It is the medical term for EXCESSIVE SWEATING. There are two types of this problem. In primary hyperhidrosis, the cause for excessive sweating is not known; in secondary hyperhidrosis, the primary disorder—such as pituitary or thyroid dysfunction, diabetes mellitus or menopause—is responsible for the hyperhidrosis.
Primary axillary hyperhidrosis is the most common location for excessive sweating in patients and often presents along with palmo-plantar hyperhidrosis.
Sweating is controlled by emotions through the limbic system and the thermo-regulatory centre in the hypothalamus. These affect the post-ganglionic sympathetic outflow of the para-spinal sympathetic chain. While the definitive cause of this condition is yet to be elucidated, most evidence points to a hyperactive autonomic system.
Despite nearly 1–2 % of the population being affected, there is very little awareness of this problem and the resources available for its solution. There are no nationally agreed guidelines for the management of hyperhidrosis in the NHS.
Most GP Surgeries and NHS Dermatologists will point you to the private sector for this condition, the treatment is generally not available on the NHS.
If you suffer from localised, visible and excessive sweating that has come on without any apparent cause over the last six months then you have hyperhidrosis. This is especially true if you have a family history of similar problems.
To be diagnosed as primary axillary hyperhidrosis, at least two of the following characteristics have to be present in an otherwise healthy patient:
• bilateral and relatively symmetric involvement
• impairment in daily activities
• age of onset < 25 years, and
• cessation of focal sweating during sleep.
We start with an assessment of sweat stains on shirts or blouses which can give a clue as to the severity of the hyperhidrosis. A mild sweat stain, 5–10cm, still confined to armpit; moderate, 10–20cm, still confined to armpit; severe, 20cm, reaching the waistline.
At Reforme Medical Clinic in Cardiff, we can perform the Minor (starch-iodine) test. This is a commonly used test, but it can be rather messy. A 2% iodine solution or 10% povidone iodine antiseptic solution is applied to both the armpits and allowed to dry; corn-starch powder is then brushed on to this area. The test is positive when the light-brown colour turns dark purple as an iodine-starch complex forms in the presence of sweat. The area can then be photographed as a preoperative record of the affected area and also to gauge the response to treatment.
There is no silver bullet or perfect cure for this condition.
The treatments include the use of Antiperspirants, Botulinum Toxin Type A, Anticholinergic medicines like Propantheline Bromide and Glycopyrrolate, Iontophoresis, Mira Dry, Surgical treatments of the sweat glands, Surgical treatments of the Sympathetic Nerves suppling the sweat glands.
Antiperspirants are one treatment. These can be roll-on gels or powders that bring about a reduction of eccrine sweat production by physical obstruction of the ductal openings by the metal salts from the chemicals used. The most common ingredient is 20% aluminium chloride hexahydrate, which is available as Anhydrol Forte or Driclor.
This should be applied every night after carefully drying the skin for 5–7 days, or until the maximum benefit is achieved. Thereafter, the frequency of application can be reduced to once or twice a week.
It is important to wash off the medication in the morning and some even suggest to neutralise the area with an application of baking soda. If the patient develops pain or has a rash, interruption of treatment and application of a topical steroid such as 1 % hydrocortisone cream can reduce the inflammation. Once this has settled, the antiperspirant, such as driclor can be restarted.
Botulinum toxin type A—Botox or Dysport—is a purified neurotoxin derived from clostridium botulinum. It works by blocking the release of acetylcholine at the neuro-muscular endplates of the sympathetic cholinergic nerve fibres of the sweat glands.
After mapping the involved area by the minor test, an outline is drawn out with a skin marking pen. The enclosed area is then divided into a grid pattern with each of the grid squares being approximately 1–2cm. Botox is injected intradermally (ensuring that a bleb is raised) into each of the marked grids.
No, while we offer our patients the option of having the area numbed with numbing cream, the majority of patients will have this treatment without it, as it is not painful.
Most patients have a perceived benefit from the treatment within 1–2 weeks and have duration of relief ranging from 6–18 months.
You can’t have this treatment if you have any allergies to Botox or its constituents, or if you suffer from myasthenia gravis, Eaton Lambert syndrome. We will refuse treatment in the presence of infection at the site; also for lactating mother, or during pregnancy.
Fewer than 1% of the patients experience any kind of side-effects. The most common are compensatory hyperhidrosis (an increase in non-axillary sweating), injection site pain, hot flushes, body odour, pruritus and rash.
The fourth thoracic ganglion of the sympathetic chain controls axillary hyperhidrosis – the part of the nervous system that controls the sweat glands in the axilla. The connections of the sympathetic nerve chain can be cut using an open or endoscopic approach to get relief from axillary hyperhidrosis. However, it is associated with a high incidence of compensatory hyperhidrosis from other areas of the trunk and is more suited for palmar hyperhidrosis.
Anticholinergic drugs—propantheline bromide and glycopyrrolate work by blocking the acetylcholine secretion and can offer relief from the symptoms. However, the incidence of adverse symptoms, such as visual blurring, dryness across mucosal surfaces and constipation reduce their utility when given systemically. Glycopyrrolate has therefore been delivered topically using iontophoresis.
Iontophoresis involves an application of a direct electrical current across the skin. The mechanism of action of this modality is uncertain. While iontophoresis pads for axillary application are available, the real utility of this modality is in treating palmar and plantar hyperhidrosis.
* All prices quoted apply to surgery done at World Class clinic in Mumbai, India and are subject to variation based on prevalent exchange rates.
Scalp Hyperhidrosis from £375 – 600 as per severity.
Axillary hyperhidrosis from £400.
Groin hyperhidrosis injections £450.
Hands or Feet hyperhidrosis £800 – 900.
We are ready to treat you.
General Medical Council
Associations of Plastic Surgeons of India
The International Society of Aesthetic Plastic Surgery
Royal College of Surgeons of Edinburgh
Disclaimer: The content on this website is purely generated for awareness and educating purposes only. This shall not be considered as a substitute for professional advice or prescription. Every individual and their case is different, so the results mentioned on the website may vary from person to person.