The average person has about three million sweat glands, located all over the body. Only about 5% of them are active, though – which clearly shows their enormous potential. An average level of perspiration of approx. 0.5 to 1 ml per minute results in the production of 1 to 2 litres of sweat per day. Sweating is essential to survival, and a bodily function that is primarily a way for the body to maintain its temperature.

Besides by producing sweat, the temperature of the body is also regulated by hormones, breathing and the constriction of blood vessels. The number of sweat glands varies quite greatly from body part to body part. The palms of the hands and the soles of the feet have the highest concentration, with approx. 600 sweat glands per square centimetre. They are followed by the armpits, the forehead and the trunk of the body, with roughly 100/cm2. The extremeties tend to have the least sweat glands.

The transition from natural sweating to maintain a steady body temperature to pathological sweating is fluent. Quite often, unique psychological factors are decisive in determining when perspiring becomes excessive, and thus is considered bothersome. Based on these factors, it is quite difficult to define the criteria for excessive sweating exactly. Roughly 1 to 2% of the population suffers from hyperhidrosis.

The first step is about differentiating between a primary and secondary hyperhidrosis. In almost all cases, this can be achieved in a targeted consultation with a specialist. In case of a secondary hyperhidrosis, one must first treat the underlying condition, after the appropriate examination. In some cases, an additional medical treatment can be necessary, to lessen the complaints.

Primary Hyperhidrosis

In the so-called focal or emotional primary hyperhidrosis, the excessive sweating is primarily located in the armpits, and/or in the palms and soles of the feet – and rarely, the forehead. The affliction usually begins after puberty and can be hereditary. In addition to the possible social isolation, secondary complications such as warts, athlete’s foot or other skin diseases (Keratoma sulcatum u.a.) can occur. For this reason, this set of problems should not be trivialised, but rather be considered a «real» illness, and be treated accordingly.

Secondary Hyperhidrosis

While emotional factors are usually the underlying cause of focal hyperhidrosis, secondary hyperhidrosis is often caused by an internal disease. Accordingly, both metabolic disorders such as diabetes, hyperthyroidism or neurological illnesses, as well as infections, and (in rare cases) cancer can be the cause.

Axilarry Hyperhidrosis

Initially, a compulsory general course of action should be taken, as this can very often already show a positive therapeutic effect. This includes frequent washing of the hyperhidrotic areas and deodorants. In addition, we recommend changing clothing daily and wearing cotton whenever possible. The next step is the prescription of antiperspirants with aluminium chloride. It must be stressed that these must be applied every evening, in order to absorb overnight. If these measures don’t lead to the desired result, a treatment with Botulinum toxin should be considered. A permanent solution is achieved by means of surgery, which in itself brings the disadvantage of a risk of scarring.

Palmoplantar Hyperhidrosis

In general, the afflicted should only wear socks made of cotton or wool, and avoid wearing shoes with wooden or rubber soles. Leather shoes are ideally suited. Changing socks and shoes daily is a must. Additionally, foot baths with tannins, combined with shoe powder have shown success. If this therapy doesn’t lead to the desired improvement, a treatment with Iontophoresis is advisable. If this doesn’t lead to results, then a treatment with Botulinum toxin should be considered. As a last resort, a endoscopic thoracic sympathectomy can be taken into consideration. This surgical procedure is only suitable for palmar hyperhidrosis and has the serious disadvantage that it has been shown to lead to so-called compensatory sweating in a number of patients.

Rarer forms (foreheads)

Excessive sweating in the face can be particularly unpleasant. A treatment with Botulinum toxin can lead to a remarkable improvement in quality of life. It’s very important to place the injections properly to avoid bothersome physical interactions. Kreyden Hyperhidrosis has wide-ranging and long-standing experience in treating patients with Botulinum toxin for this somewhat less-common indication of Hyperhidrosis.

Generalised Hyperhidrosis

In the case of so-called constitutional perspiration – or generalised hyperhidrosis with no discernible cause – one initially usually chooses a generalised course of treatment. This includes losing weight, exercise, nutritional consulting and wearing appropriate clothing. If further steps are necessary, it is possible to settle the autonomic nervous system (formerly vegetative nervous system) with the use of high-dose beta blockers. Furthermore, it’s possible to head off possible «perspiration surges» in sweating relatively efficiently by using anticholinergics. This treatment can also be combined with a Botulinum toxin therapy in the areas most afflicted.

Praxis Methininserhof
Dr. med. Oliver Ph. Kreyden, Dermatologie FMH