The hyperhidrosis is the excessive secretion of sweat can be focal or diffuse and has numerous causes. The Increased sweating in axillae, on the palms and soles is usually a normal response to stress, physical activity and high temperatures. A diffuse Increased sweating is usually idiopathic, but it should make you think of cancer, infections, and endocrine diseases. The diagnosis is obvious, and investigations may be indicated with regard to the underlying disease. The treatment takes place topically with aluminum chloride, tap water iontophoresis, botulinum toxin and, in extreme cases, surgery.
The hyperhidrosis is the excessive secretion of sweat can be focal or diffuse and has numerous causes. The Increased sweating in axillae, on the palms and soles is usually a normal response to stress, physical activity and high temperatures. A diffuse Increased sweating is usually idiopathic, but it should make you think of cancer, infections, and endocrine diseases. The diagnosis is obvious, and investigations may be indicated with regard to the underlying disease. The treatment takes place topically with aluminum chloride, tap water iontophoresis, botulinum toxin and, in extreme cases, surgery. Etiology A Hyperhidrosis can be generalized or focal. Focal sweating Emotional causes are common and cause increased sweating on the palms and soles, in the axillae and on the forehead, often with anxiety, excitement or anger. It is also a generalized increased sympathetic stress-related level. Sweating is also common during exercise and in hot areas. While this form of sweating a normal body response is to secrete patients with hyperhidrosis sweat excessively even under conditions that would not cause sweating in most people. Gustatory sweating occurs in the area of ??lips and mouth after consumption of foods and beverages that are heavily spiced or very hot. Usually there is no known cause, and gustatory sweating often increased in diabetic neuropathy, fazialem herpes zoster, invasion of cervical sympathetic ganglion, CNS injuries and diseases and injuries of the parotid gland occur. In the case of violations of the parotid gland innervation of the parotid gland by surgery, infection or injury is interrupted, so parotideale parasympathetic fibers grow into the sympathetic fibers that innervate the local sweat damaged skin, usually on the parotid gland. This disease is called Frey’s syndrome. Asymmetrical sweating can be caused by a neurological disorder. Other causes of focal increased sweating are the pretibial myxedema (shins), hypertrophic osteoarthropathy (palms) and the blue rubber bleb nevus syndrome-and glomus (via the lesions). As compensatory sweating the sweat intensive after sympathectomy bezeichnet.Generalisiertes sweating Generalized sweating relates to the majority of the body surface. Although most cases are idiopathic, many conditions may be involved (s. Some causes of generalized sweating). Some causes of generalized sweating type examples Idiopathic – Endocrine disorders hyperthyroidism, hypoglycemia, hyperpituitarism caused by GnRH agonist drug therapy antidepressants, aspirin, NSAIDs, hypoglycemic agents, caffeine, theophylline; Opioid withdrawal CNS injury, autonomic neuropathy, cervical sympathetic ganglion invasion cancer * Lymphoma, leukemia infections * TB, endocarditis, systemic fungal infections other carcinoid syndrome, pregnancy, menopause, anxiety * Primarily nocturnal generalized sweating (night sweats). GnRH = gonadotropin-releasing hormone. Symptoms and complaints sweating often occurs during the examination, sometimes to an extreme extent. The clothes can be soaked and palms or soles may be macerated and cracked. Hyperhidrosis is often emotionally stressful for patients and occasion for social withdrawal. The skin of the palms and soles often looks pale. Diagnostic history and examination iodine and starch test tests to identify the cause of hyperhidrosis is diagnosed on the basis of history and examination, but can be confirmed with the iodine and starch test. Iodine solution is applied to the affected area for this test and allowed to dry. Then, corn starch is sprinkled on the spot appear dark through the sweaty areas. The test is with increased Schweißekretion (as in Frey’s syndrome or around the area set to be treated surgically or with botulinum toxin) only to determine the foci and semiquantitative necessary for control of therapeutic success. Asymmetry of Schwitzmusters indicates a neurological cause. Laboratory tests to identify the causes of hyperhidrosis are determined by the sighting of the symptoms and may, for example, a complete blood count to uncover a leukemia, the determination of serum glucose for diabetes detection and the determination of thyroid stimulating hormone to check the thyroid function include. Treatment of aluminum chloride hexahydrate solution tap water iontophoresis botulinum toxin type A Oral anticholinergics Surgical procedures are initial focal and generalized treated Increased sweating same. For the topical treatment of increased sweating in the axillae, to the palms and soles a 6- to 20% solution of Aluminumchloridhexahydrat is indicated in ethyl alcohol, wherein this composition is available on prescription. The solution gives off salts that block the sweat glands. It is most effective when it is applied nightly, and it should be washed off in the morning. Occasionally, an anticholinergic is taken so that the aluminum chloride is not washed out by the welding before coating. Initial treatment must be several times a week to curb the symptoms, then followed by a maintenance therapy once or twice weekly application. If skin irritation through the application under occlusion, a test without occlusion should be done. The solution should not be applied to inflamed, injured, wet or recently shaved skin. In mild cases can often be achieved through highly concentrated aluminum chloride solutions, water-based relief. The tap water iontophoresis, in which are introduced into the skin by means of electricity salt ions is suitable for patients who have not responded to topical therapy. The affected areas (typically palms and soles) are placed in the container with tap water, each containing an electrode, is passed through the for 10-20 min a current of 15-25 mA. This routine is carried out daily for a week, then once a week or every two months. The effectiveness of the iontophoresis can be increased by dissolving anticholinergics tablets (z. B. glycopyrrolate) in water iontophoresis basin. Although the process is usually effective but time-consuming and tedious, and some patients do not have the patience to endure. Botulinum toxin type A is a neurotoxin that blocks the release of acetylcholine from the sympathetic nerve endings, which supply the eccrine glands. In case of direct injection into the axillae, palms or soles of the feet and the end botulinum toxin inhibits depending on the dose about 5 months, the sweat. Complications include local muscle weakness and headaches. The injections are effective but also painful and expensive. Oral anticholinergics can help some patients. Glycopyrrolate or oxybutynin can be used until symptoms bearable or the anticholinergic side effects are intolerable. Unless the conservative treatments fail, surgery is indicated. In patients with increased sweating in the armpits the axillary sweat glands either by dissection or by liposuction open excised (the latter seems to have a lower rate of complications). Patients with palmar increased sweating can be treated with endoscopic transthoracic sympathectomy. Particularly when sympathectomy the potential morbidity of the operation in must be considered. Among the possible complications phantom sweating include (a feeling of sweat without sweating), compensatory hyperhidrosis (excessive sweating in untreated areas of the body), gustatory sweating, neuralgia, and Horner’s syndrome. Compensatory hyperhidrosis is most common endoscopic transthoracic sympathectomy on after, up to 80% of patients, and can be limiting and more serious than the original problem. Summary Asymmetric hyperhidrosis indicates a neurological cause. Although diffuse sweating is usually normal, cancer, infectious and endocrine diseases must be considered. Laboratory tests to determine systemic causes based on clinical findings must be available. For treating aluminum chloride solutions, tap water iontophoresis or, if possible, use botulinum toxin.