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2017 HCHB_digital

Sweating: Excessive

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

CONTINUING OTC EDUCATION • tuberculosis or other infections. Initial assessment Offer customers suffering from hyperhidrosis some practical advice (see Advice for customers) and discuss the difference between antiperspirants and deodorants. Antiperspirants reduce the release of sweat, deodorants only contain a fragrance to mask unpleasant smells. Deodorant crystals which have natural antibacterial or antifungal properties to limit odour-causing bacteria may also be considered as a “natural” alternative to chemical products; however, they will not decrease sweating. Explain that strong antiperspirants are usually applied at night and washed off the next morning. Warn customers that aluminium antiperspirants can stain clothing. Treatment Antiperspirants usually contain an aluminium salt such as aluminium chloride, aluminium chlorohydrate, or aluminium zirconium. Aluminium zirconium tends to be better tolerated by the skin and less likely to cause irritation or aggravation after razor use. In low concentrations, aluminium ions cause a temporary closure of the sweat glands, reducing the amount of sweat produced, but reapplication is often needed. In the higher concentrations used for hyperhidrosis, aluminium can cause a more long-lasting closure and ultimately shrink the sweat gland, decreasing the amount of sweat it can produce. Ensure strong aluminium chloride or zirconiumbased antiperspirants are used exactly as directed. Most recommend to apply the product once at night for a set period of time, then to decrease the frequency of use. Sometimes aluminium salts are combined with salicyclic acid to enhance penetration. Customers who have tried strong antiperspirants with limited success may need referral to a doctor for tests to exclude secondary causes or to try other types of therapy which may include: anticholinergic medication (eg, glycopyrrolate, oxybutynin) which helps prevent the stimulation of sweat glands beta-blockers for stress-induced sweating botox (Botulinum toxin type A) – used for severe underarm sweating, temporarily blocks the nerves that stimulate sweating endoscopic thoracic sympathectomy – involves cutting of the nerve that stimulates sweat production. More effective for palm sweating iontophoresis – a procedure that uses a gentle current of electricity to temporarily turn off the sweat gland (most effective for sweating of the hands and feet) removal of the sweat glands by liposuction, curettage, microwave thermolysis or surgery. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, heart or lung problems, immunosuppression, diabetes, is pregnant or breastfeeding)? • Does the person take any other medication, either prescribed by a doctor or bought from a shop or supermarket (including herbal/ complementary medications)? • Does the sweating most often occur during sleep? • Is the sweating accompanied by other symptoms such as fever, weight loss, chest pain, shortness of breath, or a rapid heartbeat? • Is the sweating occurring in a child without the effects of heat or physical exercise? • Is the excessive sweating a new occurrence in an adult? • Is the person allergic to any topical ingredients? Advice for customers • Avoid clothes that show up sweat marks more easily. • Wear loose-fitting clothing, made of natural fibres (avoid Lycra or nylon). • Use a soap-free cleanser. • Dress shields (also known as armpit or sweat shields) can help absorb excess sweat and protect delicate or expensive clothing. • Look up the International Hyperhidrosis Society’s website for more information, support, or to purchase products (www.sweathelp.org). • See Foot Care for advice for people with excessively sweaty feet. Now you can complete your ENHANCE modules on your phone or tablet www.pharmacytoday.co.nz Page 149

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