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Hyperhidrosis

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Hyperhydrosis (Excessive Sweating)

Sweating is a normal function that regulates body temperature.  It also helps excretion of some toxins that are produced in the body.  Excessive sweating can be observed in particular conditions, such as exercise, excitement and stress, although sweating is boosted to regulate body temperature in hot weather.


Sweating - a physiological function of human body- can be a serious problem for some people. The disease, also known as hyperhydrosis, is manifested by excessive sweating in specific body regions, such as hands, armpits and feet, without any physical activity regardless of air temperature. Prevalence of hyperhydrosis is approximately 1% in Turkey.


Sweating accompanied by dizziness, nausea or chest pain points to an important health problem and you will need to visit your doctor.


There are two types of hyperhidrosis; primary and secondary. There is no definite underlying cause that may lead to excessive sweating in the primary hyperhidrosis and excessive sweating is secondary to overactive nerves. Or even the factors that cause sweating in normal circumstances may worsen the sweating.


Excessive sweating involves palms, soles, face, underarms and anterior chest wall.


In the secondary hyperhidrosis, a medical condition results in generalized excessive sweating. Secondary hyperhidrosis is most commonly due to diabetes mellitus, menopause, heart attack, cancer, infection and nervous system disorders.


The treatment of secondary hyperhidrosis involves management of the underlying cause.


Primary hyperhidrosis is an important medical condition that imposes heavy burden on the social life.


Identification of the underlying cause is the principal diagnostic approach for both primary and secondary hyperhidrosis. Final diagnosis may require blood and urine tests as well as imaging studies. Primary hyperhidrosis is diagnosed when no underlying cause can be identified.


In the case of secondary hyperhidrosis, the ultimate aim is to prevent excessive sweating by eliminating the underlying cause.



Following options can be used in the treatment of the primary hyperhidrosis:


Cream, gel and sprays

The preferred first-line treatment includes creams, gels and sprays for excessive sweating in hands and armpits. For therapeutic efficiency, those preparations should be used at high dose for several times a week lifelong. The therapeutic effect may decrease and the skin may be irritated in the course of time.


Another method is iontopheresis- therapy with low-voltage electric current. It can be used in excessive sweating of hand and feet. This expensive method requires special equipment and it is very laborious.  It cannot be used for people with metal prosthesis and pacemaker.


Botox injection

Botox is one of the most common treatments preferred in management of hyperhydrosis. In this method that is used for hyperhydrosis of armpits, hands and feet, the intent is to deactivate sweat glands by paralyzing sympathetic nerves that regulate sweating by injection the toxin regionally. This method down regulates sweating for 6 months and accordingly, it should be repeated at 6-month intervals. It is a very expensive method.


Surgical Method

The only definitive treatment of hyperhydrosis is surgery. To prevent excessive sweating in armpits, skin of armpit can be surgically removed or liposuction can be performed. Recently, this surgical modality is not used.


The globally acknowledged method is to place a clip on the sympathetic nerve that transmits the neural signal of sweating. This treatment modality provides permanent solution. The procedure is called Endoscopic Thoracal Sympathectomy (ETC). Surgery is performed under general anesthesia.


Camera and devices are inserted through one or two axillary incisions (1 cm) and relevant segment of the sympathetic nerve fibers is clipped. Surgery takes 30 to 60 minutes. Patient is discharged in postoperative day 2. Patient can engage in work and routine daily activities 1 week later.


Hyperhyrosis is not a disease that you have to acquiesce. Each patient can select the most proper treatment modality and get rid of this very annoying physical and social problem by visiting his/her physician.