What is excessive sweating?
In medical terms “hyperhidrosis”, is a chronic disorder that involves sweating excessive production of sweat in the sweat glands of the body. It usually appears in early childhood and often lasts the rest of life. It is a benign condition of unknown origin and appears to be a genetic basis for their development.

How does it manifest?
This disorder can affect one in every 100-200 people and is characterized by an increase in sweat production, depending on the situation, sweating can range from minimal to other really disabling for family or work life, and associated with psychiatric disorders including type of neurosis, social phobia or anxiety .

It is often triggered by stressful stimuli, often an emotional and, more rarely, by heat, exercise or food.

It can be basically of two types depending on their location:

Is a symmetric and in half of the cases affects the hands and the arms together (less frequently affects only hands or arms).

The way that affects the hands is what causes more problems from the social point of view, and that often leads the patient to the doctor’s office. Severe forms can be a real problem in people who have an active social life, as politicians, representatives, employees, public relations, etc.., Or use their hands to work, as painters, designers, architects, artists, etc.. Some of these people become withdrawn, avoid shaking hands, and if they do, previously usually wipe it quickly with a handkerchief or clothing, as it is completely drenched in sweat.In many cases, the imminence of having to hand merely emperorar the situation, generating even more sweating.

The ways that affect the soles of the feet can cause local infections, skin maceration and blistering that stain your socks and shoes, as well as give off an unpleasant odor.

The moisture causes axillary form, stained and fabric damage and odor.

– perspiration affects the entire body, or
– is localized in certain areas of the body, typically in the palms of the hands, soles of the feet, armpits and head and face.

Causes
In the general form, ie, it affects the whole body, various processes have been involved as pregnancy, obesity , the menopause and anxiety, diseases such as hyperthyroidism or excessive production of thyroid hormones, or neurological diseases Some tumors, certain skin diseases, and toxins such as alcohol, .

Medical treatment
For many years various topical preparations have been used, ie, applied to the skin that showed excessive sweating. However, such treatments have had limited success or temporarily, so that patients, dejected, the abandoned, and many of these treatments have failed to eliminate the excessive production of sweat.

Has also been used a technique called iontophoresis or iontophoresis, which involves the mobilization of the sodium ions from an aqueous solution by an electric current which enters the sweat glands and their temporary rest originates through a mechanism not well known. It takes 3 to 6 weekly sessions and the results are dependent on dosage and time limited, so that in severe patients discouraged and stop treatment.

In recent years it has introduced a new medical treatment combining the use of botulinum toxin type A that has proven to be a safe and effective treatment for primary axillary hyperhidrosis for the hands, with high levels of patient satisfaction . The technique involves the subcutaneous injection of the toxin in the area corresponding hyperhidrosis, causing a blockage of the nerve endings responsible for the sweat glands.Effects, ie, reduction in perspiration starting to emerge between 2 and 4 days and the symptoms subside within a week, but unfortunately can recur after about three months in the case of the hands and up to 8 months after in axillary hyperhidrosis.

Surgical Treatment
Surgical treatment is indicated in severe forms of the palms of the hands or those affecting palms and armpits together, and which affects the face and head.  Consists in performing a surgical technique called video-assisted bilateral thoracic sympathectomy, which has revolutionized the treatment of this difficult and annoying disorder.

This technique is described as minimal access surgery and is in practice a few small incisions in the chest through which is inserted a tube with a light and a video camera system that magnifies images and sectioned and selectively removed lymph nodes of the sympathetic chain for the area of ​​excessive sweating.

The technique is very effective, safe and long-term results are satisfactory.The main side effect is called redistribution of perspiration in the entire body (face, trunk and limbs) that occurs in half the cases. This compensatory excessive sweating is totally unpredictable, appears in the first 6 months after surgery and may disappear spontaneously or persist indefinitely.

Pertusa Salvador Martinez , Family Physician. Health Center Cape Huertas (Alicante)