Sweating is a normal physiological phenomenon. It is required to regulate the body temperature during times of exercises and in hot environment. Excessive inappropriate sweating is referred to as hyperhidrosis, although this can also include facial blushing.

Hyperhidrosis causes a great deal of inconvenience. A cold sweaty hand makes hand shaking embarrassing; or the handling of delicate materials impossible, and the unpleasant odour from the underarm drives everybody away from you. The sweaty feet can also lead to other problems like fungal infections and warts.

It is divided into primary and secondary hyperhidrosis.

Primary Hyperhidrosis

Means it has no known cause. It is far more common than secondary hyperhidrosis. It usually starts during childhood or adolescence and persists all life. It mainly involves a localised part. Nervousness and anxiety can elicit or aggravate the sweating.

Excessive Sweating

No one knows what the mechanism is but the endocrine system may be related. The endocrine system regulates chemicals such as epinephrine (adrenaline), nor-epinephrine (nor-adrenaline) and serotonin, which control anxiety levels, mood and appetite.

This can occur in :
1. hands (palmar hypherhidrosis)
2. feet (plantar hyperhidrosis)
3. armpits (axillary hyperhidrosis)
4. face

Facial Blushing

The mechanism is similar with chemicals above stimulate the blood vessels in the face and make them dilate. As a result more blood go through them, causing a red or flushed face. Facial blushing too can be devastating socially. People often develop vast avoidance behavior to deal with the blushing episodes.

Medications that can be helpful for facial blushing include:

• Beta blockers, such as atenolol, help to slow down the heart rate and reduce anxiety associated with public speaking.
• Alpha blockers help blood vessel to maintain constriction.
• SSRI's (selective serotonin re-uptake inhibitors) can be helpful to reduce anxiety that causes the flushing.
• Diazepam, Lorazepam and other benzodiazapines can also be very effective for controlling the anxiety that results in facial blushing.

Secondary Hyperhidrosis

As a rule it involves the whole body. It is usually caused by another disease, such as hyperthyroidism, diabetes mellitus, hyperpituitarism or similar endocrine diseases. Menopause commonly has hyperhidrosis as one of the features. Occasionally severe psychiatric disorders and obesity is the cause.

Treatment of the underlying cause is first attempted to relieve the symptoms.

Non-Surgical Treatments (Primary Hyperhidrosis)

Anti-perspirants

The simplest method and is usually recommended as the first therapeutic measure. They are effective in mild to moderate hyperhidrosis but have to be repeated regularly. The commonest agent is aluminum chloride or chlorhydrate. Sometime in the presence of sufficient moisture and heat, aluminum chlorhydrate can be converted into hydrochloric acid and causes irritation and clothes staining

Oral Medications

Oral prescription medications commonly used include:

• anti-cholinergics
• beta-blockers (e.g., atenolol, propanolol)
• benzodiazapines (e.g., diazepam , lorazepam)

Tap Water Iontophoresis

This is a very popular method being used more frequently nowadays.

What Is Iontophoresis?

Iontophoresis is defined as the topical introduction of ionized substance into the skin using direct current. The positive current will drive positively charged drug molecules away from the electrodes and into the tissues, similarly, a negative current will drive negatively charged ions into the tissues.

Simple tap water contains different minerals that can act as the substance, is successful in a vast majority of patients.

How Does Iontophoresis Work?

The exact mechanism for the effects of tap water iontophoresis on hyperhidrosis remains uncertain. However, the electrical charges may cause a plug forming in the first layer of skin (stratum corneum), blocking the sweat duct without damaging the sweat gland.

Where Do We Perform The Treatment?

Until recently, iontophoresis can be performed only in the clinic or a hospital, and require the use of expensive equipment. It is costly and involves multiple visits in a week. Now, a relatively inexpensive, portable, battery-powered iontophoresis device is available for home use.

How Is It Done?

During iontophoresis, you immerse the hands or feet (one at a time) in a shallow tray of water with a wool pad at the bottom. The electrodes in the tray emit an electrical current through the water. The electrical charges are delivered to the affected area through the saturated wool pads.

You can rotate the hand or foot to expose all affected areas to the current. There is usually little or no discomfort during the procedure. Treatments are usually given for about 20 minutes per hand or foot, every 2 to 3 days, for 6 to 10 sessions and then it can last up to 6 weeks. After that another course is initiated but some patients only need one treatment every 2 weeks.

Are There Any Side Effects?

This conservative therapy has few side effects. Mild irritation may occur immediately after therapy, and can be resolved with an application of hydrocortisone cream. Over-dryness of the skin may occur and can be dealt with by moisturisers and increasing the interval between treatments. Patients who are pregnant or who have pacemakers should not be treated with iontophoresis.

There are plenty of clinical evidences to support the effectiveness of this method. It is widely mentioned in dermatological textbook and published in dermatology journals. Different models are available from Europe and the USA. One model called Dr-ionic from the USA provide 2 forms of pads, one that only works on hands or feet, and the other is designed to work on the underarms.

Botox / Dysport

This is mentioned in the section Aesthetic Medicine > Aesthetic Treatments > Botox / Dysport.

Others

Various methods including psychotherapy, hypnosis, aromatherapy, have been tried but these are not proven to work.

Surgical Treatments

Excision of the Axillary Sweat Glands

Patients with axillary hyperhidrosis who are unresponsive to medical therapy can be effectively treated by excision of the axillary sweat glands. If sweating extends beyond the hairy portion of the axilla, several skin incisions may be needed, sometimes resulting in formation of hypertrophic and/or constrictive scars

Sympathectomy

It is a surgical procedure during which segments of the sympathetic nerve pathways that lead to excessive sweating are cut.

Traditional Open Sympathectomy

They are effective at treating palmar hyperhidrosis, but virtually all patients find that they have increased sweating in other parts of their bodies, called compensatory hyperhidrosis. Compensatory hyperhidrosis can be severe and even more disruptive than palmar hyperhidrosis. Hyperhidrosis in the original location can also recur. In addition, complications such as Horner's syndrome, injuries to arteries, veins and nearby tissues, pneumothorax, and painful scars may occur.

Open sympathectomy at the lower back area for plantar hyperhidrosis (excessive sweating of the feet) is similarly very effective, but sexual dysfunction and other complications may arise, and thus this procedure is infrequently performed at this time.

Endoscopic Thoracic Sympathectomy

This is a minimally invasive procedure, now available for palmar hyperhidrosis and hyperhidrosis of the face and head.

Under general anesthesia, a small incision, approximately one centimeter in length is made under both armpits. Endoscopic equipment is then inserted to cut a precise nerve. The process is then repeated on the other side of the chest.

Scarring is minimal, as the skin cuts made are small and well hidden in the folds of skin in the armpit. Compensatory hyperhidrosis occurs in a large percentage.