Excess sweating Resume here on a subject that we have already discussed several times, and that is by far the request has been heard most often from readers of this column. We met so many people of both sexes, who unfortunately suffer from the daily embarrassment of excessive sweating, or hyperhidrosis, which puts them at ease in dealing with others, for various reasons and ascertainable.
Sweating is a natural phenomenon that serves to regulate the temperature of our body. The secretion sudorific occurs through nervous stimuli resulting from the vegetative nervous system and, more precisely, by that section of it which is represented by “sympathetic nervous system.” Now it may happen that in some subjects this portion of the nervous system must work at higher high for the purpose of maintaining body temperature values normali.Ne follows that these individuals have an excessive sweating, with all the consequences that readers can easily imagine, configuring the pathology that is aptly named the “sweating” or excessive sweating.
If the summer is an experience quite common and annoying, for many of us, to feel the sweat pour on him, try to imagine what they ought to try those who sweat, or rather, dripping all year (gocciolazione), in a such a way that is, literally soaked clothes, and to suffer harassment and humiliation of having hands, feet or armpits constantly damp with sweat. We refer to those people who suffer from the clinical situation we have just named, characterized, in fact, a continuous and excessive sweating, is not always easy to treat.
We want to refer, in other words, to a sweating exaggerated that involves the sweat glands, as a primary or secondary, regardless of the ambient temperature, which, however, intervenes to accentuate any pre-existing disorder when its values become too high. Keep in mind, in fact, that hyperhidrosis often worsens during the summer months and increases in winter, even in non-seasonal forms of which we will discuss shortly.
Those who suffer from excessive sweating of course want to know, rather than the clinical picture of this disease (for such must be considered), the various methods of remedial treatment of the disease. This attitude is understandable in patients in general and we also often found in the many messages that we have received on this subject by our readers. But before addressing the treatment of hyperhidrosis is imperative that the doctor mentions, albeit briefly, to two points on which they must base their therapeutic requirements. That is to say the differentiation of the various types of hyperhidrosis and the possible appearance of complications.
We hurry immediately with secondary hyperhidrosis recalling the following forms to certain neurological injuries, of which we can not take care on this occasion, and those that occur in certain systemic diseases such as certain cancers. I am reminded in this connection, to have sometimes seen a unilateral plantar hyperhidrosis, abrupt in onset, which was associated with the presence of a retroperitoneal tumor. Recall also, among the causes of secondary hyperhidrosis, hyperthyroidism, hormonal therapy for prostate cancer, psychiatric diseases, obesity and menopause.
More commonly observed are primary or idiopathic hyperhidrosis which include the emotional and the forms already mentioned as hyperhidrosis season. The first sopprattutto affecting the palms of hands, the armpits and soles of the feet, are triggered by stress psychoemotive, are reduced during sleep and are not at all affected by changes in temperature, unlike the seasonal hyperhidrosis, which are determined by a altered function of the thermoregulatory center brain (hypothalamus), have spread to the entire body surface, are aggravated in the summer and become more accentuated during sleep notturno. Altre localizzazoni are represented by the trunk or legs, face and forehead, these locations less frequent.
A party must consider the so-called essential axillary hyperhidrosis, which is a basic form or primitive, almost always begins at puberty, or a few years later, often has familiar features and is similar in some ways the emotional hyperhidrosis. Teniamio that the secretion of sweat can be so important that it can sometimes be debilitating.
The most common complications may be the appearance of rashes or skin ulcerations miliariformi with intertrigo type of injury, athlete’s foot, pompholyx (palmoplantar eczema).
Regarding therapy, which we finally returned, we distinguish a medical therapy (local and / or general), surgical management and, in limited circumstances, including radiation therapy, now completely obsolete. The first-line therapy (if the sweating is not excessive) is represented by “antiperspirant” Trade (or antiperspirants) which contain, for the most part, chloride or bromide of aluminum, the latter less irritating to the results pelle.Buoni in mild or moderate forms are also obtained with iontophoresis which acts blocking the ducts of the sweat glands for a certain period of time. This technique consists of applying a direct current to the palms and / or soles immersed in an electrolyte solution.
It should be clarified, however, that both of these treatments are always provisional and must be repeated at short intervals, several times a week
. In generalized forms are sometimes administered anticholinergic drugs, which, acting on the autonomic nervous system, reduce the activity of sweat glands, although, quite often, at the doses required to achieve an acceptable result, the side effects (dry mouth and blurred vision) may be difficult to bear. In the forms that we have defined the emotional excessive sweating is often triggered by anxiety, which is why, in these cases, you have quite positive effects using sedatives and anxiolytics, in addition to psychotherapy.
The surgery involves some interventions, in severe cases, ranging from the removal of underarm sweat glands (only in this clinical variety, of course) through various incisions or, even, with aspiration techniques of subcutaneous tissue, which contains the glands . Also you can practice in the surgical thoracic sympathectomy classical (“open”) or, with better results, endoscopic thoracic sympathectomy, minimally invasive surgery that can be expressed in palmar hyperhidrosis, facial and, according to some, even in the axillary , in what form you can thus avoid direct interventions removal of the glands, we said. With regard to the plantar hyperhidrosis isolated, this can be treated only with a lumbar sympathectomy, which is an abdominal “open”, while the hyperhidrosis of the trunk and thighs or generalized that can not benefit from a surgical treatment. It remains to be said, however, that today the most effective help for the treatment of hyperhidrosis serious is supplied by botulinum toxin (produced by bacteria: Clostridium botulinum) that is injected subcutaneously in the region affected by hyperhidrosis, blocks the secretion sweat for 6 to 8 months.
The use of botulinum toxin for subcutaneous injection is a relatively recent treatment. Its therapeutic effect is caused by inhibition of the release of acetylcholine, a neurotransmitter, with the consequent result of halting the stimulation of the sweat glands. The substance mentioned causes a block at the nerve synapses preventing the release of acetylcholine which acts, in this situation, as we said, a neurotransmitter. It ‘s enough, in practice, an annual treatment in most pazienti.Più frequently the inhibitory effect lasts 5-8 mesi.Il most valuable of this method consists in the almost total absence of side effects that, when they appear, are almost always transitory.
In conclusion, therefore, we can say that in severe hyperhidrosis, unresponsive to antiperspirants or iontophoresis, the treatments of choice are considered, today, the botulinum toxin in axillary hyperhidrosis, and thoracic endoscopic sympathectomy in palmar hyperhidrosis or facial.
Some uses, among other therapies, the various methods of so-called alternative medicine, namely of homeopathy, massage (?) Acupuncture and even fitoterapia.Nella our experience the results of these treatments were almost always negligible or entirely absent, as well as those assigned to hypnosis.
Unfortunately it is a disorder that, except in cases that respond to the intervention of sympathectomy, should be treated in a continuous manner in order to save those affected notes and series in psychological and occupational consequences.