The often embarrassing, excessive sweating disorder,
hyperhidrosis, and its treatment options are gaining
greater attention from physicians. This is improving
the efficacy of treatment and minimizing its adverse
effects, Mayo Clinic authors write in the May issue
of Mayo Clinic Proceedings.
Hyperhidrosis is one of the oldest known dermatologic
conditions that even today is misconceived as rare
and untreatable, says John Eisenach, M.D., a Mayo
Clinic anesthesiologist and the primary author of
the clinical review.
"Both ancient and modern medicine have been perplexed
by this entity," says Dr. Eisenach.
The description and definition of excessive sweating
date back to Hippocrates in the 4th century B.C. Today,
the diagnosis and treatment of severe cases command
a stepwise, multidisciplinary approach from the primary
care physician, the dermatologist, the neurologist,
and the surgeon. Variables include the site affected,
the degree of severity and the response to treatment.
Dr. Eisenach and colleagues outline their findings
on the evolving therapies and how this disorder is
not as rare as commonly thought. "I think we've all
shaken hands with someone who is affected by this,"
he says. "I just hope people with this condition seek
help, because of the emerging treatment options and
high satisfaction rates that can be obtained, even
in severe cases."
The Food and Drug Administration approval of botulinum
toxin type A (Botox) has provided an effective treatment
of excessive sweating, particularly for the underarms.
Other treatments may be utilized for excessive sweating
on the face, the palms, or soles of the feet. A recent
survey suggests that the prevalence of primary hyperhidrosis
is 2.8 percent in the U.S. population, 1.4 percent
have excessive sweating in the underarms (axillary
hyperhidrosis), and one-sixth are projected to have
sweating that is intolerable or interferes with daily
activities. There also is a hereditary component,
as approximately half of these patients have a relative
with hyperhidrosis, says Dr. Eisenach.
Dr. Eisenach says one part of the brain controls
the sweating response to body temperature, while another
area controls the sympathetic, or emotional sweating
response. For reasons unclear to hyperhidrosis researchers,
the emotional component is in overdrive. The result
is typically a healthy individual who perspires excessively,
even in mildly stressful situations, such as a handshake
or job interview. This can have socially debilitating
consequences, particularly in young adults, Dr. Eisenach
Not all sweating is benign, however. Primary hyperhidrosis
affects people while they are awake, but nighttime
sweating is never normal. A careful history and physical
examination must be performed to rule out other causes
of excessive sweating, which physicians call secondary
hyperhidrosis. In contrast to the primary form, secondary
hyperhidrosis is associated with other potentially
serious medical problems that need further workup
Treatment options are based on the severity of hyperhidrosis
and the risks and benefits of therapy. They can range
from antiperspirants to surgery, which involves disconnection
of the sympathetic nerves that direct sweating in
the arms and hands.
"Mayo Clinic's surgeons frequently perform these
procedures for severe over-sweating of the hands when
other treatments have failed," says Dr. Eisenach.
"From an integrative standpoint, we are interested
in studying the long-term effects of this surgery
on the skin and blood vessels of the arm. So far,
we have found essentially no adverse consequence in
the patients' warm and dry hands."
Dr. Eisenach says Mayo researchers continue to gain
insight into how this condition affects the body,
before and after surgical correction. It also increases
physicians' understanding of the sympathetic nervous
system, also known as the "fight or flight response."