Sweat success

Excessive sweating is usually genetic (hereditary), and has been a cause of embarrassment to a lot of people.  It has a profound impact on social interactions and work-related activities.  Routine social interactions, such as holding hands, shaking hands or hugging, become awkward.  Patients report a sense of humiliation and embarrassment associated with soaked or stained clothing as well as perceived odors.

Hyperhidrosis is defined as sweating in excess of the physiologic amount necessary to regulate thermal temperature. Symptoms of excessive sweating generally begin in the adolescence but may be present even earlier.  In a study of Taiwanese patients with palmar hyperhidrosis, 75% had a childhood onset, with the rest presenting in puberty. A recent survey representing 150,000 households in the US revealed an average age of onset of 25. The average age of onset for axillary hyperhidrosis was 19 years and 13 years for palmar hyperhidrosis. The US survey revealed that 51% of patients with hyperhidrosis had axillary involvement alone or in combination with another site, 9.5% reported axillary involvement alone.  Palmar hyperhidrosis alone or in combination with another site was reported at 24% of patients, and only 1% reported palmar hyperhidrosis alone. Plantar hyperhidrosis alone or in combination with another site was reported in 30% of patients.  Facial hyperhidrosis was reported in 10% of patients.

Hyperhydrosis may be localized or generalized, with a prevalence of 2.8% of the general population.  This medical condition is associated with significant psychosocial morbidity and has a dramatic impact on activities of daily living.  A significant proportion of patients does not consult a physician for this condition, thinking it is just plain sweating anyway.

Hyperhidrosis is a disease of the eccrine sweat glands.  The human body has up to four million sweat glands, of which approximately three million are eccrine  glands mostly located on the soles of the feet, forehead, palms, and cheeks.  These eccrine glands function mainly in a thermoregulatory fashion. The remainders are apocrine glands, which are not involved in hyperhidrosis. Eccrine glands are innervated (regulated) by the sympathetic nerve fibers and, through the primary neurotransmitter released at the preglandular nerve endings, the acetycholine stimulates sweating.  These fibers originate in the hypothalamus (brain) and descend through the ipsilateral (same side) brain stem, forming a synapse (connection) with the intermediolateral cell nucleus of the spinal cord.  That is why it is usually triggered by emotional stimuli, usually fright, nervousness or stress, and even spicy foods.  It is an involuntary bodily response that cannot be controlled but can be kept at bay.  But it is not as simple as it seems to be. Hyperhidrosis is divided into primary (focal or localized, idiopathtic) and secondary (generalized and due to a variety of causes). Generalized sweating can mean a neurological problem like Parkinson’s disease, spinal cord injury or cerebrovascular accident (stroke) or an endocrine problem the likes of hyperthyroidism, hyperpituitarism, diabetes mellitus, menopause, pregnancy, pheochromocytoma, carcinoid syndrome or acromegaly.  It may also mean the presence of infection or malignancies.  It can also be due to conditions with a high sympathetic discharge such as cardiovascular shock or heart failure, respiratory failure, alcoholism or it can even be drug abuse-related.

Remedies for excessive sweating include:

1. Antiperspirants which create a water-proof barrier that prevents sweat from the glands and ducts to reach the skin’s surface.  The preparation, however, may cause skin irritation because of induced dryness.

2. Oral medications are a class of drugs known as anticholinergics.  These drugs act by blocking impulses in nerve fibers.  These prevent sweat glands from getting the stimuli necessary to produce sweat.  Side effects of these drugs include dry mouth, urinary retention, blurred vision, and constipation.

3. Injections such as Botulinum toxin injection result in a temporary blockage of the neurotransmitter acetylcholine from inducing sweat production.  This is most effective for axillary, palmar, plantar, and facial sweating.  This has to be injected every three to 12 months for a continued action or effectivity in controlling excessive sweating.

4. Iontophoresis, which uses electrical current to induce changes in the sweat glands, disrupting sweat production.

5. Surgical intervention.

For those affected with excessive sweating, this condition is extremely embarrassing and debilitating, with definitely significant impairment of activities of daily living, social interaction, and occupational activities.  It may also mean a more serious systemic problem so it should not be taken for granted.

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For questions/inquiries, call 09174976262, (0939)9171352 or 484-7821; e-mail gc_beltran@yahoo.com.