Sweating is a physiological phenomenon that occurs to control the body’s temperature. Hyperhidrosis is the production of more than enough sweat to bring body temperature back to normal. In hyperhidrosis, the amount of sweat released to the skin surface increases due to the hyperactivity of the eccrine sweat glands. It is a socially disturbing condition for the affected people. Regional excessive sweating can be seen especially in the armpits, palms, soles and more rarely in the head and neck region.
Although the cause of regional excessive sweating is not fully known, improper functioning of the nervous system is seen as the main cause of the disease.
Excessive sweating without a specific cause is called primary hyperhidrosis. It occurs equally in both men and women. The average age of onset is usually around 25 years. However, hand sweating and foot sweating may start earlier. For the diagnosis of primary regional hyperhidrosis to be made, the patient must have regional excessive sweating, which is also at rest, for at least 6 months.
It is essential to take a detailed history from the patient with excessive sweating. Additional tests are not required in primary regional hyperhidrosis that is not thought to be due to a specific cause. However, if there is general hyperhidrosis, additional tests are performed on the patient.
If excessive sweating is in the form of general body sweating, the cause is investigated and the cause is treated. There are surgical and non-surgical treatment options for primary regional sweating. In non-surgical treatment, reduction of sweating can be achieved with topical or oral medications. Botox and iontophoresis are other treatment methods used in patients unresponsive to topical treatments.
Iontophoresis treatment is especially suitable for cases of hand-foot sweating. In this treatment, patients place their hands in a plastic container with tap water and electrodes. Initially, the treatment is applied for 10 minutes a day for 2-3 days. The supplied electrical energy is gradually increased.
Botox treatment is applied for both hand and foot sweating and armpit sweating. Botox is applied to the sweating area frequently with very fine-tipped needles. It stops the excessive sweat secretion from the sweat glands for a certain period of time. There is a decrease in sweating in periods ranging from 4 days to 2 weeks after treatment. The duration of action is about 4-12 months.
Especially in the case of sweating that does not go away under the armpit, surgical treatment can be applied to the armpit nerves or the sweat glands under the armpit can be surgically removed. Today, these surgical methods can also be performed endoscopically.
Excessive sweating causes psychological problems such as embarrassment and self-confidence as well as physical problems in affected individuals. These patients often have difficulty in performing their daily activities, and their social relations are impaired.
Although the treatment of primary hyperhidrosis is difficult due to the unknown cause, many treatment options such as topical and systemic drugs, iontophoresis, botox applications and surgical intervention are applied. The treatment chosen should be acceptable to the patient and meet the patient’s expectations.