What is Hyperhidrosis, treatment, surgery, has a cure ?

What is hyperhidrosis? Hyperhidrosis is a disease characterized by excessive sweating even when there is no heat or the person is lying down. Reaches various parts of the body. Its causes may have genetic or pathological origin. It can be caused by a range of problems. The most common causative agent is heredity, but it can also be caused by phenomena such as menopause, heart disease, anxiety and diabetes, among others. The diagnosis is made through blood tests, urine and / or specific tests. The treatment can be medicated, surgical or through specific procedures done in the doctor's office. Possible complications include mycosis, rashes and infections. In the CID-10 (International Classification of Diseases) index, hyperhidrosis corresponds to code R61.0. 1- How does sweat work? Sweat is a mechanism of the body to preserve body temperature - which, in normal situations, should be around 36ºC. Thus, the body can perform its vital functions properly. For sweat to occur, it is necessary for the brain to send stimulating orders to structures scattered throughout the body, called sweat glands. The glands, in turn, conduct sweat through ducts located in the outer area of ​​the skin, causing the fluid to cool the body. Sweat is made up of water, minerals and some natural chemical compounds. So it did not smell originally. The odor that we relate to him is the result of a chemical reaction between the liquid and some bacteria that are located in the skin. 2- Types There are two types of hyperhidrosis, which are defined according to the origin of the problem. They are: A- Primary hyperhidrosis: Primary hyperhidrosis is genetic, that is, usually the individual has at least one other person in the family who presents the problem. This type of hyperhidrosis begins to manifest during childhood or at most during the early years of adolescence. The most affected areas are hands, feet, armpits and face. The episodes usually happen mostly during the day. Manifestations of primary hyperhidrosis at night are rare. According to data from the World Health Organization (WHO), it is estimated that between 2% and 3% of the world population suffers from primary hyperhidrosis. Most of these people, however, do not seek medical advice. B- Secondary hyperhidrosis: Secondary hyperhidrosis is acquired throughout life, as a direct consequence of some causative agent that is causing the problem. The most common causes for secondary hyperhidrosis are health problems or side effects of some medications. The disease can also be caused by natural phenomena - such as menopause, for example. This type of hyperhidrosis can affect any part of the body at any time of the day, including at night. In addition, secondary hyperhidrosis can affect people of all ages. However, it is more common in adult subjects. C- Classification by affected areas It is also possible to classify hyperhidrosis as focal, when it affects only one area of ​​the body, or as generalized, when it reaches the whole body. 3 - Causes: The main cause of hyperhidrosis is a kind of hyperactivity of the sweat glands. This means that some phenomena are over-stimulating these structures. The reasons for this hyperactivity can be: A- Genetic trend According to a survey by the US institution Center of Hyperhidrosis, about 50% of cases of hyperhidrosis are classified as primary hyperhidrosis - that is, the disease is inherited in half of the patients . Thus, the genetic tendency is the main cause of hyperhidrosis. The scientific community is not yet sure how the heredity factor for the disease works, but Chinese researchers have already been able to map the gene responsible for the phenomenon.As research advances, it is possible that in some decades, more effective treatments for familial hyperhidrosis will be available. B- Menopause: According to data from the gynecology department of the Scottish hospital Dumfries and Galloway Royal Infirmary, it is estimated that about 85% of menopausal women suffer from secondary hyperhidrosis. The phenomenon happens because, at menopause, there is a drastic fall in the rates of the hormone estrogen, which is produced by the uterus. Estrogen is one of the major female hormones responsible for, among other things, regulating body temperature. This process directly affects the amount of sweat produced by the body. The episodes of hyperhidrosis caused by menopause can happen 20 to 30 times a day, on average, and they tend to be more intense at night. C- Anxiety Disorders: Hyperhidrosis and anxiety disorders are closely related and work in a kind of vicious circle. Anxiety attacks can affect several parts of the body, including a region of the brain called the hypothalamus, which in turn interferes with the stimulation of the sweat glands. These glands are responsible for releasing perspiration. Therefore, it is common for anxious people to develop pictures of secondary hyperhidrosis during life. The problem is that bouts of hyperhidrosis end up causing even more anxiety in having this type of disorder. That is: anxiety causes hyperhidrosis, which causes more anxiety, causes hyperhidrosis, and so on. D - Diseases that affect the nervous system: Within the central nervous system, there is a kind of special subdepartment called the sympathetic nervous system (also known by the acronym, SNS). The sympathetic nervous system is responsible for the body's reactions to stressful situations. It is thanks to the work of the SNS that human beings are capable of instinctive actions when they are exposed to dangers - such as striking a punch at an aggressor, evading an attempted assault or starting a discussion with someone, for example. In addition, the sympathetic nervous system is also capable of stimulating another common reaction to stress: sweat. Therefore, some diseases that affect the nervous system can interfere in the work of the NHS, and end up causing a picture of secondary hyperhidrosis. Among the problems that may cause hyperhidrosis are: 1- Alzheimer's disease; 2- Parkinson's disease; 3- Huntington's disease; 4 - Multiple Sclerosis; 5. Epilepsy; 6- Cerebral Vascular Accident (CVA); 7- Migraines, in rarer cases. E Cardiac problems: Diseases that affect the functioning capacities of the heart can generate an overload of the sympathetic nervous system, which needs to react to the stress situation caused by the imbalance in the cardiorespiratory system. This overload causes the nervous system to react much more intensely than normal, generating phenomena such as dry mouth, anxiety attacks and, of course, hyperhidrosis. F- Among the heart diseases that can cause hyperhidrosis are: 1- Heart failure; 2- Aortic insufficiency; 3- Myocarditis; Vasculitis; 5 - Myocardial infarction. G - Hypoglycemia: Glycemia is the clinical name of the amount of sugar concentrated in the blood. When this index is lower than normal, we say that the person is suffering from hypoglycemia.The phenomenon of hypoglycemia is relatively common in patients with diabetes, but can affect anyone in specific situations - such as spending too much time without eating, being malnourished or taking medicines to lose weight, for example. The body's response to low blood sugar levels comes through the adrenal (or adrenal) glands, which lie just above the kidneys. These structures release a rather famous hormone called epinephrine. Adrenaline, in turn, has the function of regulating blood pressure and heart rate. The problem is that during this process, this hormone also causes symptoms very similar to those of an anxiety attack - among them hyperhidrosis.

H- Obesity: The fat acts as a layer of thermal insulation, which causes the body to retain heat. Because sweating is a thermoregulatory mechanism, it is natural for obese people to sweat more. I- Diabetes: Hypoglycaemia is a phenomenon that occurs more easily in individuals with diabetes. Consequently, diabetics end up being a population with greater predisposition to develop hyperhidrosis. J- Acromegalia: At the base of the skull, there is a tiny gland called the pituitary gland. The function of this structure is to produce and release several important hormones to various parts of the body. One of these hormones produced by the pituitary is called GH, and is responsible for the growth of the individual during childhood, adolescence and early adulthood. Acromegaly is the name given to a disease characterized by the exaggerated production of GH, especially during adult life. The phenomenon causes the affected person's feet, hands and cartilage to increase and become deformed. As the problem directly affects the pituitary gland, the consequences of acromegaly extend to various parts of the body. One such development is the development of secondary hyperhidrosis. K- Hyperthyroidism: The thyroid is one of the most important glands in the body and is located in the neck. It is responsible for releasing hormones that significantly affect the functioning of organs like brain, heart, lung, kidneys and uterus, among others. When the thyroid produces more hormones than it should produce, a problem is established called hyperthyroidism. Because of the importance of the thyroid, the excess hormones released by it accelerates chemical processes in various parts of the body, causing imbalances - among them hyperhidrosis. L- Medications Hyperhidrosis can also manifest as a side effect of certain medications. Among the drugs that may cause the problem are antihypertensives, antipsychotics, antidepressants, certain vitamin supplements and some antibiotics. If you are experiencing episodes of hyperhidrosis and suspect that the reason may be some medication, it is worth reading the package insert carefully and discussing it with the doctor who prescribed it. M- Substance abuse The use of drugs such as ecstasy, methamphetamine and PCP (which actually serves as the name of phencyclidine) may induce hyperhidrosis. N Gout Hyperhidrosis is one of the main symptoms of a disease called gout (also known as gouty arthritis). The problem is characterized by an inflammation of several joints, caused by the accumulation of uric acid in the bloodstream. Generally, in drip pictures, the parts of the body that are affected by excessive sweating also ache and become a reddish color. N - Cancer and tumors It is not yet known exactly why some types of cancer and tumors cause hyperhidrosis. Some studies suggest the possibility that excessive sweating may be a result of the body's efforts to fight cancer, but that information still lies within the range of hypotheses.The fact is, yes, certain types of cancer can cause hyperhidrosis. Some of them are: 1- Leukemias; 2- Cancer in the liver; 3- Cancer in the bones; 4- Mesothelioma, a type of cancer that affects the tissue that coats organs like heart, lung and stomach; 5- Carcinoid tumors, which usually reach the digestive system; 6- Hodgkin's lymphoma, which reaches the lymphatic system.

4- Risk factors: There are records of cases of hyperhidrosis at any age, from infants to the elderly. According to data from Cedars-Sinai Medical Center, a Los Angeles-based hospital, something between 1% and 2% of the adult population in the United States is estimated to have or will develop hyperhidrosis throughout life. Some characteristics that may make an individual more susceptible to develop the problem are: A- Family history of hyperhidrosis; B- Diabetes; C- Obesity; D- Diseases affecting the nervous system; E-Menopause; F- Thyroid dysfunction; G- Cardiovascular problems; H- Use of drugs. 5- Hyperhidrosis is a picture characterized by a single symptom: excessive sweating. It can be difficult to measure how much is too much perspiring. In general, it is normal for human beings to sweat in certain contexts and situations - when it is hot, during physical exercises or in situations of stress and / or nervousness, for example. The sweat that characterizes hyperhidrosis is, in general, abundant, to the point of disrupting the patient's quality of life and self-esteem. It usually happens at any time of the day, without any activity or situation that can motivate perspiration to happen. There is no fixed guideline on what it would be to sweat too much - no standard level or standard. In general, excessive sweating is one that causes such embarrassment in the patient to the point of preventing him or her from doing some activity, such as exercising, greeting someone with a handshake, hugging, driving, or using the computer keyboard , for example. The parts of the body that are most often affected by episodes of hyperhidrosis are the hands, feet, face and head. However, sweat can appear anywhere. It is common for patients with hyperhidrosis to suffer from at least one weekly crisis of the problem. When can hyperhidrosis mean an emergency? In some cases, excessive sweating may be a symptom of some medical urgency requiring immediate treatment. Seek a hospital as soon as possible if, in addition to excessive sweating, you experience any of the following symptoms: 1- Fever above 39 ° C; 2- Shivers; 3- Dizziness; 4- Weakness; 5- Impending fainting sensation; 6- Nipple; 7- Mental confusion; 8- Pain in the chest. P- Hyperhidrosis Trigger Syndrome: Hyperhidrosis Trigger Syndrome is a common phenomenon among patients who suffer from the problem. Basically, sweating excessively leaves patients so nervous that they experience symptoms of anxiety. Anxiety, in turn, only further intensifies hyperhidrosis, creating endless drama during the crisis. People who are suffering from Hyperhidrosis Trigger Syndrome usually experience some of the following symptoms every time they begin to sweat: 1- Tingling in the hands;2- Difficulty breathing; 3- Feeling that the heart is beating slower or faster than normal; 4- Pulsation in the ears; 5- Pain in the stomach and / or in the stomach; 6- tension in the neck and shoulders; 7- Feeling of fear and / or panic; 8- Insomnia. 6- How is the diagnosis of hyperhidrosis made? To diagnose hyperhidrosis, the most recommended professional, initially, a general practitioner. The doctor should evaluate the suspicions about the origin of the hyperhidrosis and then refer the patient to a specialist. The specialist, in turn, may be a dermatologist, neurologist or cardiologist, according to the cause of hyperhidrosis. During the first appointment, the doctor will likely ask you some questions about the patient's medical history and symptoms and then request some tests and tests to arrive at an accurate diagnosis. Some of the tests that may be ordered are described below: Q- Blood test: Blood tests are done to check if hyperhidrosis may be caused by a specific health condition - such as diabetes or hypoglycemia, for example. R- Urinalysis: Just as in the case of blood tests, urine tests are requested by the doctor to assess if any health problems are causing hyperhidrosis. Urine tests are mainly done to rule out the cause of excessive sweating being some dysfunction in the thyroid. S-iodine test: The iodine test (also known as the starch-iodine test) is one of the most commonly used tests to diagnose hyperhidrosis. It is made by applying iodine tincture to the places most affected by sweat. After a while, a small amount of starch is sprayed on the spot. The reaction of the two substances will leave the sites affected by the hyperhidrosis covered by a dark blue coloration. T Sweat test: The test consists of placing a specific paper to perform the examination on the area that is most affected by sweating during the attacks of hyperhidrosis. After some time, the paper is removed and weighed in a special scale so that it is verified how much sweat was concentrated there. 7- Hyperhidrosis has a cure? Yes, hyperhidrosis has a cure. Generally, secondary hyperhidrosis disappears once the disease that is causing the problem is treated. Already the primary hyperhidrosis can be treated through some specific procedures or surgeries.

Treatment of hyperhidrosis: Treatment for hyperhidrosis may be surgical, with medications or involve some specific procedures that are applied in sessions. They are: Long-term procedures: Long-term procedures are treatments known to be common in the aesthetic area. They usually show results after a few weeks or months and need to be redone from time to time. A- Iontophoresis: Iontophoresis is a procedure of using electrical impulses to increase the absorption of sweat through the skin through stimuli. For this, two electrodes are used - a kind of conductor of electric currents made of steel. Both are connected to the region that will be treated. One of the electrodes is responsible for charging positive charges, while the other emits negative electrical charges. Combined, these two types of current can overcome the skin barrier. Once the current enters the skin, you will be able to form a kind of electrical barrier, which, in turn, will be responsible for moving away the molecules of sweat. Iontophoresis is applied in sessions, which last, on average, 15 to 20 minutes. It is recommended that patients with hyperhidrosis make 5 to 20 consecutive days of treatment, depending on the severity of the case. After this time, the expectation is that the skin's moisture levels are already close to normal. From then on, the team responsible for the case will recommend the frequency of treatment maintenance sessions, which usually happen once or twice a week, for periods that can last for months. B-Botox: Known for its role in cosmetic procedures, Botox is a very popular treatment option for hyperhidrosis. The official name of Botox is botulinum toxin. The substance is produced by a bacterium called Clostridium botulinum and is used in a number of medical and aesthetic treatments because of its very powerful muscle relaxation capabilities. For cases of hyperhidrosis, Botox is applied in regions with high concentration of sweat glands, discouraging the production of sweat and considerably reducing perspiration for periods up to 10 months. The application is made through injections, usually applied in the hands, feet or underarms, inside the doctor's office itself. The procedure takes less than 20 minutes and should be repeated once every six months. C- Surgeries for Hyperhidrosis Surgical interventions are common treatments for patients suffering from primary hyperhidrosis, or who have secondary hyperhidrosis and do not respond to other, less invasive, types of treatment. In general, the procedures are simple and present extremely low postoperative risks. However, there is the possibility that, after surgery to treat excessive sweating in one part of the body, the problem returns to another totally different one after some time, in a phenomenon known as compensatory hyperhidrosis. D Removal of the axillary sweat glands: Removal by aspiration of the sweat glands is a surgical procedure that only presents results for patients suffering from excessive sweating in the armpit region. The surgery is relatively simple: the doctor makes two very small cuts in the armpits, and, through them, inserts cannulas of hidrossucção. These instruments, in turn, remove the sweat glands from the region by aspirating them. The procedure does not require general anesthesia, only local, and the patient can be released the same day, without need for hospitalization. The greatest postoperative care is to pass the 48 hours following surgery without lifting or making significant efforts with the arms. Thoracic sympathectomy Thoracic sympathectomy is a surgical procedure designed to inhibit certain reactions of the sympathetic nervous system that stimulate the exaggerated production of sweat. It can be used to treat people suffering from excessive sweating on parts of the body such as face, neck, scalp, back, chest, abdomen, armpits, hands and feet. The surgery is done via video, through the use of a thin and long instrument called a thoracoscope, which contains a camera attached at its tip.The thoracoscope is inserted from one side of the thorax and goes to the sympathetic nerve, located near the spinal cord. With the aid of the surgical instrument, according to the history of each patient, the surgeon can choose to clip part of the nerve or divide it into small pieces. The measure should decrease the stimulation to the sweat glands, reducing the sweat. The procedure takes about an hour and requires general anesthesia. It is recommended that the patient avoid any kind of physical exertion for two weeks. Alternative Treatments for Hyperhidrosis There are some home treatments that can help lower your levels of sweating. But attention! These treatments do not have proven efficacy and should not replace conventional treatment recommended by your doctor. F- Apple cider vinegar Apple cider vinegar can be used to control sweating on the hands, feet and underarms. The substance has constrictive properties that may help to inhibit the excretion of sweat through the pores of these regions. To bet on apple cider vinegar as an ally against hyperhidrosis, follow these steps: 1- Before sleeping, wash the affected region with warm water. Then dry thoroughly with a clean cotton towel; 2- Dip a cotton ball in the apple cider vinegar and apply well in the chosen region; 3. Let the vinegar rest there at night; 4 - In the morning, rinse with running water; 5- Repeat the procedure at least once a week. G- Lemon juice: Lemon juice works as a kind of natural antiperspirant. It is therefore ideal for controlling sweat in the feet, hands and underarms. To use this natural treatment for hyperhidrosis, follow these steps: 1- Squeeze a small fresh lemon; 2 - Add a spoonful of baking soda to the lemon juice and mix well, until it forms a homogeneous paste; 3- Apply the paste in the place where you perspire excessively; 4 - Leave to act for 10 minutes; 5- Rinse well under running water; 6. Dry thoroughly; 7- Repeat the procedure once a day. H- Therapy: Since hyperhidrosis is a problem that directly affects the individual's self-esteem, having the help of a psychologist is an important step in the treatment. Discuss with your doctor the possibility of attending a psychotherapist to work on your insecurities and how you see yourself in the world as a patient with hyperhidrosis. 9- Remedies for hyperhidrosis: A- Deodorants handled; B- Special deodorants; C- Inhibitors of the sympathetic nervous system; D- Antidepressants and anxiolytics; 10- NEVER self-medicate or stop using a medicine without first consulting a physician. Only he can tell which medication, dosage and duration of treatment is most appropriate for your specific case. The information contained on this site is for informational purposes only and is not intended as a substitute for the advice of a specialist or as a recommendation for any type of treatment. Always follow the instructions in the package leaflet and, if symptoms persist, seek medical or pharmaceutical advice. Source: FM - USP.