KOSMETIK International Special 01/2019 - Top Medical
You have showered, gotten ready and want to head out. But just shortly after showering, your T-shirt is already soaked through in the underarm area again. You have a meeting with a large group and your hands are already quite moist, so you would rather not shake hands with any of the participants. These are annoyances that people with excessive sweating frequently find desperate. Sweating is generally a natural process and important for keeping the body temperature constant. In some people, however, sweat secretion is uncomfortably high. This condition is also called hyperhidrosis. The armpits are frequently affected (hyperhidrosis axillaris), which is perceived as particularly disruptive in everyday life, professionally and also privately. Excessive sweating on the face (hyperhidrosis facialis) as well as on the hands (hyperhidrosis manuum), but also on the feet (hyperhidrosis peduum), also enormously impairs the quality of life and self-confidence of those affected, because it cannot be concealed. Anyone who struggles with permanent, excessive sweating regardless of physical activity and ambient temperature shows clear signs of hyperhidrosis. Primary and secondary hyperhidrosis: Basically, there are two types of hyperhidrosis, primary and secondary hyperhidrosis.
Two different types
Basically, two types of hyperhidrosis are distinguished: primary and secondary hyperhidrosis. The most common form is primary hyperhidrosis. It mainly affects the armpits, feet, hands or face, i.e. areas that are primarily responsible for emotional sweating. Secondary hyperhidrosis is caused by disorders of the central or peripheral nervous system. In secondary hyperhidrosis, an existing underlying condition is the trigger. This can be an overactive thyroid or accidental nerve injury. Taking medications such as corticosteroids or psychological factors can also be responsible for excessive sweating.
Primary hyperhidrosis usually develops without any recognizable cause in otherwise healthy people. The onset is usually during puberty. Overall, about three percent of the population suffers from hyperhidrosis, 51 percent of them from primary hyperhidrosis. A genetic predisposition appears to be present, as 30 to 65 percent of patients have a positive family history. Primary hyperhidrosis mainly affects the armpits (79 percent), but also feet, hands and face; multiple areas are frequently affected. No morphological changes in the sweat glands are found. It is more of a complex dysfunction of the sympathetic and parasympathetic nervous system.
To address primary hyperhidrosis, those affected should first avoid stimulants that stimulate sweat production. These include coffee, alcohol, cigarettes and spicy seasonings. Relaxation techniques or breathable clothing made from natural fibers can also help reduce excessive sweating. If these measures do not help, accompanying drug treatment may be carried out. If this therapy does not work, those affected should consider a surgical procedure.
Addressing the causes
Secondary hyperhidrosis is the result of central or peripheral neuronal damage. Various diseases, such as diabetes or neurological disorders as in Parkinson's syndrome, can be responsible for excessive sweat production. Taking medications, such as antidepressants, or hormonal changes during pregnancy or menopause can also be triggers. If there is an underlying condition causing the excessive sweating, it must be treated in order to eliminate the hyperhidrosis.
In addition to drug therapy, the following conservative and surgical methods are suitable for treating excessive sweating: Conservative therapy options include the local application of aluminum chloride as well as tap water iontophoresis. Treatment with aluminum chloride involves aluminum salts that reduce sweating by blocking the excretory ducts. These aluminum salts are available in deodorant roll-ons and creams. Tap water iontophoresis requires a suitable medical device for regularly performing electrical water baths, which can be carried out by the patient at home after a training phase.
Medical assistance
The specialist in plastic surgery has various minimally invasive and surgical treatment options available to reduce primary hyperhidrosis:
- Sweat gland treatment by injection with botulinum toxin A (Botox®). How does it work?
Botulinum toxin A, also known as Botox®, is used in plastic surgery for skin tightening of expression lines. The nerve toxin paralyzes certain muscle fibers that are responsible for wrinkle formation. In hyperhidrosis, the paralyzing effect of botulinum toxin is also utilized: the toxin is injected into the muscle fibers around the sweat glands. There it inhibits the neurotransmitters; sweat secretion through the glands can no longer be triggered. The full effect occurs within three to 14 days. Since botulinum toxin is broken down by the body, the sweat-inhibiting effect diminishes after approximately six months. Therefore, the treatment must be repeated regularly. Botulinum toxin can be used for almost all affected areas of the body.
- Suction of the sweat glands using a curette. Only the suction of the sweat glands provides lasting relief from excessive sweating. Specifically for the armpits, surgical removal of the sweat glands using a suction curette is suitable. Based on the further development of the liposuction technique, today it is possible to suction the sweat glands through 1-2 small incisions in the armpit area using a very fine cannula (diameter 2.4 mm). The procedure takes approximately one hour and can be performed on an outpatient basis under local anesthesia or a brief general anesthesia, depending on the patient's preference. Afterwards, one should allow oneself a break of three to five days and refrain from sports for approximately three weeks.
Sympathectomy
Further surgical treatment methods for extreme hyperhidrosis include endoscopic sympathectomy, also called endoscopic sympathetic blockade. Using minimally invasive technique, also referred to as keyhole technique, the sympathetic nerves are visualized via endoscopic examination of the chest cavity (thoracoscopy) using an endoscope. The conduction of these nerves to the sweat glands is interrupted by severing or blocking the nerve pathways responsible for the excessive sweating.
Weighing up carefully
Before deciding on a surgical procedure, however, all conservative and minimally invasive treatment options should already have been exhausted. In addition, an in-depth consultation with the patient should be conducted, as well as a detailed family history taken. Only in this way can the treating specialist choose an appropriate further treatment method that then successfully contributes to reducing the patient's level of suffering - and significantly improving their quality of life once again.
Author: Dr. Karl Schuhmann
