| |Probably not. But you may be familiar with antidepressant-induced excessive sweating. ADIES is the acronym for the latter. A recent study has shed more light on this topic. And that's a good thing, considering that sweating may not be something we think of as a side effect of medications. We typically associate nausea, upset stomach, rash or headache as side effects, but not necessarily sweating. That is probably due to other confounding factors such as increased activity, warm and humid weather, menopause, anxiety or just a natural tendency to sweat more in the first place. | |
Antidressants include drugs such as Prozac, Paxil, Effexor, Celexa, Cipralex, Zoloft, etc.
Scientists from the Jefferson Medical College in Philadelphia decided to have a closer look at the association between antidepressant medication and excessive sweating. Here is what they found: ADIES occurs most frequently in the scalp (62%), chest (57%) and neck (48%) areas. Almost all individuals (95%) with ADIES were affected in the facial region. So, it's fair to say that it predominently affects the central upper body. It also occurs in episodic bursts, somewhat unpredictably. ADIES is a relatively frequent side effect of antidepressants, occuring in about 5-14% of individuals taking these medications. I suppose this is of lesser interest for those not taking an antidepressant but it is something to keep in mind if you know a friend or relative that may be on such a medication.
What is surely intriguing to many of our readers is the question related to the possible effect of antidepressants on individuals with focal hyperhidrosis. It is difficult to answer this question given that studies are lacking in this area. However, keep in mind that if you have focal hyperhidrosis in regions other that those associated with ADIES (e.g. underarms, palms, soles), and if you ever take an antidepressant and begin sweating in the chest/facial area, chances are that you may have developed ADIES. Also remember, it tends to occur in episodic bursts (similar to hot flashes during menopause).
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One more thing, in case you are wondering. ADIES is self-limiting, that is, it goes away once you stop taking the antidepressant. If you ever come across ADIES, keep in mind that it may be possible to reduce or treat it by switching to different class of antidepressant. This study demonstrated that ADIES can also be reduced by adding a drug called terazocin - it is not always ideal to switch to another antidepressant, particularly if there has been a good response to it.
| |What if you could predict the outcome of surgery (endoscopic thoracic sympathectomy or ETS) before undergoing the actual procedure. For those that might be contemplating a surgical option for their excessive sweating condition, being able to predict its outcome would certainly help decide whether surgery is the way to go. One of the underlying problems that plagues surgery is the real possibility of ending up with compensatory sweating. This effect is a relatively frequent adverse event associated surgery (see blog dated March 23rd, 2013). | |
For those of you unfamiliar with this condition, as the name suggests, compensatory sweating is the development of an alternate sweating region. Ironically, the sweating region (e.g. palms, underarms, face) that is neutralized by the surgical procedure travels or moves to another region such as the groin or abdomen. Essentially the problem simply moved to another region. As such, the body has 'compensated' for the loss of a sweating region induced by surgery.
Patient satisfaction with surgery increases with young age. In other words, the older you are when you have a surgical procedure, the less your likelihood of being satisfied.
A recently published Australian study provides a pretty good idea of what factors are most likely to predict best outcomes following surgery. Over 200 individuals that underwent ETS were questioned with regards to level of satisfaction, symptom resolution and complications encountered. Over 90% of palmar and facial/scalp hyperhidrosis demonstrated the greatest degree of symptom relief. This compares with about 70% for axillary hyperhidrosis.
The rates of compensatory sweating varied dramatically depending on what regions were being surgically rectified. Compensatory sweating developed in 8% of those with palmar hyperhidrosis, 26% with axillary hyperhidrosis and 45% of those with facial/scalp hyperhidrosis.The probability of experiencing compensatory hyperhidrosis is less likely to occur in younger individuals. Not surprising, the level of satisfaction was highest in those with palmar hyperhidrosis (90%) and lowest in the facial/scalp (52%) sweating group - only half were satisfied with the surgery.Bottom line, according to this study, if you are contemplating ETS, your best odds of satisfaction are associated with young age and if you have palmar hyperhidrosis.
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If you have had surgery, we would love to hear from you. Take our survey and we will share results with our blog readers
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once we have enough responses. Not too worry...all responses are totally anonymous and all you need is a couple minutes.
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With the recent heat wave in Australia and the Summer quickly approaching in the 'up and over' part of the world, you have to ask yourself what range of temperatures can actually become dangerous. According to the Australian newspaper The Guardian, in remote Moomba, a gas exploration town in the outback of South Australia, the temperature hit 49.6C (121F).
The World Health Organization (WHO) has actually asked itself that question and it has determined that the ideal range is between 18C (64F) and 24C (75F). Any higher and the risk of harm increases. Sweating is the most efficient mechanism that our body uses to maintain a temperature between 36C (98.6F) and 37.5C (99.5F). We begin to flirt with danger as the body temperature reaches 39.4C (103F). In other words, an upward fluctuation of just 2 degrees begins to put you in harms way. So, when outdoor temperatures become extreme, our body starts to have difficulty cooling itself down. Signs and symptoms of hyperthermia include heat cramps, heat exhaustion, or heatstroke (sunstroke)*. The latter requires immediate medical attention as damage to vital organs becomes a emerging concern.
* Click here for prevention heat tips
Research has shown that when the outdoor temperature reaches 35C (95F), accompanied by high humidity, health is put at danger. Once 40C (104F) is reached, it becomes dangerous even if the humidity levels are low. Suffice to say, at 50C (122F), the risk is even higher.
The elderly, babies, children, and pregnant women are more susceptible to temperature extremes. This is also the case for individuals with heart or breathing problems. Certains drugs can also make it more difficult for the body to rid itself of excess heat. Click here for a list of these 'heat loving' drugs.
Temperature extremes often don't get the media attention that enviromental disasters get. Truth is, temperature extremes cause more fatalities than do floods, earthquakes and tornadoes. In 1988, up to 10,000 people died due to the hot summer in the U.S. (BBC News, 9jan13).
Temperature mapping for one day (14jan2013) during the recent heat wave in Australia
Over time (I mean thousands of years), humans have been able to evolve and adapt to hot weather - more on this in an upcoming post. As a species we learn to adapt to situations that consistantly confront us. Extremes in temparature come and go (e.g. heat waves) and that's the reason we have difficulty dealing with them. And so, when those inevitable heat waves hit us this Summer, takes it easy....'we humans' are just not used to them.
The sweating process is vital and is controlled by thermal as well as non-thermal mechanisms
| |If you think body temperature is the only parameter controlling the sweating process, think again. Actually, you are right in terms of it being the principle mechanism involved in dictating whether the body will sweat. A thermoregulating center within the brain senses our body temperature and when it begins to rise, signals are fired out to the eccrine sweat glands via our nervous system. Our sweat glands then begin to pump out sweat to maintain a temperature that will keep our vital organs from overheating. It turns out the these brain heat sensors aren't the only controls at play. A study has demonstrated that a number of non-thermal factors also modulate the sweating process. The one thing in common is that they all use the nervous system as their way to communicate to the sweat glands. Among the non-thermal controls are sensors in our muscles, as well as pressure and fluid sensors. Researchers have shown that some these non-thermal sensors actually can start the sweating process before our temperature begins to rise. These non-thermal controls include sensors in our muscles that are sensitive to muscle contraction. Makes sense, given that activity is a major source of heat generation.
| |Sensors that feel our blood pressure (called "baroreceptors"; from the word 'baros', greek for weight; similar to barometer), and sensors that detect our fluid balance are also involved. If we begin to lose too much water and start to become 'hypovolemic' ( a loss of blood plasma volume) these baroreceptors sense a drop in blood pressure and fluid sensors will begin to put the brakes on the sweating process in efforts to reverse the fluid loss. The body has many types of sensors (e.g. chemoreceptors that detect blood oxygen, carbon dioxide and pH) designed to keep critical bodily functions in balance. Fluid volume is one of those parameters. And because hypovolemia can actually be life threatening, that's the reason we need to stay hydrated (drink fluids) during intense exercise or heat waves. | |
Sweating and Non-thermal Sensors
Our core body temperature isn't the only parameter dictating whether our sweat glands should be active. Non-thermal sensors also detect other important body functions that will trigger sweating via our nervous system
And so, it appears the sweating process, like so many other bodily processes, is more complicated then we thought. Like so many other of our bodily processes, sweating seems to be a somewhat deceptively simple or even at times, primitive response. However, the underlying control mechanisms are very complicated and extremely sensitive. Perhaps not that surprising given that sweating is among one of the body's many important life sustaining processes.
| || |In case you haven't visited our website lately, we have created a new web page called the Focal Hyperhidrosis Learning Center. The idea behind the learning center is based on the following: every day, our site gets a significant number of visitors that have one thing in common. You guessed it, focal or primary hyperhidrosis. And so, if we can get these individuals to respond to the variety of questionnaires featured on our site, we will have access to a lot of interesting information. More importantly, we will be able to share the information with our blog readers. And, that's consistent with one of our objectives - keeping our readers in the know. So we decided to group our questionnaires on one page and called it as per the title of this post. We have have developed a number questionnaires related to a variety of issues and subjects related to hyperhidrosis. The heredity of hyperhidrosis, gustatory sweating, post-surgical compensatory sweating, sweating triggers and quality of life are the principle subject matters of these questionnaires. Of course, the information becomes more credible or reliable as we get more responses. The more the better.
Once we get a significant number of responses, we will collate, analyze and present the data to our readers. Let's be clear that this information will not stand to the scientific rigour of a well designed study but, on the other hand, the information should be very interesting given that the responses will come from individuals like youself. The information will provide a window or at least shed light on many aspects of focal hyperhidrosis. Your help with this initiative will be much appreciated by ourselves but mostly by your colleagues.
| || |Click here and we will take you to the learning center where you can get started on one of these questionnaires. One more thing.....the questionnaires are short, concise and take little time to complete. And, in case you are wondering, all questinnaires are totally anonymous - we have no clue from whom or from where the information is coming. Learning from one another, it's the right thing to do!
Pasteur, Hippocrates, Curie, Freud, Frey. Most of us are pretty familiar with these names, as the individuals bearing them made significant scientific /medical contributions. But the name Frey might be one that most of us are less familiar with. Frey's syndrome, a type of gustatory sweating derived its name from Lucja Frey, a Polish neurologist whose life was abruptly ended during the Holocaust.
Lucja Frey in 1918, age 29 years
| |Duphenix, a French surgeon was the first to describe gustatory sweating in 1757. However, our understanding of the condition became clearer thanks to Frey. In 1923, she observed gustatory sweating in a Polish soldier that was recovering from an infected bullet wound in the parotid gland. Frey suggested that a specific nerve called the auriculotemporal nerve played a key role in this excessive facial sweating condition. Today, we know that injury to this nerve (often the result of surgery, for example, a procedure called parotidectomy) will give rise to Frey's syndrome. As the nerve attempts to heal, it will erroneously reattach itself to the sweat glands. The nerve's attempt to reattach itself to the parotid gland (a saliva producing gland) is fruitless because it has been surgically removed. As a result, the response to the consumption, sight and/or smell of food is sweating instead of salivation.
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Lucja Frey was born in 1889 in Lwow Poland, where she studied medicine until she moved to Warsaw to work as a neurologist. She was a prolific author publishing 43 scientific papers throughout her career.
During the Second World War in 1941, Frey was resettled to her native town of Lwow. Sadly, the last evidence of Lucja Frey's life is in April of 1942, when she applied for a work permit issued by the German authorities.
Later that year, in August, almost 400 patients and staff from a clinic in which she had been working were murdered. It is believed that she was either a victim of that massacre or that she was deported during that same month to the Belzec death camp. In early 1943, only a few thousand from the original 150,000 were surviving in the Lwow ghetto. There is no evidence to suggest Frey was among these survivors. By July of that same year, the Nazis murdered the reamining residents of the Lwow ghetto. As such, some biographers believe she was killed in 1943. A few residents were able to survive by seeking refuge in the homes of Gentiles, in sewers, or in the surrounding forests of Lwow.
Unfortunately, we will never really know the exact details of Lucja Frey's fate. Fortunately, her legacy does live on.
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I woke up this Easter morning thinking about a few years ago when my kids would frantically hunt down treats hidden by the Easter bunny the night before. Those are good memories. By association, crazy as it sounds, I also began to wonder about rabbits and how they regulate their temperature. I also thought how grateful we should be to the rabbit and many of its related furry friends. From a medical perspective, animals have helped immensely in our understanding of how our body works, how it can get sick and how it can be treated.
And so, like my kids used to do on Easter morning, I started scrambling, thinking and looking for what might be some of the biggest medical breakthroughs. Albeit a little off topic today, rest assured we will return to stories related to sweating in the coming week.
I often think where the human race would be without the advent of antibiotics and antivirals. Gerhard Domagk can be credited for discovering the first commercially available antibiotic called Prontosil. It saved thousands of lives including that of Winston Churchill. Sulfonamides are still in use today but to a lesser extent. A few years later, Alexander Fleming serendipitously, discovered penicillin by leaving a petri dish by a window sill while vacationing. Upon returning he noticed the bactiria in the dish had disappeared in the areas that had grown mold. Turns out that mold was secreting penicillin.
In the late 1800's, Wilhelm Conrad Roentgen discovered the x-ray, allowing us to further optimize devices that today help us see all sorts of internal body structures.
| |One hundred years before the discovery of the x-ray, Edward Jenner rubs pus from a dairymaid's cowpox lesion into scratches on the arm of his gardener's 8-year-old son. Six weeks later he exposes the boy to smallpox. The gardener's son remains healthy. Jenner created the word 'vaccine' from the Latin vacca for cow. Vaccines are subsequently discovered for disease such as cholera, anthrax, rabies, typhoid fever, plague, diphtheria, tuberculosis, pertussis, influenza, measles, rubella and many more. More recently for lyme disease and in the future perhaps for HIV. | |
First successful public demonstration of anesthesia in an amphitheatre at the Massachusetts General Hospital, Boston 1846
So many more discoveries have contributed to longer and healthier lives. Lister's work in antisepsis, Crawford Long and William Morton's discovery of anesthesia are largely responsible making surgery a viable medical treatment. Before the discovery of insulin by Banting and Best, diabetes was a death sentence, with very few individuals living three years after its onset. Perhaps one of the more exiting discoveries made as we go forward is that of Watson and Crick. In the mid 1950's they described the structure of DNA. More recently, we are uncovering the genes responsible for many debilitating conditions. And with this understanding we are answering with treatments that specifically attack, inhibit or neutralize molecular disease pathways.
Perhaps one day researchers will find the gene or pathway responsible for regulating or normalizing sweat glands that don't seem to know the difference between on and off. Back to hyperhidrosis and matters related to sweating after the holiday. Happy Easter!
| |If you haven't already heard you will be hearing more about 'stress sweating' otherwise called psychological sweating. As the name implies, this is a sweating response to anxiety, emotion and /or pain. Large antiperspirant manufacturers are begining to talk about stress sweating as they introduce products in attempts to carve out a new niche in the antiperspirant / deodorant marketplace. | |
Malodour is the product of certain strains of skin surface bacteria that thrive off apocrine sweat. The more of these bacteria reside on your skin (heavy bacterial load) the greater the likelihood of malodour
Makers of antiperspirants will claim that stress sweat is smellier than ordinary sweat brought on by the body's response to excess heat. In an attempt to cool off, the brain's thermoregulating centre will signal eccrine glands to produce sweat. In turn, sweat will reach the skin's surface, evaporate and dissipate heat in the process. This sweat is principally water and electrolytes like sodium and potassium - an odorless product. In contrast, psychological or stress sweating relies on a different mechanism. Under stressful situations, powerful nervous system stimulants called catecholamines (pronunced: kata-kol-a-meens), adrenaline being an example, are released and a number of reactions ensue. Among the many reactions are dilating pupils, a racing heart, fast paced breathing, and breaking into a sweat. This type of sweating is largely activated through your aprocrine sweat glands. Sweat originating from the latter has a different composition from that derived from the eccrine glands. Sure, it is water based, but it contains large molecules called lipids and proteins.
| |The bad odor story starts here. These lipids and proteins get digested by skin surface bacteria which result in smelly by-products. That being said, in and of itself, the apocrine sweat is odorless. The cause of the odor is the residing microscopic creatures we call bacteria. As such, a stress sweat antiperspirant may not be necessary under good hygiene practices. It depends on your so-called bacterial load - if your skin surface has a lot of bacteria your will be prone to malodorous sweat. Less so, if you have fewer bacteria or a light bacterial load. | |
The ' love to smell bad ' bacterial trio: Corynebacterium, Propionibacterium and Staphylococcus epidermidis
The bottom line is don't be fooled by advertising that makes the association between stress and smelling bad. Most of us have some form of stress in our lives, and that, on a daily basis. Does that mean we all need to be on a stress sweat antiperspirant? I don't think so. It really comes down to an individual decision. If you shower on a daily basis and put into place some anti-stress strategies, chances are your underarms may not need anything or at most just a regular and less costly 'stress-free' antiperspirant.
Check out the promo videos below - lots of hype. Is a new ligitimate market being created? Or, is this just a lot of balony? Any thoughts?
| |If you have been living with excessive sweating or focal hyperhidrosis for some time, chances are you may have or currently contemplating a surgical solution. Hopefully you have tried other options as surgery is recommended only as a last alternative treatment. You should also be aware of the potential drawbacks associated with surgery before you commit to this option. | || |A recent study* in the UK followed up on a number of individuals having had surgery in efforts to rid themselves of their excessive sweating problem. The study involved 45 people (34 females) and the follow-up occured three and a half years after the surgical procedure. Twenty patients suffered with hyperhidrosis in a combination of regions, 14 in the axillae (underarms) alone, 9 palms alone and 2 with facial involvement. The good news is that almost 70% of individuals reported complete dryness or a significant improvement in their condition (i.e. not necessarily completly dry). Fifteen reported a substantial improvement in their quality of life.
The bad news is that a signifcant proportion, more than 9/10 people, developed compensatory sweating. More than half (27/43) had to change their their clothes more than once daily. The compensatory sweating was graded as severe in 18 of 43 individuals and 2 people rated their sweating as incapacitating.
In a few patients, 5/43, the compensatory sweating had improved over time. Here is the bottom line: 26/43 or 56% of the patients said that they would recommend surgery (thoracoscopic sympathectomy) to others with hyperhidrosis. If you are thinking about surgery, make sure you are well informed. Talk to health professionals and if possible to others who have had the procedure. Ask your surgeon about his/her experience with the procedure (e.g. how many procedures he/she has done, success rate, possible complications during and after the procedure etc.). Your surgeon should know the answers to all your questions. You want to be as informed as possible before you decide to have a surgical procedure.* Currie AC et.al. Int J Surg, 2011;(9)5:437-9.
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Tell others about your experience if you have had surgery....it would be great to hear from you! Click on the icon and fill in our seven multiple choice questions. Not too worry, answers are 100% anonymous. Once we have received a few we will share results!
Palmoplantar hyperhidrosis has been traced back through three family generations. Probably more for some folks - they may just not be aware.
| |There is mounting evidence that demonstrates that primary or focal hyperhidrosis is an inherited condition, at least in some individuals. A Japanese research group asked themselves whether excessive sweating related to the hands and feet (palmoplantar hyperhidrosis) is passed along between individuals within families. | |Over the course of a two year period, researchers have surveyed over 400 people with palmoplantar hyperhidrosis. More than one-third (36%) of these individuals had a family history of hyperhidrosis. When compared to the group that had no family history, there was no difference in terms of gender, sweat volume, or the age of onset of the condition. With respect to patterns of incidence within families, more than half (58%) had a parent-child link, while about one-fifth (18%) of the occurences were related to siblings. Some individuals had deeper roots with 13% having a family history that was sourced from three generations. Having said this, these numbers may even be underestimated given that we are not always fully aware whether our ancestors had particular traits or conditions. Feel free to leave a comment if you think your condition was inherited. Better yet if several generations are involved.