Generality
The term hyperhidrosis indicates an excessive secretion of sweat compared to the norm; it can be generalized, circumscribed and appear following environmental or emotional factors. Other causes of hyperhidrosis can be endocrine stimuli (hypoglycemia, hyperthyroidism), dietary stimuli (high consumption of foods or supplements containing caffeine, capsaicin or other thermogenic agents), pharmacological (antipyretic, cholinergic, antidepressant, amphetamine) and vegetative (hyperhidrosis induced by vomiting, nausea or pain).
Sweat and Sweating
Causes
Hyperhidrosis therefore represents a significant obstacle to social relations, as well as a possible indication of a pathological state. When it is determined by an idiopathic phenomenon (whose causes are unknown) we speak of primary hyperhidrosis ; when instead it is a manifestation of a pathological process (hyperthyroidism, psychiatric illnesses, obesity, hormonal therapy or endocrine alterations linked, for example, to menopause) one speaks of secondary hyperhidrosis .
The location of the problem is a first, important diagnostic clue. If excessive sweating is extended to the entire body surface (generalized hyperhidrosis) it is likely that at the base there is an endocrine problem, such as hyperthyroidism (excessive production of thyroid hormones), pharmacological, febrile, etc.
Emotional states are generally implicated in the appearance of local hyperhidrosis, which is found with predilection in the palms of the hands, on the soles of the feet, in the axillary area and in the forehead. While excessive sweating in the extremities is often associated, axillary hyperhidrosis can exist alone. In the latter case the disorder is almost always an expression of emotional irritability.
Other pathological alterations of sweating include cromohydrosis (colored sweats that tinges the clothes with which it comes into contact with yellow) and bromidrosis (foul-smelling sweat due to the increased decomposition of apocrine sweat caused by the bacterial skin flora).
Treatment
See also: Hyperhidrosis - Hyperhidrosis Drugs
Since hyperhidrosis causes considerable discomfort in the social and work environment (for example, we think of an activity that requires considerable manipulative precision), it is important to establish an adequate therapeutic path. In the first instance it is necessary to exclude all the secondary forms through an accurate anamnesis and further, possible, diagnostic investigations such as blood tests.
Clothing and Deodorants
In addition to normal hygiene practices, too-tight clothing should be avoided, especially if made of synthetic fibers.
In the pharmacy you can find particular long-lasting deodorants, able to limit the disturbance thanks to the presence of aluminum chloride . Indicated above all for the axillary region, they can also be prepared by the pharmacist (20% solutions in absolute alcohol). In this case the local application, to be done preferably before night rest, should be covered with a paper film and removed in the morning with subsequent washing of the affected area. In some cases, aluminum chloride can cause unfavorable topical manifestations (redness, itching).
Iontophoresis
Also the ionophoresis can produce a temporary anhidrosis (loss of the ability to produce sweat), if the antiperspirant strategy with specific deodorants has not given the desired effects. Iontophoresis, carried out in an outpatient setting, consists in connecting a low intensity current generator to two water basins (in which the patient's hands or feet are immersed), or to two wet pads to be applied to the armpits or forehead. The flow of energy charges generated by the appliance acts by blocking the ducts of the sweat glands for a certain period of time. The efficacy of this therapeutic technique in the treatment of hyperhidrosis is variable, generally good for milder cases and less noticeable in more intense situations.
drugs
The pharmacological therapy of emotional hyperhidrosis is based on the use of sedatives and anxiolytics, capable of limiting excessive emotionality, but also of reducing the vigilance threshold and causing drowsiness. The general treatment can also use anticholinergics, but the results are inconsistent and the side effects are often unbearable in the long term.
Particular attention should be paid to the use of botulinum toxin applied to the treatment of hyperhidrosis. This toxin is lethal to humans, so much so that only one gram can harvest ten million victims. Death occurs due to flaccid paralysis, that is, due to the inability to contract the muscles (including involuntary ones) due to the non-release of acetylcholine by the nerve endings. However, when used in infinitesimally small concentrations, the muscle relaxant action of botulinum toxin is limited to the area of injection and can thus contribute to smoothing out wrinkles or blocking sweat secretion (since the activity of the glands responsible for producing sweat it is controlled by the nervous system). Only after 4-6 months from the injection there is a gradual recovery of the secretory activity and in many cases a single treatment is enough per year. The latter, as mentioned, consists of multiple local injections of the botulinum toxin; it is suitable for the underarm area, contraindicated in the face, and can be painful in the absence of adequate anesthesia. Botulinum toxin injections to treat hyperhidrosis must be more superficial than those used to smooth expression lines.
Surgery
Finally, in the case of drastic and debilitating hyperhidrosis, appropriate surgical interventions are performed, performed under local anesthesia and based on the removal of the sweat glands or on the interruption of their sympathetic innervation.
