CAUSES AND EFFECTS

INTRODUCTION
Sweating is a normal bodily function, but for some people, it can be an embarrassing or traumatic experience. They find themselves changing clothes several times a day; they sweat even when the weather is cool and when they are not doing any strenuous work. A number of these people do not realize they are suffering from a disorder called hyperhydrosis, or the condition can be treated.

The human body has about 2-5 million sweat glands. The two main ones are; eccrine and apocrine. Eccrine Sweat Glands
Approximately 3 million eccrine sweat glands Secrete a clear, odorless fluid Aid in regulating body temperature Areas of concentration: Facial, plantar, and axillae

Apocrine Sweat Glands

Inactive until puberty Produce thick fluid Secretions come in contact with bacteria on the skin and produce characteristic body odor Found in axillary and genital areas

MECHANISM OF SWEATING
Hypothalamus serve as the thermoregulatory centre. It controls both blood flow and sweat output to the skins surface. It is triggered by exercise, temperature change, hormones and stress. Once trigger send message to the spinal cord via neurotransmitters (acetylcholine an catecholamine). These neurotransmitters travel down to ganglion to nerves innervating the skins surface

Photo used with permission: The Whiteley Clinic,2007

DEFINITION
Hyperhydrosis is a state of excessive sweating of the axilla, palms, soles, or face that interferes with daily activities. It is a condition characterized by abnormally increased perspiration in excess of that required for thermal regulation.
University of Miami Cosmetic Center, 2007

CLASSIFICATION
Hyperhydrosis is classified into primary and secondary types.
Primary type: is associated with hyperactivity of the

sympathetic nervous system and can affect one or several areas of the body (Strutton et al(2004), Hornberger et. al (2004)), starts during childhood or adolescence. Secondary type: is caused by other factors mainly disorders.

GENETICS
Hyperhydrosis appear to be inherited in a

dorminant fashion. It was thought to be autosomal recessive genetic potential. A new UCLA (University of California-Los Angeles) study published in the journal of vascular surgery shows strong evidence that sweaty palms syndrome is genetic (Champeau,2002). It is caused by dorminant gene, indicating that family members of those who have the disorder may suffer from it more than has been previously reported.

It has been found by the Department of Human Genetics of UCLA that as much as 5% of the population maybe at risk for some form of hyperhydrosis, commonly known as sweaty palms syndrome. Also according to research carried out by UCLA, it was found that 65% of the patients reported family recurrence of the disorder.

CAUSES
Excessive sweating affects a great number and

there are various factors, this include; heart attack: Infections: eg T.B those living with it. Malignancy: eg Lymphoma Obesity Neurologic and endocrine disorder (eg hyperthyroidism, diabetes) Others; (anxiety, hypoglycemia, menopause, stress) (Clinic, 2011)

SOCIAL EFFECT
This pose a lot of problem on individuals with

this disorder, such as; Low esteem and self confidence Embarrassment Rule out a career such as being a chef Workplace limitations such as low output, time management, mental and interpersonal tasks.

Social isolation Daily activities impacted

DIAGNOSIS
Diagnosis involve two types i.e. Patients examination history)(Hornberger et. al, 2004).

(include

Clinical test could include; i. Minor starch iodine test: this delineates the area of sweating by use of iodine solution in 3.5% of alcohol. ii Thermoregulatory sweat Test (TST): This

delineate the distribution response to a controlled heat and humidity stimulus (Fealey, 1997).

Photo used with permission: Eisenach, Atkinson, & Fealey, 2005

Treatment Option Review

HYPERHYDROSIS
AXILLARY TOPICAL TREATMENT PALMOPLANTAR

BOTOX IONTOPHORESIS LOCAL EXCISION

IONTOPHORESIS BOTOX ETS

TREATMENT
Treatment depends on the outcome of the

diagnosis and the area affected. Topical treatment: use of Antiperspirants eg. Aluminum chloride hexahydrate, block sweat pore and reduce sweat, and also eliminate odour Systemic treatment: use of Anticholinergics, has sympathetic inhibitory action. Iontophoresis: block sweat duct by directing a mild electrical current through the skin (Hornberger et. al, 2003).

Treatment contn
Botox: use of Botulin toxin injection, inhibit nerve impulse (Heckman, 2001, Naumann and Lowe, 2001, lowe et. al, 2003).

Surgery: can be done for severe cases. It is of two types; (i) Local Excision (ii) Endoscopic Thoracic Sympathectomy. Endoscopic thoracic sympathectomy (ETS) is the most effective of all. It also have some side effects.

CONCLUSION
Hyperhydrosis is an embarrassing disorder that even today is misconceived as rare and untreatable. It is aggravated during emotional stress and the pathophysiological mechanism appears to be hyperfunctioning of the gland. Hyperhydrosis does not have to be a problem of epic proportion. By acknowledging the condition and by getting help from the right sources, you can minimize its impact on the quality of your life.

REFERENCES
Fealey R.D (1997): Thermoregulatory sweat test. ed. Clinical Autonomic Disorders. 2nd pa: Lippincott-Raven; 245-257 Hamm, H., Naumann, M., & Kowalski, J. (2006). hyperhydrosis: Disease characteristics impairment. Dermatology, 212. 343-353.

In: ed. Primary and

low PA, Philadelphia, focal functional

Heckmann M, Ceballos-Baumann A.O, Plewig G study Group, Botulinum toxin A for 344:111- 117.

(2001): Hyperhydrosis axillary hyperhydrosis;

Hornberger J, Grimes K, Naumann M, et al. (2004 Aug):MultiSpecialty Working Group on the Recognition, Diagnosis, and Treatment of Primary Focal Hyperhydrosis. Recognition, diagnosis, and treatment of primary focal hyperhydrosis. JAmAcad Derm. 51(2):274-286,

Mayo Clinic (2011): What causes excessive sweating, Article M.J Ingram, Rachel Champeau (2002); Evidence that 'sweaty palms' is genetic , UCLA issues of the journal of vascular Reisfeld R, Berliner K (2008): Evidence based review nonsurgical management of hyperhydrosis, clin 18(2); 157-166 Strutton DR, Kowalski JW, Glaser DA, Stang PE.(2004 Aug.): US of hyperhydrosis and impact on individuals hyperhydrosis: results from a national survey. Derm. 51(2):241-8,

reviewed

by

syndrome surgery of the thorac surg prevalence with axillary J Am Acad