Hyperhidrosis

from Wikipedia, the free encyclopedia
Classification according to ICD-10
R61.- Hyperhidrosis
R61.0 Hyperhidrosis, circumscribed
R61.1 Hyperhidrosis, generalized
R61.9 Hyperhidrosis, unspecified
  • Night sweats
  • Excessive sweating
ICD-10 online (WHO version 2019)

As hyperhidrosis , from Greek. Ὑπέρ ( hyper ) "even more, about, about ... out" and ἱδρώς ( HIDROS ) "sweat", excessive perspiration is known that can occur generalized or local. The opposite is a hypohidrosis or anhidrosis .

definition

Hyperhidrosis of the hand

Sweating is a vital function for the human organism. It regulates body temperature and not only cools the skin, but also the inside of the body. Approx. 1–2% of people in Germany suffer from the disease hyperhidrosis, in which the body produces excessive and often uncontrollable sweat regardless of heat or cold, time of day or time of year.

What constitutes excessive sweat depends on the extent of suffering on the part of those affected and is therefore subject to subjective assessment. For scientific purposes, hyperhidrosis is defined as the production of 100 mg of sweat in an armpit within five minutes.

Localized hyperhidrosis occurs 60% on the palms ( sweaty hands ) or soles of the feet ( sweaty feet ), 40% in the armpits, 10% on the head (primarily the forehead) and rarely on other parts of the body.

Classification

It becomes the primary, i.e. H. congenital hyperhidrosis differentiated from the secondary form, which is a consequence of a disease. A distinction is made on the basis of the medical history . Typical for a primary form is:

  • Onset of symptoms in childhood or adolescence ( <  25 years)
  • Occurrence of sweating independent of temperature, unpredictable and not deliberately controllable
  • Focal occurrence in one or more predilection site (s) with symmetrical infestation on both sides
  • Occurrence more than once a week with impairment in everyday life
  • No increased sweating during sleep
  • Positive family history

A special form of hyperhidrosis is bromhidrosis or bromhidrosis , in which the increased sweat produced continuously moisturizes the horny layer of the skin and promotes the multiplication of the local bacterial flora, which creates a foul-smelling sweat.

Severity

As a guide, hyperhidrosis can be semiquantitively divided into three degrees of severity based on the extent of perspiration on the palms and feet (H) and armpits (A):

Severity Symptoms
I - mild hyperhidrosis A + H: significantly increased skin moisture
A: sweat spots with a diameter of 5–10 cm
II - moderately severe hyperhidrosis A + H: formation of weld beads
A: sweat spots with diameter 10-20 cm
H: sweating on palms or soles limited
III - severe hyperhidrosis A + H: sweat drips off
A: sweat stains more than 20 cm in diameter
H: sweating also on the back of the fingers and toes as well as on the side of the hand and foot

causes

Primary hyperhidrosis

The cause of a localized tendency to sweat has not yet been researched and is unknown.

An exception is the localized sweating due to gustatory stimuli in Frey's syndrome ( Łucja Frey-Gottesman , neurologist, 1889–1942, Lemberg), which occurs due to a malfunction of the auriculotemporal nerve .

Secondary hyperhidrosis

An increased general sweat production can have various causes, so that clarification is necessary here.

Generalized hyperhidrosis without its own disease value can be triggered by physical exertion and sweating during the fever - both in the sense of regulating body temperature ( thermoregulation ). The heat generated during body work is dissipated through an increase in sweat production; when fevering, the current core body temperature does not (yet) correspond to the required setpoint, so that here too the excess heat has to be released to the outside world.

Possible reasons for generalized excessive sweating include:

Nocturnal hyperhidrosis ( night sweats ) is the term used to describe excessive sweating during sleep, which should be taken seriously as a possible sign of a systemic disease such as collagenosis , lymphoma or tuberculosis . But here, too, it is difficult to distinguish between sweating with and without illness. A very reliable criterion for this is whether the quality of sleep is significantly impaired and whether one z. B. have to get up at night to change laundry or even sheets.

Hyperhidrosis can result in trichomycosis palmellina , the colonization of secondary hair by saprophytic corynebacteria .

Diagnosis

As part of the diagnosis , several qualitative and quantitative test methods that primarily determine the extent and location of the hyperhidrosis available. While qualitative test methods prove the points at which increased sweat production occurs, quantitative measuring methods can determine the amount of sweat per time interval. These objective test procedures help the attending physician - together with a detailed anamnesis (in addition to the subjective perception also the family history) - to determine the degree of hyperhidrosis and to select suitable therapies.

  • Iodine starch test (also known as the minor test ): The minor test enables the affected area of ​​the body to be differentiated in color using a special iodine solution: Potentially affected skin areas are brushed with it and then dusted with starch powder. Areas where there is excessive sweat production turn brown.
  • Gravimetry : Here, a special paper is applied to the affected skin area for a certain period of time. The amount of sweat per unit of time can be determined by measuring the difference in the weight of the test paper before and after.

Differential diagnosis : psychosomatics , medication (for example cholinesterase inhibitors, antidepressants such as serotonin reuptake inhibitors , serotonin-norepinephrine reuptake inhibitors and tricyclic antidepressants, opioids , tramadol ).

therapy

There are a variety of treatment options. The German Dermatological Society recommends a step-by-step procedure depending on the extent of the disease:

Axillary hyperhidrosis
  1. Topical therapy with antiperspirants ( aluminum chloride , topical agents containing tannic acid )
  2. Chemical denervation with botulinum toxin A.
  3. Surgical axillary sweat gland removal
  4. Systemic therapy with antihidrotics or psychotropic drugs
Hyperhidrosis of the palms and feet
  1. Topical therapy with antiperspirants
  2. Tap water iontophoresis
  3. Chemical denervation with botulinum toxin A.
  4. Systemic therapy with antihidrotics or psychotropic drugs
  5. Ultima ratio in palmar hyperhidrosis: surgical thoracic sympathectomy
Generalized, primary hyperhidrosis
only systemic therapy with antihidrotics or psychotropic drugs

Topical therapy

  • Aluminum Chloride Treatment: Aluminum chloride is used in most antiperspirants, but people with hyperhidrosis need a much higher concentration. The aluminum salts penetrate the sweat ducts , combine with the keratin there and thus clog the ducts of the glands. Depending on the area of ​​application, there are formulations with different concentrations of aluminum chloride in the solution (usually 10–20%) which are available in pharmacies . The solution is applied to the sweaty parts of the body before going to sleep, as there is less perspiration at night and the solution is not exuded. After a week of daily use, it is sufficient to repeat the treatment 1–2 times a week. The goal is the permanent regression of the sweat glands so that the therapy can finally be stopped. Side effects are itching on sensitive skin and skin irritation. In addition, the clothing can discolour. The success rate of therapy with aluminum chloride is 95%.
  • Methenamine : The ointment containing methenamine is applied to the affected skin areas once or twice a day. The formaldehyde produced by this substance in connection with acid sweat denatures the proteins in the sweat and thereby closes the sweat glands.
  • Glycopyrronium bromide : In 0.5 to 3 percent concentration for application to the skin in the event of gustatory sweating (sweating on the upper lip, cheeks and forehead caused by chewing or biting off), to be formulated individually, no topical finished products are currently available.

Tap water iontophoresis

Tap water iontophoresis is a direct current therapy without the use of drugs or drugs. To do this, the hands or feet are placed in two tubs of water. There is an electrical conductor in each tub. The hands or feet are the electrical conductor that closes the circuit. The current is individually adjusted so that it is noticeable as a tingling sensation, but is neither uncomfortable nor painful. The cause of the effect of iontophoresis has not yet been conclusively explained, and the sweat glands are not damaged in any case. On the other hand, the effect is certain: in over 80% of users, the tendency to perspire can be significantly reduced. In addition to the hands and feet, the armpits can also be treated using sponge pockets.

Chemical denervation

Botulinum toxin (Botox): The poison of Clostridium botulinum , the strongest known toxin , is injected intracutaneously (into the skin) in extreme dilution and appears to be effective in localized (axillary and palmar) hyperhidrosis. It inhibits the release of acetylcholine and thus the production of sweat by the cholinergic innervated sweat glands. The duration of the effect varies from person to person. The effect can wear off noticeably after half a year. The IGeL monitor of the MDS (Medical Service of the Central Association of Health Insurance Funds) rates this self-payer benefit as "unclear". The systematic research of the scientific literature yields indications of a benefit, but also indications of damage: Botox presumably increases the quality of life and reduces sweat production, but according to the manufacturer, a number of side effects are possible. When used properly, the botulinum toxin is not toxic. Botulinum toxin is only permitted in primary axillary hyperhidrosis; Use in other places, such as on the hands, feet and forehead, represents so-called off-label use .

Systemic therapy

  • Sage : no controlled studies, most as adjuvant therapy to consider
  • Anticholinergics : Two preparations are approved in Germany for the systemic, peroral therapy of hyperhidrosis:
  1. Methanthelinium bromide : effective in focal hyperhidrosis.
  2. Bornaprine : Weak studies suggesting effectiveness in axillary but not in hyperhidrosis of the palms and feet.

Microwaves

Microwave treatment has only recently been introduced to patients with hyperhidrosis in the armpit region. Unfortunately, the current study situation does not provide any conclusive information about the long-term effectiveness and safety of this form of treatment.

The microwave therapy is carried out with a specially developed device that the medical practitioner holds in their hands and then guides them over markings in the armpit. A corresponding device received FDA approval in 2011 . The energy of the microwaves is supposed to destroy sweat glands in the armpit region through heat - while the tissue around it remains undamaged. Usually there are two sessions of 20 to 30 minutes each, about three months apart. At the beginning of a session, the area to be treated is anesthetized.

A double-blind, randomized study from 2012 with 120 participants showed that more patients after microwave therapy either no longer noticed the sweating or found it tolerable. However, direct measurements of sweat production by medical personnel could not substantiate this difference perceived by those affected. After six months, 63 percent of people in the microwave therapy group had half their sweat production compared to 59 percent after sham intervention. The difference was not statistically significant. Since there is only one study with a small number of participants, the strength of the evidence for the present results is low.

Surgical therapy

  • Local sweat gland excision : (surgical procedure): The affected skin area is removed together with the sweat glands. Wound healing disorders are common , scarring can affect the mobility of the affected parts of the body, and large, visible scars develop. In addition, it is often not possible to cut out the entire sweating area. This method of treatment is no longer used today.
  • Subcutaneous curettage
  • Subcutaneous sweat gland suction curettage : (surgical procedure under local anesthesia): In the armpit area, the hyperhidrosis can be removed by suctioning off the sweat glands. The effect can wear off after a few years, as the nerve endings partially reach the remaining sweat glands again and the sweat glands start sweating again. The success rate is 70–80%.
  • Endoscopic transthoracic sympathectomy (ETS): This minimally invasive operation , which is performed under general anesthesia, probably improves the symptoms significantly, but should be due to the possible complications ( pneumothorax , Horner's syndrome , compensatory sweating of other skin areas, back, abdomen, step partially on one side) can only be carried out in otherwise therapy-resistant cases. In particular, compensatory sweating, which is almost untreatable, is a very serious phenomenon. Various studies report a relapse rate of 60–90%. In sympathectomy, the nerve ganglia of the sympathetic trunk near the thoracic spine are destroyed by means of high-frequency electricity or the trunk is severed or clamped (clipping). Hyperhidrosis of the hands and face, often also of the armpits, can thus be successfully treated in the majority of patients. Treatment of the feet requires a nerve block near the lumbar vertebrae. This more complex operation requires the abdominal cavity to be opened and involves high risks (for example impotence).
  • CT-guided percutaneous sympathectomy : similar to the ETS, the ganglia are, however, by computed tomography controlled injection destroyed by concentrated alcohol.

Supportive measures

Secondary hyperhidrosis can be caused by obesity, so weight loss can help.

See also

literature

Individual evidence

  1. ^ Wilhelm Gemoll , Karl Vretska: Greek-German school and hand dictionary. 9th edition. Verlag Hölder-Pichler-Tempsky, 1991, ISBN 3-209-00108-1 .
  2. ↑ a b c d e f g h S1 guideline definition and therapy of primary hyperhidrosis of the German Dermatological Society. In: AWMF online (as of 2012).
  3. ↑ Results of the surgical treatment of axillary hyperhidrosis in the period 1995–2000 at the Darmstadt Dermatology Clinic. Dissertation . (PDF; 502 kB).
  4. ↑ Identity check of glycopyrronium bromide. In: Pharmazeutische-Zeitung Online. 44/2003; Retrieved July 7, 2015.
  5. ↑ Red List query , current drug, web research; Status 07/2015.
  6. ↑ Schiller-Frühwirth: Tap water iontophoresis . Ed .: Main Association of Austrian Social Insurance Institutions. February 2013.
  7. ↑ IGeL-Monitor, assessment of Botox against sweating . Retrieved October 31, 2018.
  8. ↑ M. Hund, R. Sinkgraven, B. Rzany: Randomized, placebo-controlled double-blind study to evaluate the efficacy and safety of methanthelinium bromide (Vagantin) for the treatment of focal hyperhidrosis. In: J Dtsch Dermatol Ges. 2, 2004, pp. 343-349.
  9. ↑ a b Microwave Therapy for Primary Hyperhidrosis - Evidence-Based Information Center for Doctors. Retrieved April 25, 2018 .
  10. ↑ a b Microwaves against sweating: effect unclear. In: Medizin-transparent.at. Retrieved April 25, 2018 .
  11. ↑ FDA approves miraDry system for long-term treatment of excessive underarm sweat, makes antiperspirant obsolete? medgadget.com, February 10, 2011 (accessed October 7, 2015).
  12. ↑ Dee Anna Glaser, William P. Coleman, Larry K. Fan, Michael S. Kaminer, Suzanne L. Kilmer: A randomized, blinded clinical evaluation of a novel microwave device for treating axillary hyperhidrosis: the dermatologic reduction in underarm perspiration study . In: Dermatologic Surgery . tape 38 , no. 2 , February 2012, ISSN  1524-4725 , p. 185-191 , doi : 10.1111 / j.1524-4725.2011.02250.x , PMID 22289389 .
  13. ↑ Summary of the topics in issue 2/1996 ( Memento of the original from May 4, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. of Swiss Surgery magazine . As of June 26, 1997. Accessed July 19, 2008. @1@ 2Template: Webachiv / IABot / verlag.hanshuber.com
  14. ^ German Society for Thoracic Surgery: Abstracts of the Free Lectures for the 14th Annual Conference (2005). ( Memento of the original from December 19, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 297 kB). P. 74. Retrieved July 19, 2008. @1@ 2Template: Webachiv / IABot / www.dgt-online.de
  15. ↑ Angelica Schorre: Wet with sweat without effort . In: balance. 11/2006. Retrieved July 19, 2008.

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