2017 HCHB_digital

Sweating: Excessive (Hyperhidrosis)
Although everybody sweats to a certain extent, some people have a problem
with excessive or uncontrollable sweating, known medically as hyperhidrosis. The
condition mainly affects the underarms, but may also affect the palms or feet.
Although hyperhidrosis is not life-threatening, it can cause significant
embarrassment and discomfort to the person involved and impact on work,
school and social relationships. The excessive sweating can stain clothing,
chafing can occur leading to dermatitis and infections, and damp feet can begin
to smell or damage footwear.
Sweat glands
There are two types of glands located in the skin that contribute to sweat
production. These are the apocrine and eccrine glands.
Apocrine glands are present from birth but only mature at puberty and start
manufacturing sweat at that time. They are mainly found in the armpits, round
the belly button, and in the genital area and produce a milky type of sweat
that exits the body along the hair follicle. Sweat production is increased during
periods of heightened emotional state (eg, stress, fear). In animals, apocrine
glands produce body odours that attract sexual partners. There is no conclusive
evidence to indicate that these glands perform this same function in humans.
Eccrine glands secrete a watery salty solution in response to heat, exercise,
or emotional stress and have their own duct system to move the sweat to the
surface of the skin. Evaporation of this solution (sweat) from the surface of the
skin provides a cooling effect, helping to control body temperature. The skin
contains between two million and three million eccrine sweat glands and these
are more concentrated in the soles of the feet, palms, armpits and forehead.
Body odour from sweating occurs when bacteria, that are normal inhabitants
on the surface of the skin, feed off the sweat and break it down. It is the bacteria’s
waste products that smell, and bacteria proliferate quickly in the presence of
sweat, especially if the pH balance of the skin is disrupted (such as with using
alkaline soap), or if the sweat is allowed to remain on the skin for a prolonged
period of time. Shaving can also contribute to bacteria growth as the absence of
hair does not allow the sweat to wick away from the surface of the skin.
Hyperhidrosis is classified either as primary or secondary hyperhidrosis,
depending on whether there is an underlying medical condition or not.
Primary focal hyperhidrosis (PFHH)
This is the most common form of hyperhidrosis and most frequently affects the
underarms, hands, feet or face/scalp, with normal sweat production occurring on
other parts of the body.
Sweat production can occur without the effects of heat or physical activity,
and the severity can vary from time to time. Sometimes, certain “triggers” such as
anxiety, emotion, spicy foods, heat, and even being anxious about sweating can
make it worse. At other times, no obvious factor can be pinpointed that will have
triggered the sweating. PFHH tends to be a long-term condition, but in some
cases symptoms can improve over time.
The condition affects around 2%–3% of the population, and typically first
occurs in adolescence, although can also begin in childhood or even in infancy.
Although the exact cause is unknown, it appears to be due to overactivity of the
hypothalamus (the area of the brain that maintains body temperature) which
stimulates the sympathetic nervous system to release sweat from the eccrine
sweat glands.
Secondary hyperhidrosis
Secondary hyperhidrosis refers to excessive sweating that is due to an underlying
medical condition. Secondary hyperhidrosis can either be generalised, in that it
affects the whole body versus, less commonly, localised (focal), which means it
just affects one particular part (for example, after a spinal injury sweating may
occur in only one leg). Usually a cause is found or suspected. Some conditions
that have been associated with secondary hyperhidrosis include:
• anxiety
• diabetes, heart problems or stroke
• menopause
• nerve damage
• obesity
• Parkinson’s disease
• respiratory failure
• some medicines (eg, nortriptyline, paracetamol, zinc)
• some tumours (rarely)
• thyroid gland overactivity
TREATMENT OPTIONS
Category Examples Comments
Aluminium-containing
antiperspirants for
hyperhidrosis
Other products
[PHARMACY ONLY]
eg, contains aluminium chloride hexahydrate
20% (Driclor), aluminium zirconium (Rexona
Clinical Protection)
[GENERAL SALE]
eg, contains diphemanil 2% (Prantal powder)
eg, aluminium chlorohydrate (Neat 3B Action
Cream)
Do not shave 24 hours before applying product. Use pH neutral soap. Apply at night to
clean, dry underarms and wash off the next morning. Use normal deodorants during the day.
Reduce frequency of application once sweating has stopped. May damage clothing.
May be useful for mild hyperhidrosis. Can be applied to affected body part (eg, hands,
amputated stumps, between the toes, under the breasts, on the groin area, skin folds).
Page 148 HEALTHCARE HANDBOOK 2017-2018 Common Disorders