ARTICLE | HYPERHIDROSIS | options. Rarely, an underlying medical cause or drug
side-effect may be identified, but the majority of cases are idiopathic. The eccrine (and possibly apoeccrine) glands are
generally considered to be the source of sweat production in axillary hyperhidrosis1
. Eccrine gland
overstimulation via sympathetic pathways has been suggested as a mechanism for the disease. Eccrine glands are derived from surface ectoderm and are tube- like structures that do not multiply after birth. Their proximal location is just beneath the dermis or in the reticular dermis, with ducts that traverse the dermis. Eccrine sweat is hypotonic, consisting mainly of water (99%) and sodium chloride (0.7%). Apocrine sweat glands, in contrast, have secretions that are rich in proteins and lipids, and are the cause of bromhidrosis or odorous sweat.
Eccrine sweat is hypotonic, consisting mainly of water
(99%) and sodium chloride (0.7%). Apocrine sweat glands, in contrast, have secretions that are rich in proteins and lipids, and are the cause of bromhidrosis or odorous sweat.
Evaluation The diagnosis of axillary hyperhidrosis is mainly made through taking of the patientÕs history. Distribution should be symmetrical in primary hyperhidrosis and symptoms are inactive during sleep. Secondary causes should be sought in atypical presentations. The Hyperhidrosis Disease Severity Scale (HDSS)2
helps to qualitatively measure the degree of daily activity impairment caused by the disease (Table 1 ). The HDSS consists of a four-point scale based on the patientÕs report of disease tolerability and interference with daily activities. Grades 1 and 2 indicate mild-to-moderate disease, while grades 3 and 4 indicate more severe disease. MinorÕs iodineÐ starch test is used to demarcate the
zones of hypersecretion and to evaluate response to treatment. The affected area is first painted with an iodine solution. After air-drying, corn starch is powdered over the same region. As the patient produces sweat, the areas of interest turn deep-blue to purple. Photographic documentation allows for precise treatment delivery and analysis of interval change after treatment. Sweat volume can be gravimetrically measured by weighing filter paper that has absorbed sweat over a given interval, but this test is seldom performed.
Treatment options Topical therapy is the first-line treatment for axillary hyperhidrosis. Aluminium chloride salts (aluminium hexahydrate)3
cause a temporary physical blockade of
the distal sweat ducts, preventing fluid efflux. Typical regimens call for application before bedtime followed by cleansing with soap and water the following morning. After initial daily applications, some patients are able to taper to once- or twice-weekly treatments. Skin irritation is the most common side-effect. Iontophoresis involves the direct administration of electrical current to the skinÕs surface4
be conducted through water and the treatment Tem harunt explit enihillam velit, cum rehenis eum fuga. Ut rem. Ehenihilit animinu mquibus 38 ❚ June 2012 |
prime-journal.com
. The current can is
generally well-tolerated. A typical regimen may include initial daily sessions followed by maintenance
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