Hyperhidrosis means excessive sweating. The skin of our body contains from 2 to 5 million sweat glands, small glands that produce sweat; these glands are particularly concentrated on the head, the axilla, the palms of hands and the soles of the feet. The main function of sweating is to regulate the body temperature as the evaporation of sweat removes heat from the body and thus cools it.
According to ancient traditional medicines (Chinese, Mediterranean), the skin is also an emunctory organ, i.e. an organ responsible for the elimination of toxic substances and/or waste from the body which are eliminated precisely by sweat, through normal perspiration.
The amount of sweat produced in 24 hours is very variable, depending on the amount of physical activity and the climate; it may also increase in response to different physical, nervous, mental, chemical and metabolic stimuli.
Sweating, necessary for regulating body temperature, is regulated by nerve impulses of the sympathetic nervous system: its excessive activity can cause excessive sweating which is called hyperhidrosis.
Hyperhidrosis is classified into primary (idiopathic or essential, or with no known cause) and secondary. Primary idiopathic hyperhidrosis, also called essential, is a disorder characterized by excessive sweating of the armpits, the palms of the hands and the soles of the feet, and is frequent in the general population (0.5-1%). Essential hyperhidrosis starts at a young age and occurs more frequently in the palms and in the armpit.
This type of disorder often presents with a pattern of familiarity and can be so serious and severe as to be debilitating, causing difficulty and discomfort in interpersonal relationships. It can be triggered or aggravated by emotional stress and / or thermal stimuli, but it can also occur without any trigger.
Patients with this condition are often referred to as emotional, but generally it is the phenomenon of excessive sweating that causes embarrassment and anxiety and not vice versa. Axillary hyperhidrosis affects the female sex more frequently, especially in childbearing age, plantar and palmar hyperhidrosis affects males more frequently, especially in childhood and puberty.
Secondary hyperhidrosis refers to hyperhidrosis associated with pathologies such as hyperthyroidism or other alterations of the endocrine system, hormonal therapies for cancer (prostate cancer), psychiatric disorders, obesity, menopause or use of drugs.
There are several approaches to the treatment of primary hyperhidrosis, from the use of antiperspirants to surgical or laser treatments. Treatment with botulinum toxin type A is the treatment of choice, especially for hyperhidrosis that is poorly controlled with antiperspirants. This method was introduced into clinical use in 1995 and is now validated and completely free of side effects.
It is an outpatient treatment which involves injecting botulinum toxin, a drug approved for such use by the Ministry of Health and for this reason highly tested and controlled, with a thin needle, in minimal doses, directly into the thickness of the skin of the armpits, the palms of hands and soles of the feet; the toxin blocks the nerve impulses (by inhibiting the release of the neurotransmitter acetylcholine), drastically reducing the production of sweat.
The minute doses used pose no risk to the general health of the individual. The results are visible 48-72 hours after treatment and last on average 8-9 months in the axillary region and 5 months in palmar and plantar regions.
Contraindications to treatment with botulinum toxin type A are myasthenia gravis, Eaton-Lambert syndrome, pregnancy, breastfeeding, known allergy to botulinum toxin.
By Dr. Roberta Perna