Hyperhidrosis Flashcards
Define hyperhidrosis
Excess of sweating regardless of body temp
What is sweating controlled by?
Autonomic nervous system
Increased sympathetic stimulation from thoracolumbar autonomic fibres stimulate the eccrine sweat glands to increase sweat production.
What can hyperhidrosis be divided into
Primary and secondary
Primary hyperhidrosis
No underlying cause is present and usually localised to specific areas such as the hands, armpits, scal, feet.
Most commonly symmetrical
Most cases start in teenage years and will improve as patient gets older
Secondary hyperhidrosis
Associated with an underlying condition
Systemic conditions or medication
Can present with generalised sweating or focal to specific areas
Causes of secondary hyperhidrosis
Pregnancy or menopause
Anxiety
Infections like TB, HIV or malaria
Malignancy (lymphoma especially)
Hyperthyroidism, phaeochromocytoma, carcinoid syndrome
Anticholinesterases, antidepressants or propanolol
Clinical features or primary
Focal sweating bilateral and symmetrical
At least once a week
Typical onset is before 25 years of age
Should be present for >6 months for the daignosis to be made.
Clinical features of secondary
Generalised sweating that is predominantly at night time
Features of underlying disease like pyrexia, palpitations and unexplained weightloss.
Investigations
History and examination is where diagnosis is made
Routine bloods like FBC, CRP, U%Es TFTs and glucose might be done
CXR as well
General management
Lifestyle advice to avoid stress or anxiety, avoid spicy food and using absorbant underlayers
Loose fitting clothes of natural fibre and leather shoes can also help.
Anti-perspirants from over the counter can be used as well.
Propantheline is the only anticholinergic agent licensed for use in hyperhidrosis, this can help to reduce sweating.
Indications of surgical interventions
Resistant symptoms that are significantly affecting QOL
Surgical approaches
Iontophoresis
Botulinum toxin
Endoscopic thoracic sympathectomy
Explain iontophoresis
Weak electrical current through the area through water soaked sponges
This is only a short-term solution
It likely works by a combination of blocking sweat glands, disrupting nerves and making sweat more acidic.
Explain botox in hyperhidrosis
Injected into the skin in very small doses to block the nerve supply to the sweat glands.
The effects lasts around 2-6 months and can be repeated.
It is only licensed for underarm but not for hands or feet since it can lead to weakness.
Explain endoscopic thoracic sympathectomy
Involves causing damage to the thoracic sympathetic ganglion supplying the affected region.
This is most useful for palm and face involvement
This is a major operation with risk of damaging other nerves and lung parenchyma so should only be done as last resort.
