Sweaty Hands and Feet? – Help is available

Primary Hyperhidrosis is a disorder of unknown cause. It can affect the hands, feet, soles, armpits, face and head, it affects both men and women equally, and can be extremely socially debilitating, interfering with work activities and negatively affecting the patients quality of life.

Multiple small doses of injection therapy is an effective and safe treatment. A survey at the Karolinska University Hospital in Sweden found that injection therapy had good effect, with 90% of patients surveyed reporting that the therapy worked well for their condition.

Many patients do complain however of pain during the injections. A medical device used for delivery of drugs, via the skin by jet nebulization can however be used to deliver anaesthetic prior to injection therapy being provided. This device is very well tolerated, and has been shown to produce a greater numbing effect than topical numbing cream, giving better results in terms of procedure related pain.

At DrySpell, we now have this device, and have been using it effectively for both hand and feet sweating, with improved results in terms of procedure related pain and patient satisfaction able to be achieved.

Note: Information on this site is not a substitute for professional medical advice. Also as per TGA guidelines we are not permitted to name the drug referred to as “injection therapy”.

References:

Treated patients in survey: High satisfaction with ‘injection therapy’ in palmar hyperhidrosis, Deebaj R et al, Lakartidningen 2015 Jan 27; 112
Short review on face rejuvenation procedures: focus on preoperative antiseptic and anaesthetic delivery by JetPeel 3, Iannitti et al, Minerva Chir. 2011;66(3Suppl 1):1-8

Treatment of Primary Craniofacial Hyperhidrosis

Craniofacial hyperhidrosis (CH) is a facial form of focal hyperhidrosis referring to excess sweating beyond normal physiological function. The condition usually affects the forehead bilaterally but can also involve other regions of the face such as the scalp, nose, chin and cheeks less frequently. Primary CH can have debilitating effects on an individuals quality of life, and hence effective treatment is of great importance.

The condition differs from other forms of focal HH in that it presents more frequently in an older subset of patients. Before a diagnosis of CH can be made, it is important to rule out secondary causes such as the onset of menopause, diabetes mellitus, endocrine disorders or certain medications.

First line therapies for the condition include oral anticholinergics, topical glycopyrrolate, and intradermal injection therapy. These therapies are first line due to their high efficacy and favourable side effect profiles, and a sweat specialist can devise a treatment plan considering each of these options in more detail.

There is surgical management, through T2 sympathectomy, though this should be reserved for patients who are refractory to first line therapy due to the high incidence of postoperative compensatory sweating and rare, yet significant postoperative complications.

Note: Information on this site is not a substitute for professional medical advice.

References:

Treatment of Primary Craniofacial Hyperhidrosis: A Systemic Review, Nicholas et al, Am J Clin Dermatol (2015) 16:361-370

Treatment Options for Axillary Hyperhidrosis: Important Considerations

Primary axillary hyperhidrosis can be associated with significant occupational impairment, is frequently detrimental to physical and emotional well being, and can result in difficulties in personal relationships and potential social stigmatization.

First line therapies for axillary hyperhidrosis (ie deodorants) are often short acting, ineffective or not well tolerated. Surgical approaches such as excision of the sweat glands and endoscopic transthoracic sympathectomy (ETS) are an option, however can be associated with potentially serious side effects. ETS is generally not recommended for axillary hyperhidrosis because of high recurrence and high rates of compensatory sweating.

Injection therapy is an important treatment option for axillary hyperhidrosis. The therapy blocks the release of acetylcholine from peripheral cholinergic nerve terminals effectively chemically denervating the sweat glands and consequently reducing sweat gland production.

Studies have demonstrated that injection therapy is a safe and effective treatment for primary axillary hyperhidrosis. A single injection treatment can provide an average relief of hyperhidrosis of 6 to 7 months.

In addition there have been no treatment related serious adverse effects reported in clinical trials of injection therapy for hyperhidrosis even after repeated treatments. The side effects, if any, are typically mild and transient.

The excellent efficacy, safety and tolerability of injection therapy are reflected in consistently high levels of patient satisfaction, with 93% of patients satisfied at week 16 after treatment.

Injection therapy substantially reduces the marked functional impairment associated with hyperhidrosis and improves patients health related quality of life. Significant improvements are also reported in occupational functioning, time spent managing the condition, emotional well being, and functioning in interpersonal relationships and social situations.

Note: Information on this site is not a substitute for professional medical advice

References:

Prospective Open-Label Study of Botulinum Toxin Type A in Patients with Axillary Hyperhidrosis: Effects on Functional Impairment and Quality of Life, Solish MD et al, Dermatol Surg 2005; 31:405-413

Hyperhidrosis Treatment

Treatment Options

It is important in Generalised Hyperhidrosis that the cause be addressed.

There are a number of surgical and non surgical treatments for focal hyperhidrosis.

Non Surgical Treatments

  • Topical therapies include topical antiperspirants containing aluminum chlorohydrate. These should be applied once daily, usually at night. This agent however can be associated with skin irritation.
  • Iontophoresis is a specialized treatment, with some devices available for home use. It can cause some discomfort however and may take up to 10 sessions to show benefit.
  • Botulinum toxin A is a highly effective treatment for focal hyperhidrosis. The PBS has approved Neurologists to administer the treatment for patients with hyperhidrosis of the armpits who do not respond to topical aluminium chloride hexahydrate based antiperspirants. This has reduced the out of pocket expenses for patients per session significantly.
  • The treatment is easy and quick to administer for armpit sweating, and gives highly effective results without scarring. Sweating is reduced within a week, with therapeutic effects lasting 4-8 months in 92% of patients. The treatment is associated with high patient satisfaction and low side effect profile.
  • Systemic therapy. Anticholinergic medications can be used. They can be effective and are relatively inexpensive, though can have limiting side effects of dry mouth and eyes, urinary retention, and constipation.

Surgery

Surgery is reserved for those refractory to medical therapy and in whom the condition is having a significant impact on their life.
Note: Information on this site is not a substitute for professional medical advice.

References

AFR Sweaty Australians are turning to Botox May 5 2015
AFP Hyperhidrosis and bromhidrosis May 2013
Treatment of Primary Axillary Hyperhidrosis with Botulinum Toxin Type A: Our experience in 50 patients from 2007 to 2010 ISRN Dermatology 2012

Hyperhidrosis Implications

Some sufferers may not be aware that Hyperhidrosis is a disease, and have learned to live with their symptoms. Even if they suspect they have a condition, they are not sure who they should approach for advice, with many uncertain which group of health care providers can manage the complaint. Patients may even have been told that they will have to live with their condition, because of a doctor’s lack of knowledge of treatment options.

Whilst the condition has obvious aesthetic problems, the excessive sweating can have significant social, psychological and professional implications as well.

Psychological:
Hyperhidrosis is a very distressing condition for patients. It is the most common skin disease associated with a co-morbidity of psychiatric disorders (anxiety, depression, social phobia). People who sweat excessively often get caught in a cycle, in that they become anxious that their sweat is visible to others, and the anxiety causes them to sweat even more.

It can impact negatively on many aspects of a person’s life from forming close relationships to choosing a career.

Social and Occupational:
Even the simplest day to day activities can be challenging, with sufferers agonizing over the choice of what to wear in the morning, with others having an entire wardrobe only full of black clothes.

Sweaty palms can be very embarrassing, with patients leaving damp patches on documents, having a slippery keyboard, or dreading the welcoming of a new colleague or client with a wet handshake. Often these patients carry a piece of cloth with them everywhere so that they can wipe their hands repeatedly during any sort of activity.

Men who are required to wear business shirts become self conscious about their obvious armpit sweating, and worry that their managers may feel that they are not able to cope with the pressure at work. This situation can be compounded by the fact that men tend to be more reluctant to discuss medical matters, and therefore may be less likely to seek help.

The teenage years are a particular challenge, with the social embarrassment associated with the condition, causing many to avoid seeking the formation of intimate relationships, for fear of rejection.

Forehead and head sweating is another embarrassing problem, with woman often reporting that they have completely given up on ever being able to style their hair.

Next post we discuss the treatment options available for this condition.

Note: Information on this site is not a substitute for professional medical advice.

References

AFR Sweaty Australians are turning to Botox May 5 2015
AFP Hyperhidrosis and bromhidrosis May 2013
Treatment of Primary Axillary Hyperhidrosis with Botulinum Toxin Type A: Our experience in 50 patients from 2007 to 2010 ISRN Dermatology 2012

Excessive Sweating – Part 1 “What is it?”

What is it?
Hyperhidrosis (excessive sweating) is the production of excess sweat, beyond the amount required to return elevated body temperature back to normal.

What areas does it affect?
Hyperhidrosis can be generalized or focal.

Generalised hyperhidrosis affects the entire body, the cause may be unknown, or it may be due to an underlying medical condition. These conditions can be identified on history, examination and investigations.

Focal hyperhidrosis affects specific sites of the body, most commonly the armpits, palms, soles or head/face. Focal hyperhidrosis typically occurs in otherwise healthy people, commonly before the age of 25.

How common is it?
It is estimated to affect about 3% of the general population.

Is it genetic?
Roughly two thirds of patients report a positive family history

Next post we will talk about the implications of this serious disorder.

Note: Information on this site is not a substitute for professional medical advice.

References:

AFR Sweaty Australians are turning to Botox May 5 2015
AFP Hyperhidrosis and bromhidrosis May 2013
Treatment of Primary Axillary Hyperhidrosis with Botulinum Toxin Type A: Our experience in 50 patients from 2007 to 2010 ISRN Dermatology 2012