Hyperhidrosis is the medical term for excessive sweating. The problem may be limited to the armpits, but often the palms and soles sweat excessively also. Excessive sweating becomes noticeable after puberty. Stressful situations such as examinations, job interviews, or an important date will aggravate the sweating. Most over-the-counter antiperspirants do not control Hyperhidrosis.
Perspiration is the body's way of naturally regulating heat. But in some individuals, it can be excessive. Physicians have found that nerves, involuntary controlled by the Sympathetic Nervous System, can become overactive and cause extreme sweating. Excess sweat serves no purpose and often creates social embarrassment because of odor or stained clothes. Both sexes and all ages, except young children are effected.
Different Hyperhidrosis Conditions
Primary Hyperhidrosis: In non-medical terms, it is a condition that causes severe localized sweating in specific areas of the body. It causes unexpected, uncontrollable and embarrassing sweating of the face, scalp, hands, underarms or the feet. A bright and glowing facial blush may also occur by itself or with any combination of sweating in other areas. Facial blushing is usually associated with hand sweating. Invariably, the patient's family, friends or strangers may make embarrassing comments about his or her condition.
After all, It's only sweating, right? or You're just nervous, that's all. It is difficult for others to understand that undue anxiety or nervousness does not necessarily cause the condition. It is a genetic condition that is totally uncontrollable. Symptoms of Hyperhidrosis may develop during any stage in a person's life. Doctors have seen patients as young as 6 to 74 years old. The sites of Hyperhidrosis may be in only one specific location or on all the classic locations which include the face with sweat, face with blush, hands, underarms or the feet. Any combination may occur, the most common being the hands and feet.
One may dry off the sweat, only for it to recur within a minute or two. The hands or feet become cold, clammy and wet. The face usually has a greasy appearance and the underarms may develop a chronic and foul odor. The face may also develop a bright and attention-getting red color, perhaps eliciting responses such as Are you OK? You must be ill, or Why are so nervous? You don't have to be, or worse, Are you sure that you can handle this job? As adolescence is a critical time for individuals to build their self-esteem, individuals afflicted with Hyperhidrosis at this life stage are especially at risk for developing inappropriate coping mechanisms.
A student afflicted with this syndrome, while in middle school or high school, usually finds that peers frequently misunderstand what the condition means to them. A teenager may resort to withdrawing and distancing himself/herself from potentially embarrassing situations. Furthermore, they may lose confidence in their ability to interact with others. It is not unusual to hear of a teenager quitting band, cheerleading, sports, or even dating because of the embarrassment brought on by his/her Hyperhidrosis. The longer the teenager has this syndrome, the greater the emotional fallout.
He/she may start to withdraw from close friends. As the sufferer approaches graduation from high school, the thought of leaving an understanding home environment to go to college may be unbearable. This insecurity can lead to avoidance behavior problems that may become more ingrained and complex with time. Every day, the human body perspires to maintain constant internal body temperature. Perspiration is regulated by the Sympathetic Nervous System, which controls about five million sweat glands in the body, with about half of these being located in the hands.
Sweating in the right hand is controlled by branches of the right sympathetic chain that is located within the right chest cavity. Sweating in the left hand is controlled by branches of the left sympathetic chain that is located in the left chest. Hyperhidrosis is a medical condition that causes perspiration far greater than the physiological needs of the body. The most common areas where Hyperhidrosis occurs are the hands, feet and face, primarily in adolescents, and its cause is unknown.
Axillary Hyperhidrosis: This condition causes severe dripping sweat from the armpits. Sweat may drip down the arms and down the sides of the chest wall to the waist. Patients with this condition cannot wear certain types of fabrics (nylon) or colors. Clothes become stained, fabrics are ruined and colors may run. The sweating and odor is constant and resistant to all deodorants. It may even be resistant to the first line of therapy called Drysol®.
In many ways, it is just as embarrassing and disabling as hand sweat. Axillary sweat may occur independently or in combination with sweating of the hands, face and scalp, or feet. Facial blush may also be present. The condition is caused by over-stimulation of the sweat glands by the sympathetic nervous system. As with hand Hyperhidrosis, the mechanism is involuntary and cannot be consciously controlled. Anxiety may aggravate it, but the sweating will occur with or without stress or anxiety. In short, the patients were born with a tendency to sweat excessively.
Treatment of primary underarm Hyperhidrosis with ETS is reserved only for patients with the most severe forms of underarm Hyperhidrosis or Axillary Hyperhidrosis that is in combination with severe hand sweat, face and scalp sweat, foot sweat or severe facial blush. A memorable patient was a woman from Taiwan who had severe underarm, hand and foot Hyperhidrosis. She was 34 years old and a partner in a well-known accounting firm. During a follow-up visit one week after her operation, she was sitting on the examining table and quietly crying. She wore a beautiful floral silk dress.
When asked why she was crying, she revealed that this was the first time that she had been able wear that dress. The excessive sweating had prevented her from wearing any silk fabrics. The dress had been a treasured wedding gift that had been given to her 10 years ago by her mother who was still living in Taiwan.
Palmary Hyperhidrosis: Hand sweat may occur independently or in combination with sweating of the armpits, face and scalp, or feet. Facial blush may also be present. The most common combination is for the hands and the feet to be involved at the same time. The condition is caused by over-stimulation of the sweat glands by the sympathetic nervous system. Hand sweating can be severe. Many patients sweat so profusely that the sweat actually drips onto the floor. One patient demonstrated the ability to fill a cup with sweat from her hands.
These symptoms may occur in even the coldest of conditions. Other patients may not drip sweat, but their hands are usually discolored, cold and clammy. Newspaper print stains their hands and books will have curled edges from the constant moisture on their hands. Prior to the onset of sweating, many patients report a tingling in their fingers or report that "my skin pores are opening up". The mechanism is involuntary and cannot be consciously controlled. There is a usually an interrelationship between anxiety and sweating that develops to a greater or lesser degree in nearly all patients with severe Hyperhidrosis.
The condition is often aggravated by anxiety and the onset of symptoms is in itself anxiety provoking, thus a vicious cycle is created. Many individuals try to escape by withdrawing or avoiding stressful situations. This repetitive pattern only serves to create more emotional injury. During conversations with others, those with Hyperhidrosis may hide their hands under their arms, behind their backs or placed under their thighs. Many patients have reported that, during a party or some social gathering, holding a cold drink in their hands makes shaking hands with others socially acceptable.
People would assume that the hand they just shook was cold and clammy because of the cold drink and not because the afflicted was nervous. One young professional woman mentioned that, before a job interview, she would park her car and rub her hands on the tire. She would then tell the interviewer that she had had a flat tire and she shouldn't shake his hand because her hands were dirty.
Pedal Hyperhidrosis: Excessive sweating of the feet is the result of over-stimulation of the sweat glands in the feet by the sympathetic nervous system. Unlike Hyperhidrosis involving the hands, face and scalp, and armpits, the sympathetic nerve fibers that stimulate sweating of the feet arise from both the thoracic and lumbar sympathetic nerve chains.
Approximately 30% to 60% of patients who undergo ETS for upper body Hyperhidrosis will have the additional benefit of developing dryness of the feet after the operation. However, to ensure complete elimination of pedal sweating, it is necessary that the lumbar nerves also be disconnected.
This is NOT recommended on males because it will cause impotence or lead to retrograde (reverse) ejaculation. If a lumbar sympathectomy is done in conjunction with ETS, it may lead to postural hypertension, i.e. the blood pressure may drop when the patient stands, and the patient may faint. Again, men should NOT have this performed, and women should be forewarned of the potential side effect of postural hypertension.
Facial Blush And Facial Hyperhidrosis: Facial blush is a physiologic normal response to a variety of emotional stimuli. Facial blush is caused by over stimulation of the sympathetic nervous system. The mechanism is involuntary and anxiety may aggravate it, but the facial blush may also occur with or without stress or anxiety. Patients with this condition were born to blush excessively. Physiologic blush occurs more frequently in some individuals than others but generally occurs only in special situations, coming on quickly and fading rapidly. Individuals with facial blush, with or without facial Hyperhidrosis, characteristically experience a glowing red face that occurs more frequently than physiologic blush.
The blush is intense, constant and lasts for a prolonged period of time. Prior to onset, patients usually feel facial heat. The face and neck will usually glow a bright red color. The glow may start over the cheeks, radiate onto the forehead and neck, and also cover the ears. Individuals with facial blush may respond with exaggerated blushing to a multitude of stimuli. A triggering stimulus may be internal or external and often is exceedingly subtle. A person with this condition may even be alone at home, reading a book or watching a movie, and the facial blush may come on un expectantly with no apparent stimulus.
The person with facial blush often stands out in a crowd. A constantly blushing and glowing red face attracts attention. It is often misinterpreted by Others frequently misinterpret the blushing to mean that the afflicted is sick or embarrassed. Facial blush may occur independently or in combination with sweating of the hands, face and scalp, armpits, or feet. The most common symptom occurring in combination with facial blush is hand sweat. Patients with severe facial blush often have some degree of Hyperhidrosis involving their hands.
It is common for the patient to focus on their facial blush, leaving them unaware of how much their hands actually sweat. Many patients who undergo surgery for severe facial blush realize, only after the operation, that for years they had also been modifying their behavior because of cold, clammy and discolored hands. Facial sweat may occur by itself or in combination with blushing. The aggravating stimuli are the same as with blushing. The facial sweating usually involves the scalp, back of the neck, forehead and into the eyes, cheeks and over the upper lip. Either blushing or sweating causes severe embarrassment and frustration to anyone who has this syndrome.
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