HYPERHIDROSIS

Axillary Hyperhidrosis Treatment

(Excessive sweating/Malodourous sweat/Coloured sweating)

• Hyperhidrosis or excessive sweating is a disorder that makes you feel socially embarrassed; disrupting your personal and professional life. The main causes of hyperhidrosis are usually unknown.
• It results due to overactivity of eccrine sweat glands (present all over the body).
• The severity can vary from just saturation of clothes to pools of water dripping off the body.
• It can be particularly debilitating for the patient in hot humid environment in addition to the social embarrassment, caused as a result of wetting of clothes and the associated malodour in some cases.
• Bromhidrosis means malodourous sweat due to excretion of various substances (garlic, onion, arsenic, drugs) in it or decomposition of sweat secretion by surface coryneform bacteria, as in axilla.
• Chromhidrosis is the secretion of coloured sweat and its existence as a disease is doubtful unless urine and/or saliva is also coloured similarly.

TYPES OF HYPERHIDROSIS:

Hyperhidrosis can be continuous or phasic and is also classified according to the site of occurrence, as follows:

a) Generalised: This occurs due to thermoregulatory imbalances as in fever, diabetes, hyperthyroidism, obesity, menopause, following alcohol, night sweats (tuberculosis, Hodgkin's disease), following spinal cord injury and pheochromocytoma.

b) Localised: This is usually restricted to palms, soles and axillae, sometimes face and groins, usually following some emotional disturbance. Gustatory hyperhidrosis is a variant in which sweating occurs on lips, forehead and nose after eating hot spicy food or on localized areas of the face following abnormal autonomic nervous system connections (following herpes zoster, parotitis, abscess).

c) Asymmetrical: Excessive sweating occurs in just a few isolated areas (around glomus tumours) or may involve entire half of the body.

EXAMINATION:

This helps in evaluating the type (generalised, localized, asymmetrical), know the severity, presence of bromhidrosis and chromhidrosis (stained clothes & associated changes) and the emotional stability of the patient.

PRINCIPLES OF THE TREATMENT:

I. HYPERHIDROSIS

1. Reassurance and counselling is of utmost importance, as spontaneous remissions are possible (months to years).

2. If any underlying cause is established, it should be treated adequately. Psychiatric consultations may be required in cases of severe emotional instability.

3. Use of cosmetic products like antiperspirants and deodorants is sufficient in mild cases.

4. Medical line of treatment is usually temporary and needs maintenance therapy.

5. Surgical procedures give long lasting benefits, but may also require repeated sessions and have limitations too.

II. BROMHIDROSIS

1. Causative foods like garlic should be avoided.

2. Since eccrine and apocrine secretions are odourless by themselves, frequent washing of the area with deodorant soaps reduces bacterial colonisation, which is the responsible factor.

3. Bacterial count can also be reduced with topical antibiotics and shaving of axillary hair or one can opt for a permanent laser hair reduction treatment.

4. Cosmetic products like antiperspirants and deodorants are also useful.

MANAGEMENT OPTIONS:

A. Medical options:

1. Topical – Formaldehyde, Glutaraldehyde & Aluminium Chloride Hexahydrate

2. Systemic - Antichlolinergics, Ganglion blockers, Calcium Channel Blockers, Sedatives

B. Surgical options:

I. Subcutaneous injections of anti wrinkle protein injection:

Patient Selection:

It is important to diagnose and choose your patient carefully. The patient needs to understand the temporary nature of the treatment, wherein repeat injections would be needed to maintain the effects. In cases of palmar hyperhidrosis, it is very important to caution the patients about the temporary weakness of the intrinsic muscles of the hand. People who use their hand for finer movements, machine operators, surgeons, musician who play instrument and painters may not be the ideal candidates for this treatment. The patient also needs to understand that only one hand is treated in one sitting.

Pre injection Protocol:

1. Consent

2. Measuring extent of the most helpful semi quantitative with iodine solution sweating, purplish thereafter.

3. Anesthesia: Injection in the axillary area is relatively painless and given without any anesthetic. Though you might need to use a topical cream for an hour before the procedure.

Procedure:

1. Cleansing the treatment area

2. Injection technique:

Injections are given intradermally with the needle placed obliquely to prevent back flow. The spots can be marked as a grid over the area, so as not to miss any area while injecting.

Post Injection Protocol:

1. Instruction to the patient: Apply ice packs to alleviate any pain.

2. Treatment completely abolishes sweating in the injected area with in 3-7 days.

3. Effects may last for 6-8 months; subclinical activation of sweat gland function can be seen at a length of 4 months.

II. Iontophoresis

III. Sympathectomy