Essay: Hyperhidrosis. Sweating. Sweat

The hyperhidrosis is excessive production of sweat by the physiological needs of the organism. Usually bilateral and relatively symmetrical and affects mainly the armpits, palms, soles and face.
The sweating is a mechanism used to regulate body temperature and is controlled by the sympathetic nervous system through existing cholinergic receptors in the sweat glands. Of the 4 million sweat glands that have 3 million eccrine and apocrine are rest. The eccrine glands are found throughout the body surface but are more numerous in the palms, soles, face and armpits. They cool the body by evaporation and moisten the palms and soles. They work from birth. The apocrine glands are responsible for body odor. Found in armpits, nipples, perineum and external auditory canal. These work since puberty.
Sweating.  Sweat.  Hiperhidroxis.
What is the cause of hyperhidrosis?
Primary. The cause is unknown and is usually located on the palms, plant, face and neck. It usually starts in childhood and family history is usually 30-50% of patients. Secondary. It usually occurs in older ages of life. It may be secondary to:
endocrine diseases such as hyperthyroidism, diabetes mellitus (especially in relation to episodes of hypoglycemia or diabetic neuropathy), hypoglycemia, acromegaly or pheochromocytoma.
Drugs, toxins and drugs. It has been observed hyperhidrosis on some drugs such as acetaminophen, aspirin, insulin, morphine, fluoxetine, venlafaxine …
Tumors. Hodgkin’s disease, carcinoid tumor …
What types of hyperhidrosis there?
Depending on the area of ​​body involvement:
Widespread . Usually it has an underlying cause and affect the entire body surface. The most common is fever.
Located . Most often it affects the palms, soles and underarms. Idiopathic focal hyperhidrosis is located on the palms, soles and armpits and less frequently on the forehead. It is believed that the eccrine glands (sweat glands) of palms and plants respond to emotional stimuli and axillary and forehead also do so to thermal stimuli. It usually begins in children under 25 years and having prior family history of the disease. Episodes occur with a frequency of one or more a week. Most patients with palmar hyperhidrosis also usually have in plant or axillary location. The hands of patients with palmar hyperhidrosis usually cold and acrocianosis (bluish).
How hyperhidrosis diagnosed?
The history is the main thing to know if hyperhidrosis is focal or generalized, if there is family history of the disease, the age of presentation, precipitating factors … When secondary hyperhidrosis is an emotional reaction usually occurs in the palms and soles.
When the diagnosis of focal hyperhidrosis is not required additional studies.
If there is suspicion of some secondary cause conducting analytical, chest radiography, electrocardiogram may be necessary …
How is hyperhidrosis treated?
Whenever possible you should treat the underlying cause. The patient is recommended to wear light clothing, staying in cool environments and have good hydration.
Topical treatment. In mild or moderate hyperhidrosis are used as antiperspirant products with aluminum salts that produce an occlusion of eccrine gland duct that lasts several days until it is removed with the peeling skin. They differ from the latter deodorant prevent odor but do not prevent sweating.
In the axillary hyperhidrosis  is useful to know the difference entreantitranspirantes and deodorants is that the former prevent the secretion of sweat while antiperspirants prevent body odor by killing bacteria that degrade sweat.
Topically start using aluminum chloride hexahydrate 10-12% alcohol or salicylic acid gel, may increase the concentration to 35%. Use it on dry skin before bedtime and wash it the next morning (leave it on the skin between 6-8 hours) every 24-48 hours for 1-3 weeks.
If skin irritation occurs apply a hydrocortisone cream 1% 2 times a day.
If no improvement combined with the botulinum toxin injection.
If it had not improved sympathectomy evaluate endoscopic resection or glandular weighing the side effects.
For palmar-plantar hyperhidrosis  hygienic measures are very important as the replacement of socks 2 times a day, alternate several pairs of shoes and do not wear athletic shoes or boots occlude feet.
Start with the topical use of aluminum chloride hexahydrate 10-12% alcohol or salicylic acid gel may increase the concentration to 35%. Apply on dry skin before bedtime and wash it in the morning (leave it on the skin between 6-8 hours) every 24-48 hours for 1-3 weeks.
If skin irritation occurs apply a hydrocortisone cream 1% 2 times a day.
Iontophoresis is very useful in this location so can be considered even first choice. 3-4 sessions per week of 20-45 minutes are necessary. They usually require 6 to 10 treatments. If skin dryness occurs, this usually improves with emollients and sometimes requires the use of hydrocortisone cream 1%.
If the topical treatment or not improved iontophoresis can be applied botulinum toxin injections. In plantar hyperhidrosis it is more painful.
In palmar hyperhidrosis if there is no improvement with previous measures can be attempted surgical resection measures with glandular or endoscopic sympathectomy. Not recommended plantar hyperhidrosis because of the risk of sexual dysfunction.
Iontophoresis. The technique involves introducing ions of soluble salts into the skin through electrical currents. The patient puts his hands or feet in a basin filled with water through passing these currents. It is believed that the ionic particles clog the glandular ducts and electrical changes alter glandular secretion. Sessions are usually performed about 20-35 minutes 3-4 times a week to achieve the goal. Maintenance is usually a fortnightly session. It is contraindicated in patients with pacemakers, pregnant, denture wearers, pins and plates. Must remove metal objects before each session. As side effects can be irritation, dryness and flaking of the skin. Its effectiveness increases if we associate it with other topical therapies.
Botulinum toxin. It is a neurotoxin produced by Clostridium botulinum. Botulinum toxin inhibits sweat production by blocking temporarily sympathetic innervation of eccrine glands by blocking the release of acetylcholine.
It injects diluted in saline and the technique is painful at previously usually anesthetize or apply ice before and after injection to reduce pain.
The effects begin to be felt from 2 to 4 days after symptoms and refers to the week in 60-90% of patients for palmoplantar hyperhidrosis and 95% for axillary effect lasting between 4-8 months . Should be effective new infiltrations will be needed to maintain results. It has been found that some patients produce antibodies against the toxin so that further treatment would not be effective and to avoid it is necessary to use the lowest effective dose and the intervals between injections are older than 3 months.
Surgical treatment.   Thoracic sympathectomy endoscopically. Surgery should only be used when we have obtained no results with conservative treatments and always have been taken into account side effects. Endoscopic thoracic sympathectomy involves destruction of the sympathetic ganglia by excision, pinching or laser ablation or cauterization for palmar hyperhidrosis bilateral ablation of the sympathetic ganglia T2-T3 is performed, if axillary hyperhidrosis is extended to T4. In plantar hyperhidrosis is not advisable bilateral removal of lumbar sympathetic ganglia (L2) as a side effect in men is ejaculatory impotence. The main limitation of this technique is the occurrence of compensatory hyperhidrosis in the trunk and lower extremities. This method is effective for intense local hyperhidrosis (axillary, palmar, plantar …)
For the treatment of axillary hyperhidrosis can be used other surgical techniques such as local surgery with direct excision or curettage of the subcutaneous tissue or liposuction and eccrine sweat glands elimnado in the area.
Systemic treatment . Treatment of localized forms of hyperhidrosis is based primarily on taking anticholinergic drugs at low concentration which work by blocking the effect of acetylcholine on the sweat glands. It is not a widely used treatment for bothersome side effects such as dry mouth, blurred vision, urinary retention or glaucoma .