Hyperhidrosis

Question 1

What is hyperhidrosis?

Answer 1

• Sweating in excess of that required for regulation of body temperature

Question 2

How is sweating usually controlled?

Answer 2

• Autonomic nervous system
• Increased sympathetic stimulation from thoracolumar autonomic fibres stimulate eccrine sweat glands to increase sweat production

Question 3

Two types of hyperhidrosis

Answer 3

• Primary - no underlying cause, localised to specific areas eg hands, armpits, scalp or feet - symmetrical usually
• Secondary - underlying condition, including systemic or medication, generalised sweating or focal

Question 4

Causes for secondary hyperhidrosis

Answer 4

• Anxiety
• Pregnancy
• Menopause
• Infections eg TB, HIV or malaria
• Malignancy esp lymphoma
• Endocrine disorders eg hyperthyroidism, phaeo, carcinoid syndrome
• Medication - anticholinesterases, antidepressants, propanolol

Question 5

Primary hyperhydrosis

Answer 5

• Focal sweating
• Bilateral and symmetrical
• Occuring at least once a week
• Onset before 25 yrs old usually
• Present more than 6 months for diagnosis

Question 6

Secondary hyperhidrosis

Answer 6

• Generalised sweating
• Predominant at night time

Question 7

Quantifying hyperhidrosis

Answer 7

Can use visual scale eg

Question 8

Investigations for hyperhidrosis

Answer 8

• Through history and examination
• Secondary causes exclude first
• Bloods - FBC, CRP, U&E, TFT, glucose, CXR

Question 9

Management hyperhidrosis - lifestyle

Answer 9

Lifestyle eg:
* Reducing stress/anxiety
* Avoiding spicy foods
* Absorbant underlayers or armpit pads
* Loose fitting clothes of natural fibre
* Leather shoes

Question 10

Management hyperhidrosis - medical

Answer 10

• Antiperspirant OTC first
• Aluminuim chloride can be applied at night - but can cause painful adn erythematous skin
• Propantheline - ONLY anticholinergic licenced for this use
• Glycopyrrolate and oxybutynin can reduce but offlicense use

Question 11

Surgical intervention - when is it done for hyperhidrosis?

Answer 11

• Resistant symptoms
• Significantly affecting quality of life

Question 12

Surgical options for hyperhidrosis

Answer 12

• Iontophoresis
• Botulinum toxin
• Endoscopic thoracic sympathectomy

Question 13

What is Iontophoresis?

Answer 13

• Use of weak electrical current through the area via water soaked sponges
• Short term solution - works via combination of blocking sweat glands, disrupting nerves and making sweat more acidic

Question 14

How does botulinum tocin work for hyperhydrosis?

Answer 14

• Injected into skin in very small doses to block nerve supply to sweat glands
• Lasts for 2-6 months
• Can be repeated
• BUT only licenced for under arm, not for hands and feet as can cause weakness

Blocks release of Ach from synaptic bouton

Question 15

What is endoscopic thoracic sympathectomy?

Answer 15

• Causing damage to thoracic sympathetic ganglion supplying affected region
• Major operation, risk of damaging other nerves or lung parenchyma - only done as last resort

Question 16

What happens to patients who have surgery for hyperhidrosis?

Answer 16

• Often develpp compensatory sweating at other locations - side effect