Question

Hyperhidrosis.

Hint:

For localized hyperhidrosis, first-line treatment includes topical antiperspirants, while systemic treatments or surgical options are reserved for more severe cases.

Answer 1

Hyperhidrosis is a condition characterized by excessive sweating beyond what is necessary to regulate body temperature. This condition can occur in localized areas or be generalized.
Step 1: Types of Hyperhidrosis:
1. Primary (Essential) Hyperhidrosis: This is the most common form and occurs without any underlying medical conditions. It typically affects the palms, soles, underarms, and face. The exact cause is unknown but is believed to involve overactivity of the sympathetic nervous system.
2. Secondary Hyperhidrosis: This form is caused by an underlying medical condition such as obesity, hyperthyroidism, diabetes, infections, or neurological conditions. It may also be a side effect of medications.
Step 2: Clinical Features:
- Sweating occurs without any clear trigger, or in response to minimal stimuli such as emotional stress or slight physical exertion.
- It typically involves localized areas like the armpits, hands, feet, and face, but can also be generalized.
- The sweating may be severe enough to cause discomfort, interfere with daily activities, and lead to social embarrassment or anxiety.
Step 3: Diagnosis:
The diagnosis of hyperhidrosis is primarily clinical, based on the patient’s history and symptoms. There are no specific tests, but certain techniques may be used to assess the severity, including the starch-iodine test or the gravimetric test.
Step 4: Treatment Options:
1. Topical Antiperspirants: Aluminium chloride-based antiperspirants are often the first-line treatment for localized hyperhidrosis.
2. Oral Medications: Anticholinergic drugs, such as oxybutynin or glycopyrrolate, can help reduce sweating by blocking acetylcholine at sweat glands.
3. Iontophoresis: A non-invasive procedure where a mild electrical current is used to reduce sweat production in the palms and soles.
4. Botulinum Toxin Injections: Botox can block the release of acetylcholine and reduce sweating for several months.
5. Surgical Treatment (Sympathectomy): For severe cases that do not respond to other treatments, thoracic sympathectomy may be considered to remove or interrupt the sympathetic nerves responsible for excessive sweating.