23 de Maio de 2022 - 09:46
Medical Reference
[-] Hyper-Hidrosis
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Hyperhidrosis - Excessive perspiration

Hyperhidrosis could be generalized and it is normally related to physical exercises and emotional factors. Obesity, hyperthyroidism, menopause, psychiatric diseases, tuberculosis, feochromocitoma (?), acromegaly and lymphoma could cause secondary hyperhidrosis.

The hyperhidrosis that cause more concern are the localized or regional ones: (primary hyperhidrosis), palmar, axillar, plantar, and craniofacial. They may occur associated or separately and their intensity may cause discomfort or a change in psychosocial behavior of the individual.

Hyperhidrosis is a dysfunction in the Sympathetic Nervous System resulting in an excessive perspiration at the affected region. Emotional factors are involved and this sweating which is normally intermittent and linked to an excitement reaction, anguish, anxiety, fear or stimulating drugs like caffeine, present in tea, coffee and sodas “cola” type. Hyperactivity of the Sympathetic Nervous System causes hyperhidrosis. During Summer time its intensity is a little more exacerbated. Stress, high temperatures and eating are considered triggers, being the stress the greater one. As proof of such statement, is the fact that while a person is asleep hyperhidrosis seldom occurs. It may happen at any time, any place – in an air-conditioned room, high temperature environment, while eating, reading, watching TV, or without any stress or anxiety.

About 20% of affected people are born with such dysfunction. This fact and the presence of hyperhidrosis in members of the same family may indicate that in some cases a hereditary factor is present. There is no racial distinction, but the incidence is discretely increased among Jewish and Asians and it seems to have a family predominance. It occurs in 0,5 to 1% of the population.
25% of people present palmar hyperhidrosis isolated or associated to plantar at birth, although the majority refers the observance of excess of sweating around 5 years of age, when school activities start. Carriers of Axillar hyperhidrosis report its onset at puberty. Craniofacial hyperhidrosis shows up in adult life and it is exacerbated at mid–life. It may start or be exacerbated in women close to menopause with no relationship to the amount of hormones produced.

Individuals with palmar hyperhidrosis have their social activities, working activities and relationships limited by this dysfunction. They do not feel comfortable to shake hands, and often avoid such contact. School children have difficulty to perform activities using paper. They spot their work, stick to them; handling paper is quite impossible. Adult cannot sign checks and have to wear gloves (even during warm seasons) or carry a hand towel with them constantly. Several patients reported a difficulty to start dating or even to touch other person during moments of intimacy.

Hyperhidrosis may be a hindrance for some professions – pianists, plastic artists, typist, massotherapists, beauticians (make-up), medical doctors, physiotherapists, etc. One of our patients, a dentist, reported a great limitation she had to perform routine tasks in her patients because the required use of rubber gloves provoked an accumulation of sweat inside the glove. Another patient said she was so irritated because she wet the stirring wheel she left the car on the street. Simple gestures like holding hands become impossible for this people.

Axillar hyperhidrosis becomes very unpleasant because of sweat dripping all over the body and the permanent sensation of lack of hygiene, especially if accompanied by foul-smell. Big wet spots are formed in the region and adjacencies causing this people to wear only white or black clothes. We had a picturesque case of a patient whose major desire was to wear a blue shirt. Women dream about wearing colorful clothes especially during Summer time. One of our patients took five baths a day because of the anguish sensation and insecurity concerning her own hygiene. She was worried about what people would think of her. Some people put absorbent pads under the armpits to minimize the effects of perspiration on their clothes.

Plantar hyperhidrosis especially limits patients who have to wear shoes with cotton socks all time. Sandals make them slip. They become irritated with the unpleasant odor of wet leather or plastic, even worse when associated with bromhidrosis. Some patients who try to wear sandals report the mixture of sweat and dust form mud under their feet.

Axillar and/or plantar hyperhidrosis may contribute for or aggravate diseases like bacterial infections, mycosis and contact dermatitis.

Craniofacial hyperhidrosis is less common. In our study 13,6% of patients presented it isolated or associated to another type of hyperhidrosis. Especially the face gets wet when the level of stress or anxiety rises, for instance, in public appearances. Executives, teachers, media professionals and lawyers are particularly limited in their professional activity because they need towels to dry themselves often.

The following table and graph show the hyperhidrosis location in 467 patients submitted to surgery

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