not possible to eliminate compensatory hyperhidrosis after the destruction of the sympathetic trunk. Compensatory hyperhidrosis in a pronounced form occurs only in 2% of patients who have undergone sympathectomy, and more comforting are the predictions in eliminating this side effect when applying a clip.
It should be noted that 95% of people who have resorted to sympathectomy do not experience any troubles and remain satisfied with the results of hyperhidrosis treatment. They have overcome their illness and started a new, full-fledged life.
In the photo on the right: a patient with primary hyperhidrosis at rest at room temperature. On top – Iodine-starch test Minor on the surface of the palms – colors from light orange to purple. Bottom – the test is repeated with the same patient under the same conditions 2 months after successful endoscopic thoracic sympathectomy.
Complications of sympathectomy – compensatory hyperhidrosis
The operation of endoscopic thoracic sympathectomy in the vast majority of cases – 95-98% – gives a stable long-term effect, however, according to statistics, one in ten patients is complicated by the so-called compensatory hyperhidrosis.
The human body is so arranged that it constantly tries to make up for the lost function with the help of various compensatory mechanisms. Compensatory hyperhidrosis is the body’s response to the abrupt cessation of the sweating function familiar to it in certain areas of the body. Its manifestations are an increase in the intensity of sweating in other parts of the body that were not previously subject to hyperhidrosis. For example, after a sympathectomy of the armpits or palms, the chest or back often begins to sweat, and with a sympathectomy of the feet, the lower parts of the trunk and hips.
The manifestation of compensatory hyperhidrosis cannot be calculated in advance, but the surgeon is obliged to warn the patient who has decided on this operation about the likelihood of this side effect of sympathectomy. If sympathectomy was performed by clipping the sympathetic trunk, then compensatory hyperhidrosis can still be overcome by repeated surgical intervention (removal of the clip and restoration of the intercostal nerve), whereas after electrical destruction, implying complete destruction of the sympathetic nerve trunk, correction of compensatory hyperhidrosis is no longer possible. Unfortunately, it is impossible to calculate in advance the probability of compensatory hyperhidrosis after radical sympathectomy, but modern medicine is working on finding methods for predicting this complication.
Manifestations of compensatory hyperhidrosis due to sympathectomy usually occur in the first months after surgery. Over time, its manifestations may decrease significantly. A constant level of sweating is established within a year after the operation and practically does not change.
Compensatory hyperhidrosis is especially pronounced with increased physical activity, visiting a swimming pool, bath or sauna, being in a humid hot environment. At the same time, under normal conditions, sweating may be within the physiological norm. Excessive sweating can be regulated by limiting the use of coffee and spices, as well as by conditioning the room.
Since sympathectomy is a radical surgical method of treatment, and like any surgical intervention is fraught with a lot of complications, it is worth resorting to it only in extreme cases, after all the conservative treatment methods taken have shown their ineffectiveness.
Compensatory hyperhidrosis can manifest itself to a mild degree, and can be expressed quite significantly with profuse sweating in other parts of the body.
Compensatory hyperhidrosis can also occur with other surgical methods, such as liposuction or curettage, also aimed at excision or blocking of sweat glands. However, as a result of these manipulations, its manifestation will not be so pronounced.
It is important for both the patient and the doctor to understand that radical surgical sympathectomy is an operation of choice and does not guarantee a 100% result. First of all, weigh all the “pro et contra” and decide which is the least painful for you: to live with ordinary hyperhidrosis or to struggle with the irreversible consequences of compensatory hyperhidrosis all your life.
The latest methods of treatment
The newest word in cosmetology is the method of treating hyperhidrosis with a laser. SmartLipo laser technology, familiar to some women, successfully used in the treatment of cellulite, has also found application in the treatment of hyperhidrosis. Experts in the field of cosmetology have expanded the range of indications for laser beam treatment, including hyperhidrosis. The effect of the thermal energy of the laser on the cells of the sweat gland leads to its complete blocking and termination of function. As a result, there is a complete cure for hyperhidrosis, which does not require additional interventions.
The manipulation is performed on an outpatient basis under local anesthesia: a cannula with a laser beam at the end is inserted into the skin through a micro-puncture and affects the gland cells. The procedure is characterized by low traumatism due to superficial intervention, takes 20-30 minutes, does not require special training and subsequent stay in the clinic.
There is practically no risk of complications after laser treatment: there is no hyperthermia of tissues, there are no hematomas at the puncture site, in addition, laser radiation has an additional bactericidal effect on the intervention area.
Hyperhidrosis of the armpits is treated with a neodymium laser that destroys up to 70% of the sweat glands. Literally in 1 session, a complete cure of axillary hyperhidrosis occurs. As a result of the procedure, the sweat gland is removed once and for all. Treatment of hyperhidrosis using laser technology today is the newest method and has not yet been widely used due to its high cost and insufficient number of trained specialists.
