Hyperhidrosis in summer: what are the most innovative treatments

“Hyperhidrosis - explains the doctor - means excessive secretion of sweat by the sweat glands”. Broadly speaking, 2 types can be distinguished:

• focal (or localized or primary) hyperhidrosis: affecting only 1 or more specific body regions, unilaterally or symmetrically on both sides, such as:
  • palms of hands;
  • soles of the feet;
  • armpits;
  • face.
• generalized (or secondary) hyperhidrosis: sweating is widespread in various areas of the body.

As regards focal hyperhidrosis, it is caused by anomalies in the regulation of sweat secretion processes, probably due to a neurological dysfunction. The triggering causes can be:

• genetic: familiarity and genetic predisposition, whereby the condition tends to occur in the family in 30 to 50% of cases;
• physical, including trauma/injury or diseases affecting the nervous system: much more rarely and in particular if the hyperhidrosis is unilateral;
• psychological: for example, stress, anxiety, sense of unease, etc.

Generalized hyperhidrosis, on the other hand, is a physiological response of the body to some primary triggering pathologies/conditions including:

• cardiovascular diseases such as heart failure;
• endocrine diseases such as diabetes, hyperthyroidism etc.;
• trauma and neurological diseases (Parkinson's disease, ischemia, multiple sclerosis, spinal cord or peripheral nerve lesions, etc.);
• neoplasms, for example, lymphomas (tumors affecting the lymphatic system) and neuroendocrine tumors (affecting the cells of the neuroendocrine system);
• infections;
• menopause;
• pregnancy;
• obesity;
• as a side effect of certain medications.

If generalized hyperhidrosis occurs mainly at night, it is necessary to exclude in particular the presence of:

• tumors of the lymphatic system (lymphomas);
• hyperthyroidism;
• neuroendocrine tumors;
• diabetes mellitus.

The most obvious clinical manifestation of hyperhidrosis is abnormal sweating which, in the most severe cases, leaves the affected part of the body almost as wet as if it had been immersed in water.

Sweat can also cause an intense bad odor linked to bacterial infections in cases of:

• skin lacerations, for example, in focal forms on the feet, in which there may be rubbing with footwear and contact with the bacteria present in it;
• bromhidrosis.

Excessive sweating and bromhidrosis

When excess sweating causes a strong and pungent bad odor, it is called bromhidrosis: a somewhat pathological condition as it is caused by an infection caused by certain bacteria which degrade the sweat molecules present on the skin, causing the stench.

Dr. Guanziroli reminds us that there are numerous treatments available against hyperhidrosis and the use of one rather than the other also varies in relation to the severity of the problem.

Deodorants with bactericidal action

Deodorants that combine fragrance with a bactericidal action block the agents responsible for the degradation of sweat, therefore they tend to consequently also improve the unpleasant effect on an olfactory level.

Antiperspirants

Antiperspirants are products that exert an astringent effect, clogging the sweat pores and thus reducing the amount of sweat secreted by approximately 40%.

They are commonly available in various formulations (spray, cream, roll on) and can be purchased in pharmacies or supermarkets. In the most popular ones on the market there are formulations with aluminum salts which have good anti-perspirant efficacy, with the possibility, however, of side effects such as:

• irritation;
• alteration or wear of the textile fibers of clothing.

Antiperspirants are applied daily or, if sweating occurs in conjunction with sports and particular emotional states, when needed.

Iontophoresis

Iontophoresis is a procedure particularly suitable for the treatment of moderate focal hyperhidrosis, localized at the level of the palms of the hands and soles of the feet.

The treatment, absolutely painless and carried out in sessions lasting approximately 20 minutes, consists of passing a low intensity electric current through the skin of the areas affected by hyperhidrosis which are immersed in water or put in contact with a sponge soaked in waterfall. The current generated appears to act by obstructing the ducts of the sweat glands with a transitory effect over time.

It should be specified that the treatment cannot be performed in the presence of:

• electro-medical devices such as pacemakers;
• orthopedic prostheses or fixators.

Botulinum toxin

Micro-injections of botulinum neurotoxin in the area affected by excessive sweating (localized hyperhidrosis) represent another treatment commonly used against hyperhidrosis. In fact, botulinum inhibits the release of acetylcholine, a substance that transmits the nervous impulse to secrete sweat to the sweat glands.

The treatment, which is carried out on an outpatient basis, lasts approximately 7-8 months, after which it must be repeated.

Endoscopic thoracic sympathectomy and surgical treatment

The most serious cases of hyperhidrosis, particularly in the focal form of the hands and armpits, can be approached with surgical treatments such as thoracic sympathectomy, which can be performed percutaneously or via thoracoscopy.

The procedure, performed under general anesthesia, physically cuts or inhibits the nerve ganglia, i.e. the nodular nervous structures that transport the impulse to sweat secretion to the sweat glands in the area of ​​interest. It is a procedure with a decisive effect in almost all cases, but which, like all surgical procedures, involves a percentage of risk, therefore it is generally reserved for the most serious cases.

High summer temperatures, as we know, cause a general increase in sweating and, especially for those suffering from hyperhidrosis. There are some general lifestyle measures that can help to partially limit the secretion of sweat and any bad odor, including:

• avoid consumption of spicy foods and some drinks, such as alcohol and coffee;
• do not exaggerate with sun exposure, especially in the central hours of the day;
• do not play sports during the hottest hours and under the sun;
• wear natural fabrics such as cotton, preferably white, in contact with the skin; also use underarm protectors to protect clothing from sweat stains.