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Excessive sweating disorder, also known as hyperhidrosis, and its
treatment options are gaining greater attention from physicians.
ROCHESTER, Minn. -- The often embarrassing,
excessive sweating disorder, hyperhidrosis, and its
treatment options are gaining greater attention from
physicians. This is improving the efficacy of treatment and
minimizing its adverse effects, Mayo Clinic authors write in
the May issue of Mayo Clinic Proceedings.
Hyperhidrosis is one of the oldest known dermatologic conditions
that even today is misconceived as rare and untreatable, says John
Eisenach, M.D., a Mayo Clinic anesthesiologist and the primary
author of the clinical review.
"Both ancient and modern medicine have been perplexed by this
entity," says Dr. Eisenach.
The description and definition of excessive sweating date back to
Hippocrates in the 4th century B.C. Today, the diagnosis and
treatment of severe cases command a stepwise, multidisciplinary
approach from the primary care physician, the dermatologist, the
neurologist, and the surgeon. Variables include the site affected,
the degree of severity and the response to treatment.
Dr. Eisenach and colleagues outline their findings on the
evolving therapies and how this disorder is not as rare as commonly
thought. "I think we've all shaken hands with someone who is
affected by this," he says. "I just hope people with this condition
seek help, because of the emerging treatment options and high
satisfaction rates that can be obtained, even in severe cases."
The Food and Drug Administration approval of botulinum toxin type
A (Botox) has provided an effective treatment of excessive sweating,
particularly for the underarms. Other treatments may be utilized for
excessive sweating on the face, the palms, or soles of the feet. A
recent survey suggests that the prevalence of primary hyperhidrosis
is 2.8 percent in the U.S. population, 1.4 percent have excessive
sweating in the underarms (axillary hyperhidrosis), and one-sixth
are projected to have sweating that is intolerable or interferes
with daily activities. There also is a hereditary component, as
approximately half of these patients have a relative with
hyperhidrosis, says Dr. Eisenach.
Dr. Eisenach says one part of the brain controls the sweating
response to body temperature, while another area controls the
sympathetic, or emotional sweating response. For reasons unclear to
hyperhidrosis researchers, the emotional component is in overdrive.
The result is typically a healthy individual who perspires
excessively, even in mildly stressful situations, such as a
handshake or job interview. This can have socially debilitating
consequences, particularly in young adults, Dr. Eisenach notes.
Not all sweating is benign, however. Primary hyperhidrosis
affects people while they are awake, but nighttime sweating is never
normal. A careful history and physical examination must be performed
to rule out other causes of excessive sweating, which physicians
call secondary hyperhidrosis. In contrast to the primary form,
secondary hyperhidrosis is associated with other potentially serious
medical problems that need further workup from physicians.
Treatment options are based on the severity of hyperhidrosis and
the risks and benefits of therapy. They can range from
antiperspirants to surgery, which involves disconnection of the
sympathetic nerves that direct sweating in the arms and hands.
"Mayo Clinic's surgeons frequently perform these procedures for
severe over-sweating of the hands when other treatments have
failed," says Dr. Eisenach. "From an integrative standpoint, we are
interested in studying the long-term effects of this surgery on the
skin and blood vessels of the arm. So far, we have found essentially
no adverse consequence in the patients' warm and dry hands."
Dr. Eisenach says Mayo researchers continue to gain insight into
how this condition affects the body, before and after surgical
correction. It also increases physicians' understanding of the
sympathetic nervous system, also known as the "fight or flight
Other Mayo Clinic physicians who helped write the article are
John Atkinson, M.D., a neurosurgeon, and Robert Fealey, M.D., a
A peer-review journal, Mayo Clinic Proceedings publishes original
articles and reviews dealing with clinical and laboratory medicine,
clinical research, basic science research and clinical epidemiology.
Mayo Clinic Proceedings is published monthly by Mayo Foundation for
Medical Education and Research as part of its commitment to the
medical education of physicians. The journal has been published for
more than 75 years and has a circulation of 130,000 nationally and
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