Hyperhidrosis is an abnormal condition of the sweat glands, which overreact to stimuli, producing more sweat than is necessary.
Hyperhidrosis may affect hands, feet, axillae and other areas of the body. Although there is not an exact cause of this excessive sweating,
hyperhidrosis may be a disorder of the nervous system for regulating body temperature.
Hyperhidrosis may seriously affect daily living of persons. Some patients may experience unpleasant odor, skin irritation, skin pigmentation and fungus. This severe condition tends to interfere with the person´s ability to interact and function. In many patients, anxiety can exacerbate this situation, as they get nervous because they sweat and then they sweat more.
What is the treatment for hyperhidrosis?
There are different methods to treat the hyperhidrosis. The treatment will depend on the type of hyperhidrosis of the patient. In some mild cases of hyperhidrosis the use of antiperspirants and medications has proved to be an efficient treatment. However, for severe cases this treatment is not sufficient.
The most commonly used treatments are:
Antiperspirants containing aluminium or zirconium compounds are the most used method to control mild hyperhidrosis cases. Antiperspirants block the sweat ducts and then the perspiration is released through the urine.
Oral medications - Systemic prescription
Anticholinergics medications, such as glycopirrolate, are sometimes considered by physicians for the treatment of hyperhidrosis. However, this treatment may need of high doses of medication, which frequently has serious side effects such as dry mouth, blurred vision, urinary retention, constipation and heart palpitations.
Botulinum toxin type A (Botox)
The Botulinum toxin type A, which is commercially sold under the name of Botox or Dysport, is a neurotoxin produced by the anaerobic bacteria Clostridium Botulinum. Botox is used to temporarily reduce or abolish excessive sweat production. Botox may be used in the axillary area, hands and feet, previous iodine starch test, which is used to identify the area of hyperhidrosis. However, this form of treatment requires to be applied every four months. This treatment is not used in severe cases of hyperhidrosis.
Surgical treatment of hyperhidrosis
Axillary hyperhidrosis occurs specifically in the area where the axillary hair grows. This area delimits the site for sweat glands excision. The expert surgeon does not penetrate the axillae during the surgical treatment. Through a small incision, a careful subcutaneous excision of the apocrine glands is performed. Curettage and liposuction also may be used to treat the extreme underarm sweating.
This procedure is usually performed under local anesthesia and in an outpatient basis. Any post-surgery discomfort can be minimized with the pain medication prescribed by your physician.
The thoracic sympathectomy surgery is usually performed by a surgeon specialized in thorax. This procedure destroys by excision the T2 and T3 ganglia of the sympathetic nervous system. This treatment has proved to be effective for hyperhidrosis in hands (68-100%) and feet (58-85%). The 86% of the treated patients refer compensatory sweating in trunk and extremities, phantom sweating and neuralgia.
You will be asked to remove your underarm hair by using depilatory cream instead of razor. The use of razors prior to surgery increases the incidence of wound infection.
Patient preparation includes treating the surgical site before surgery, using appropriate antiseptic agents for skin preparation.
In the operating room the intravenous therapy or IV will be initiated. The IV is the giving of liquid substances directly into a vein.
Through a needle you will receive saline solution, anesthesia, and other medications you may need during surgery.
Once you have moved over the operating table, you will be placed in a supine position with arms in abduction.
This means that you will be lying down with the face up and open arms. The elbows are cushioned with pillows to prevent any postoperative discomfort.
This procedure usually does not require of drainage tubes.
The surgery may take 1-2 hours and it is performed on an outpatient basis.
Palmar Hyperhidrosis - Well sweaty hands
Suffering from sweaty hands is a problem every day, people who have this problem often feel bad or feel personal embarrassment at certain times that are normal such as:
When the person shakes hands with another person because of greeting, farewell or affection, immediately the other person feels like they leave his hand wet.
In the office or at home:
When the person is concentrated writing, finishing a job or working on the computer, all work items are wet or dirty.
Professional Aspects (workplace):
In the jobs of the professions themselves.
The architects when they are finishing a project, the artists when they are concentrated in their works, the musicians when they are playing their best notes, the carpenters when hammering a nail, among many more examples ... unexpected drops of sweat in any surface can reach make a catastrophe.
Application of Botulinum Toxin or BOTOX®
BOTOX® is a neurotoxin produced by the anaerobic bacterium Clostridium botulinum. It is injected intradermally and blocks the release of acetylcholine in the neuromuscular junctions and sympathetic nerves that innervate the eccrine sweat glands by inhibiting the production of sweat. Normally this procedure is performed in the office of Dr. Claudia Patricia Nieto González, A useful diagnostic test to determine the areas of greatest sweating is the iodine starch test.
Initially, iodine solution is applied on the area to be studied, and minutes later, starch is applied to this same area, the sweat interacts with the iodine giving a violet color.
Although it is not a diagnostic test, it serves to establish the areas of greatest sweating and to make a comparison after treatment.
A detailed marking of the areas to be treated is carried out.
The palms of the hands are very sensitive, which is why the procedure is not very painful but it does not take long, Dr. Nieto performs a radial, median and ulnar nerve block, with a local anesthetic BOTOX® is applied on the palms of the hands ., with a syringe and needle, making multiple punctures.
The application of BOTOX® has shown a success rate of 95% with a duration of effect between 6 to 12 months. The average dose is 100 IU per palm.
Its effect begins to be evident after two days and reaches its maximum efficiency at 2 weeks is necessary that the patient does not exercise intensively or take a sauna after and before the procedure.
The most important limitation is that its application is painful. Another adverse effect is the possibility of compromising the neuromuscular junctions of the muscles of the hand causing weakness especially for the clamp.
It is contraindicated in pregnant women, lactation period, Miastemia Gravis or if medications are taken that interfere in the neuromuscular transmission.
Endoscopic thoracic sympathectomy
The operation is carried out under general anesthesia by a Thoracic surgeon. It consists of destroying the sympathetic ganglia T2 and T3 by ablation. The final interruption of the nerves that transmit the signals to the sweat glands is made. It is indicated in severe cases of associated facial and palmar hyperhidrosis, with good long-term results. It has a success rate between 68 and 100% for palmar hyperhidrosis while for plantar it is only 58 - 85%. The adverse effects include the appearance of compensatory hyperhidrosis in the trunk and extremities in up to 86% of patients, compensatory sweating, phantom sweating and neuralgia.
To obtain a clear vision of the sympathetic nerve, the lung must be displaced downwards, which is achieved by blowing air into the chest. The sympathetic chain is composed of lymph nodes, the exact number of lymph nodes varies with each patient taking into account the characteristics of each case. Once the operation is completed on one side, it is done on the other side, always under the same anesthesia. The procedure lasts between 30 and 60 minutes.
It is important to emphasize that only the branches of the sympathetic nerve that go to the hands stop working. The rest of the sympathetic nervous system continues to function normally.
The results are evident immediately.
Hyperhidrosis / Excessive sweating has a solution
Excessive perspiration severely affects the quality of life of people who suffer from it.
According to experts, this condition, also called hyperhidrosis, usually appears in childhood and affects 2 percent of the world's population.
Bogotá D.C., Excessive sweating of the facial region, hands, armpits and feet is one of the problems that most creates insecurity in people when interrelated. It is usually a situation that is lived with shame, so it is intended to hide it, with not very good results.
It consists of a disorder of the sweat glands, located mainly on the face, on the palms of the hands, the soles of the feet and the armpits, as an exaggerated response to an emotional stimulus.
It is caused by a disorder at the nervous level, whereby the body produces more sweat than necessary, in an attempt to regulate or maintain body temperature, "explains Claudia Patricia Nieto González, a surgeon specializing in Plastic, Aesthetic and Reconstructive Surgery. the Image and Youth Plastic Clinic. Excessive perspiration severely affects the quality of life of people who suffer from it. In addition to the unpleasant sensation of moisture, some patients experience bad odor, irritation, skin pigmentation and fungus.
Hyperhidrosis often becomes a limiting factor in social relationships. Some people even produce more perspiration in the face of the stressful feeling of feeling excessively sweaty, thus causing a repetitive cyclic phenomenon.
There are several therapeutic methods to treat it and its management is determined by the severity of the problem, and the site to be treated. In certain cases of mild hyperhidrosis, topical antiperspirants or drug administration may be an effective treatment. However, in accentuated hyperhidrosis, these solutions may be little or nonexistent.
For excessive sweating, prior to carrying out an iodine test for the location of the areas of greatest sweating, botulinum toxin is used. Botulinum toxin commercially known as BOTOX® It is a neurotoxin produced by the anaerobic bacterium Clostridium botulinum. The application of botulinum toxin is one of the most innovative and effective methods for the treatment of this disease, in the area of the armpits has shown a success rate of 90%. It is injected intradermally into the skin, inhibiting the production of sweat. Its effects can be seen from 3 to 7 days after the application. Botulinum toxin can be applied to the face area, cranial region, armpit area, palms of the hands and soles of the feet. Treatments with botulinum toxin for hyperhidrosis take 20 to 40 minutes in the office, depending on the area to be treated. You can resume daily activities immediately after treatment. A dose replacement is needed every 6-8 months.
Regarding the surgical treatment, specific in the axillary area, it is an intervention of one to two hours, with local or general anesthesia and ambulatory regimen, in which the surgical removal of the sweat glands is performed. "The expert surgeon who knows the axillary anatomy practices an intervention that does not require penetrating the armpit. He makes the incisions, lifts the planes and performs, by means of liposuction or direct curettage, a careful surgical resection of the apocrine glands causing the problem, "says plastic surgeon Claudia Nieto. This is an almost definitive solution and is usually a little or nothing painful therapy, with minimal discomfort that can be controlled with analgesic medication.
This page has translation from Spanish to English by an automatic translator.
With treatments ranging from antiperspirants to surgical procedures, the quality of life of the patient can be improved. People who are afraid of shaking hands with others or of remaining in a crowded place because of excessive sweating and the consequent bad smell, should know that controlling hyperhidrosis, as this disorder is called in medical terms, is possible. .
The plastic surgeon Claudia Patricia Nieto, from the New Granada Military University, explains to EL NUEVO SIGLO why this disease occurs and what is the best way to treat it to improve the quality of life of patients. "First of all, those who suffer from hyperhidrosis have excessive sweating on the palms of the hands, the soles of the feet and the armpits. These are the parts of the body where the problem basically manifests itself. It is related to an exaggerated response to an emotional stimulus, generated by a disorder at the nervous level, in which the body produces more sweat than necessary, "says the expert. This disorder, says Nieto, "severely affects people's self-esteem because it produces an unpleasant sensation of humidity, bad smell and irritation that prevents them from socially interacting normally." When patients consult it, adds this surgeon, many times they do not know that it is a health problem, but above all they do not know that there are methods for their treatment. The specialist makes the diagnosis by means of the colorimetric technique, which consists of impregnating the surface of the affected skin with an alcoholic dye of 2% iodine. When the substance dries, sprinkle with starch. This procedure produces a discoloration of the iodine, which allows to visually identify the areas where the sweat is concentrated, with blue and brown marks on the skin, which indicate the location of the secretory sweat glands. Once you have the results, there are several types of treatment: topical, systemic and surgical. "To treat mild hyperhidrosis, the most convenient way is with topical antiperspirants, they are substances that contain aluminum and zirconium salts and act by partially blocking the sweat ducts, causing the deviation of sweating. What is done is placing a layer of the product on the palms of the hands and the soles of the feet, then a plastic film is placed and it is done in about two weekly applications, "he recommends. Nieto makes a differentiation between deodorant and antiperspirant, which have specific uses.
"The antiperspirant decreases the amount of sweat, moisture, and deodorant decreases the bad smell that produces moisture, because sweat does not produce a bad smell but bacteria or microorganisms of the body that mix with sweat," he says. The systemic treatments consist of anticholinergic drugs, says the expert, and these drugs are given in high doses, but have secondary problems such as dry mouth, blurred vision, urinary retention and tachycardia, so that people do not use them frequently, says the doctor. There is also Iontophoresis, as Nieto explains, it is "a procedure approved by the highest North American health authority, FDA, where electricity is used to temporarily close the ducts of the sweat glands and this produces a decrease in the amount of sweat. It is used mostly on the hands and feet. " In addition, surgical procedures are also used, when the problem manifests itself very severe. These cases include thoracic sympathectomy, which "produces a definitive interruption of the nerves that transmit the signals to the sweat glands so that the patient does not sweat" or the axillary curettage, "a surgical resection of the apocrine sweat glands causing the problem. "And it is done under local or general anesthesia. The last thing that is being used, explains Nieto, is botulinum toxin. "Basically it is injected intradermally and this produces an inhibition, blocking the chemical signals of the nerves that control sweating. It is like a neuromodulator, which when injected, inactivates the substance responsible for stimulating sweating. " This treatment lasts between 6 and 12 months and the effects begin to be seen between the third and seventh day of application.
Women , Hyperhidrosis Surgery
Was all very simple, excellent attention from the doctor and others.
Men, Hyperhidrosis Surgery
From the first moment you feel comfortable with the attention from the doctor, explaining the surgery, post operative care and follow-up recovery, make the process a whole great experience.