Hyperhidrosis: types, causes and treatment

Perspiration or sweating is a function of the skin that maintains a constant body temperature. However, unpredictable and uncontrollable hyperhidrosis or excessive sweating can hinder the sufferer's social or professional relationships. IML is equipped with therapeutic options for the personalised treatment of excessive sweating.

1. What is hyperhidrosis?
2. Types of hyperhidrosis
3. Causes of hyperhidrosis
4. Treatment of hyperhidrosis at IML
5. Other hyperhidrosis treatments

1. What is hyperhidrosis?

Hyperhidrosis is the excessive sweating or perspiration that occurs spontaneously, not caused by high temperatures or physically and emotionally tense situations.

Why do we sweat?

Perspiration is a bodily function that involves the liberation of liquids high in salts, from the sweat glands. This function basically serves the purpose of favouring thermoregulation, that is, to maintain the body temperature constant at 37 ºC.

When the body needs to free heat, perspiration occurs and the skin is cooled down by evaporation. This is why we sweat when hot, during physical activity or in tense situations, in which nervous discharge increases our body temperature.

The human body has a total of 2 to 4 million sweat glands, that are activated during puberty . Sweat glands in the palms, soles, skull, face and armpits are particularly sensitive to psychological stimuli.

Sweat glands in the hands, feet and armpits are more sensitive to psychological stimuli.

Hyperhidrosis: the silent handicap

Hyperhidrosis can affect 2% of the white population. This percentage is higher is Asian patients, above all in those of Japanese origin. It is most common in the 25 to 64 year age group and in 40% of the cases, another family member also suffers from it, which indicates a genetic component.

It is observed mainly on hands, armpits, feet and pubic region, due to the high concentration of sweat glands in these areas.

Hyperhidrosis presents different degrees of affectation for the patient:

• Grade I: Sweating is never noticed and does not interfere with the sufferer's normal activity.
• Grade II: Sweating is tolerable, but sometimes interferes with the sufferer's normal activity.
• Grade III: Sweating is rarely tolerable and frequently interferes with the sufferer's normal activity.
• Grade IV: Sweating is intolerable and constantly interferes with the sufferer's normal activity.

Although this is fairly frequent problem that can cause stress and anxiety, and despite the limitations faced in the place of work, study and socially that hyperhidrosis causes, a great deal of sufferers refrain from visiting the dermatologist when the symptoms first appear.

The psychological impact of hyperhidrosis can cause complexes or interfere in the daily lives of those suffering from it. Affected patients try and adapt themselves to the problem and tend to adopt particular behaviours:

• They avoid physical contact situations, such as shaking hands
• They limit movement in their arms and adopt rigid positions to hide the excessive sweating in their armpits
• They change their clothing several times a day
• They avoid activities that require having a firm hold on something

2. Types of hyperhidrosis

According to cause:

• Primary: usually localised (focal) and its cause is unknown.
• Secondary: occurs as a result of another medical condition and usually involves the body as a whole. It can appear at different times in the patient's life, related to menopause, certain drugs, thyroid conditions, tumours or mild mercury poisoning.

According to location:

• Axillary
• Palmoplantar
• Gustatory
• Generalised

According to extension:

• Localised hyperhidrosis: when the excessive sweating covers 100 cm² or less skin area.
• Generalised hyperhidrosis: when the excessive sweating covers an area of skin greater than 100 cm².

According its location, hyperhidrosis can be axillary, palmoplantar, gustatory or generalised

3. Causes of hyperhidrosis

Primary hyperhidrosis

The cause of primary hyperhidrosis is unknown.

It is clearly related to sympathetic over-activity and an excessive sudomotor function response.

Patients suffering from it are well aware that stressful situations, such as excitement or nervousness can exacerbate the situation. A common complaint among patients suffering hyperhidrosis is they get nervous because they sweat, then sweat more because they are nervous.

Certain habits, such as drinks, nicotine, caffeine and certain foods or smells can also trigger excessive sweating.

Secondary hyperhidrosis

Secondary hyperhidrosis is usually generalised and presents itself within the symptoms of an underlying condition:

• Spinal cord injuries
• Peripheral neuropathies
• Brain lesions
• Intrathoracic tumoral lesions
• Systemic disorders (pheochromocytoma, Parkinson's disease, thyrotoxicosis, among others)
• Mercury poisoning

Localised hyperhidrosis

Excessive sweating of up to 100 cm² can be related with the presence of (among others):

• Glomus tumour
• Blue rubber bleb naevus
• Pachydermoperiostosis
• Diabetic nephropathy
• Parotitis
• Parotid abscesses

4. Treatment of hyperhidrosis at IML

The dermatologists at IML perform a case history to diagnose the degree of hyperhidrosis and then choose, together with the patient, the treatment best suited to them, according to the patient's personal characteristics and the severity of the symptoms.

Hyperhidrosis treatments can be dermatological, aimed at inhibiting secretion from the sweat glands or surgical, which entails their excision or ablation.

IML has SlimLipo Aspire at its disposal, this is dual laser power technology emitting at 924 and 975 nm, that melts away the sweat glands lodged between the subcutaneous fat tissue. Over 90% of these glands are eliminated in a procedure performed under local anaesthesia and with almost no recovery period.

SlimLipo Aspire® is an FDA-approved technology for laser-assisted lipolysis. The sweat glands in the armpits are housed among the fat cells in the subcutaneous tissue, making this laser the optimum treatment for the ablation of the structures responsible for hyperhidrosis.

What does Laser Assisted Ablation consist of?

The technique is performed through a 2 mm incision, through which the Klein' formula local anaesthesia is administered.

A fine and flexible cannula with optical fibre on the end is then placed into the incision through which the laser power is transmitted.

Once inside the skin, the physician moves the optical fibre gently and continuously over the sweat glands selectively eliminating them.

A paper suture and an adhesive gauze are placed on the incision, which the patient should keep on for 48 hours.

Recovery causes no discomfort and allows the patient to resume their normal activity just a few hours after the procedure.

Benefits of Laser Assisted Ablation for axillary hyperhidrosis:

• Results are permanent
• The technique has a 90% efficacy rate in eliminating the sweat glands
• Local anaesthesia
• Laser coagulates the vessels in the treatment area, reducing swelling and bruising
• Laser power is selective: it acts only on the fat tissue surrounding the sweat glands, without affecting the adjacent tissue
• Brief recovery period. The patient can resume their normal daily activities just a few hours after treatment

The dual laser melts the sweat glands lodged in the subdermal fat tissue

5. Other hyperhidrosis treatments

Dermatological treatments:

• Aluminium chloride: used as an antiperspirant, but usually requires high concentrations, which can cause skin irritations. Its effectiveness takes about 5 days to show.
• Anticholinergic substances: Oxybutynin, glycopyrrolate among others, although not exempt from adverse effects.

 Surgical treatments:

• Elimination of the sweat glands using surgical procedures with different degrees of invasiveness: suction, subdermal curettage, liposuction or direct curettage, the latter through the dissection and detachment of a skin flap, which is everted and most of the glands and then excised.
• Endoscopic Thoracic Sympathectomy: disables the main thoracic ganglia in the paravertebral chain, responsible for the innervation of the region to be treated. The success of this surgery is high in children with an efficacy of 80%. High rates of compensatory sweating have been reported, appearing in body areas that did not sweat prior to surgery. A variation of this technique is lumbar sympathectomy for plantar hyperhidrosis, entailing side effects that make this technique fairly unviable.
• Other techniques include Subcutaneous Temporal Sympathectomy with phenol and iontophoresis.