SWEAT MORE NO

Sweating is a physiological phenomenon that regulates our body temperature by keeping us cool through evaporation.

As we are used to sweating on a daily basis, not many of us are aware that excessive sweating is a medical condition.

This condition called hyperhidrosis. It can affect any part of the body face, palms, underarms (axilla), soles and/or torso.

It is said that sympathetic overactivity in the nerves that supply the eccrine sweat glands lead to hyperhidrosis. Hyperhidrosis patients will sweat at cold temperature and even when he is at ease and there is no stress involved. But this phenomenon usually disappears during sleep.

It’s a permanent condition but treatable with modern medicine.

TYPES AND CAUSES

Hyperhidrosis is divided into two main types Primary Focal Hyperhidrosis and Secondary hyperhidrosis.

Focal hyperhidrosis tends to occur on the face, palms, soles and/ or torso and no apparent cause can be identified it whereas secondary hyperhidrosis can be due to underlying conditions like obesity, endocrine diseases such as diabetes, hyperthyroidism, hyperpituitarism, acromegaly, certain cancers such as lymphomas, carcinoid tumours, pheochromocytomas, pregnancy, menopause, anxiety and many more.

In Malaysia, most patients suffer from Primary Focal Palmo-AxillaryPlantar Hyperhidrosis compared to facial or even secondary hyperhidrosis.

EPIDEMIOLOGY

There is no race or sex predilection with regards to hyperhidrosis as the tagline goes “Now Everyone Can Sweat”. Primary focal hyperhidrosis appears from early childhood or puberty. Some patients have late onset of hyperhidrosis in adulthood but this is rare.

In a study of 850 patients with palmar, axillary or facial hyperhidrosis, 62% of patients reported that they couldn’t remember when they began to sweat excessively sweating began, 33% since puberty and 5% during adulthood. In the United States, an incidence rate of 0.6-1% is reported for hyperhidrosis in adolescents and young adults. In UK, the incidence of hyperhidrosis is about 1 and 3 in every 100 people, hence it is a very common disorder. Palmoplantar hyperhidrosis occurs 20 times more frequently in the Japanese than in any other ethnic group.

In Malaysia, there is no registry for hyperhidrosis, hence exact figures are not available.

The International Hyperhidrosis Society (IHS) is an independent, nonprofit global organisation based in the United States. It strives to improve the quality of life of people affected by hyperhidrosis globally. It was formed in 2003.

IMPLICATIONS TO SOCIETY

For a patient suffering from hyperhidrosis, it is definitely a big social stigma as he is even unable to shake hands with other people due to sweaty palms. Most patients tends to hide the disease by avoiding public meetings or keeping their hands in their pockets. Some have even postponed their marriages due to hyperhidrosis, which has caused feuds between two families. Some due to hyperhidrosis, have bad body odour and this adds to their misery.

Imagine students wetting their examination papers due to sweat dripping on it, waiters dropping food or drinks on their customers as food trays slip from their wet hands, electrical engineering student getting electrocuted due to wet hands, teachers or other professionals unable to carry out their duties due to sweaty hands, CEO of a company conducting a meeting in an air-conditioned room while sweating away and many other scenarios.

There are many patients suffering from severe psychological stress as well as depression, losing friendship and being sidelined due to hyperhidrosis. Sadly, many patients do not know that hyperhidrosis is a treatable and curable medical condition and by seeking medical advice, they can go on with their lives like other people.

You may have hyperhidrosis if:

you avoid physical contact, such as shaking hands, because you feel self- conscious about your sweating you don’t take part in activities, such as dancing or exercise, for fear they will make your sweating worse excessive sweating is interfering with your job – for example, you have difficulty holding tools or using a computer keyboard you’re having problems with normal daily activities, such as driving you’re spending a significant amount of time coping with sweating – for example, frequently showering and changing your clothes you become socially withdrawn and self-conscious

TREATMENT OF HYPERHIDROSIS

There are many treatment options for hyperhidrosis.

Non-Surgical Treatment

Traditionally most patients buy antiperspirants over the counter to cope with this stressful medical conditions. Brands offering clinical strength include Secret, Gillette, Degree, Dove, Arrid, and Sure, PerspireX, Certain-Dri and Hydrosal. Oral medications, especially anti-cholinergics drugs such as Atropine, helps too but they have adverse effects like dry eyes and mouth, palpitations and many more. So they should be used under medical advice and preferably not for, the long term.

Many have also tried out tap water iontophoresis, where feet and hands are soaked in water with a device attached to pass a low voltage current through it in the hope to deactivating sodium channels in the sweat glands which in turn decreases sweating. This requires repeated sessions for many months. Other modalities are Botulinum Toxin A (Botox) injected into the palms and feet and this too needs repeated sessions every 2 to 6 months and its expensive as well. Liposuction or Laser surgeries have been tried by many to the under arms as well.

Surgical Treatment

Surgical treatment is currently offered to patients suffering from

Primary Focal Hyperhidrosis and is the treatment of choice for sustained long-term cure. Minimally invasive techniques have emerged and currently Video Assisted Thoracoscopic Sympathicotomies (VATS) or Needlescopic Surgery (Endoscopic Thoracic Sympathectomy) is the gold standard surgery for this disorder.

The technique is safe with negligible complications.

Although many patients experience a mild increase in sweating in other parts of their body, this is rarely problematic and 95-98% of patients will be cured of excessive sweating when the appropriate levels of the sympathetic trunk are divided. Patient satisfaction has been outstanding. The hyperhidrosis ceases immediately after the surgery. Hence, patients Sweat No More !!! Article is written by Dr George John, Consultant General & Thoracic Surgeon, Prince Court Medical Centre.