Sweating Excessive heat is a physiological process thanks to which we can maintain the body temperature in an optimal range for the vital functions of our organism. Perspiration lowers body temperature in situations where there is an increase in body temperature, such as exercise, fever or environmental heat. Although sweating is a natural and necessary process, 2-3% of the population is affected by a condition called hyperhidrosis, a non-physiological excess of sweat production. It usually affects the palms, soles and armpits and, although it is not a serious health problem, it can significantly affect the patient’s quality of life and his or her personal and professional relationships.
Although hyperhidrosis is chronic, dermatologists have an arsenal of treatments that allow us to control sweat production in these cases. In this way our patients can live with this problem in their daily life, without fear of shaking hands or wetting their clothes.
Antiperspirant solutions:
Contain aluminum chloride. They are effective in axillary hyperhidrosis, although not so effective in hyperhidrosis affecting the palms/ soles. Its main side effect is local skin irritation. The main limitation found by specialists is that the body tends to generate tolerance to these products, and these compounds lose their effectiveness with successive applications…
Iontophoresis:
It is based on the principle that when the skin is subjected to an alternating current, the penetration of active ingredients through the skin is favored. In the case of hyperhidrosis, the current itself would be able to decrease sweat production, apparently by closing the pore. For these treatments it is necessary to have devices capable of generating these currents. These may consist of electrodes that are placed dry on the areas to be treated or containers in which the areas to be treated are immersed. These second devices are more complete since they allow us to dilute active ingredients for hyperhidrosis in water. The main limitation of this treatment is the high cost of the devices and the time needed for the patient to undergo the therapy.
Anticholinergic drugs
These include glycopyrrolate and oxybutynin, which can be administered orally. However, due to the side effects (dry mouth and eyes, urinary retention, constipation), we usually formulate them in excipients for topical application because of their lesser side effects. For this purpose, we use magistral formulas of glycopyrrolate 0.%-2%
Botulinum toxin
It is the most effective non-surgical treatment. Used for more than 20 years, it has been a milestone for dermatologists in the treatment of both axillary and palmar hyperhidrosis. It involves the superficial infiltration of botulinum toxin in the area to be treated. It is a quick treatment and hardly bothersome. Symptoms remit within a maximum of one week after injection and persist for 6-8 months, depending on the patient, after which a new treatment is necessary. It is not necessary to have severe hyperhidrosis to apply botulinum toxin to the armpits. It can be used in cases of sweat associated with bad odor or simply during the spring and summer months to avoid frequent stains on shirts or T-shirts.
Surgical treatment: sympathectomy
It consists of a surgical procedure in which, by means of videothoracoscopy, the sympathetic ganglia that innervate the sweat glands of the palms and armpits are sectioned at the thoracic level. This procedure is performed by thoracic surgeons and is now considered a definitive treatment for palmar and axillary hyperhidrosis, once the risks of surgery of this caliber have been assumed. Efficacy is high and immediate. However, a very high percentage of patients who undergo surgery develop paradoxical sweating (excessive sweating in other areas such as the thighs, abdomen or back).
We hope this information has been of interest to you and that this summer we will not have to worry about the fabrics or colors of the clothes we wear.