A recent Brazilian study* looked at whether individuals with focal hyperhidrosis (FHH) are more likely to be anxious and depressed than the general population. Almost 200 people were recruited for this study so the results are quite reliable. 
Half (49.6%) the individuals with FHH were considered anxious while 11.2% were depressed. While the prevalence of anxiety is increased in FHH, it is not of depression. 
Interestingly, the prevalence of anxiety is greater in axillary (or underarm) and craniofacial hyperhidrosis. Anxiety tends to affect about 16% of the population. So, individuals with excessive sweating are at least three times more likely to have some form of anxiety than those without hyperhidrosis. 
The study also determined the degree of severity in those suffering from anxiety. While 
about half had mild anxiety, a little more than one third had moderate anxiety. Severe forms of 
anxiety were identified in 10%. 
For more information, go to our Social Anxiety Disorder and Hyperhidrosis page.
* An Bras Dermatol. 2014
 
 

In previous posts we reported on studies related to surgical interventions including their outcomes and satisfaction rates as assessed by individuals undergoing these procedures ( see Feb 2014 / March & May 2013). A recent study* looked at similar parameters but over a much longer time horizon. Medical researchers from the University of Alabama interviewed almost 200 individuals that underwent thoracoscopic sympathotomy.  
A little over three quarters (77%) reported 'clinically bothersome' post-surgical compensatory hyperhidrosis (CH). However, this rate decreased over time. The rate of CH decreased to an average of 35% after 5 and 12 years post-operatively. This is still a significant number - about one-third of individuals having had surgery essentially 'relocated' their region of excessive sweating. Granted the relocalized region may be less bothersome than their initial or pre-operative site of excessive sweating. A smaller number of individuals, 6.2%, regretted having the operation in the first place.
These results are worth bearing in mind, particularly if you are contemplating a surgical option. While you may get relief from the site that is affected, it is likely that you will develop hyperhidrosis in another site. Knowing this up front will help you better manage the disappointment if you happen to be one of those individuals that ends up experiencing compensatory hyperhidrosis.
* Bryant AS, Cerfolio RJ. J Thorac Cardiovasc Surg, April 2014
 
 
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A recent German study demonstrated that individuals with hyperhidrosis tend to be more chronically stressed and 
depressed than the general population. Those with 
hyperhidrosis scored higher and therefore had greater 
association with stress attributes such as 'lack of social recognition', 'chronic worrying', and 'excessive demands from work'. 

These attributes scored particularly high in those with axillary hyperhidrosis. This same group of individuals was also associated with additional stress attributes such as 'work discontent' and 'social overload'. There was a similar trend related to depression, again showing a greater propensity (higher depression scores) for depression among those with hyperhidrosis. As many as sixty percent of 'excessive sweaters' showed significantly higher depression scores compared to 10% of those in the non-hyperhidrosis group.
The authors of the study do make a point that individuals with hyperhidrosis often develop their condition at an early age - these are formative years that are particularly sensitive to changes and disturbances in the development of esteem and identity.


Next Month: a look at satisfaction rates 5 years after surgery 
 
 
Do men sweat more than women? Turns out that, in general, men do sweat more. And, at a faster rate to boot. From an  evolutionary  perspective, men developed a more efficient way to cool off given that they were more physically active (don't get me wrong here - we are talking way back in time). For example, they were more likely to be outdoors involved in activities such as hunting. Greater exposure to heat and a more active lifestyle helped develop a more efficient means of reducing body temperature when needed. 


On the other hand, women tended to be engaged in relatively less physically demanding activities (e.g. rearing of children, etc.) and as a result evolved to sweat less then men. While this may seem more appealing to some, sweating less does come with a few drawbacks. Women tend to be at greater risk of heat stroke or exhaustion. Their smaller body size/surface area along with a less efficient cooling mechanism makes them at greater risk of dehydration. 
 
 
Endoscopic thoracic sympathectomy (ETS) is a surgical procedure that helps to reduce the production of sweat in individuals that have focal hyperhidrosis, particularly in the palm and sole regions of the body. 
A group of medical specialists decided to look at whether this procedure is associated with any emotional outcomes in those that underwent ETS
Results were collected from 86 patients using specific questionnaires before and three months after the procedure. The research* showed that women are likely to have more crying episodes after having undergone ETS. This tendency was not observed in men. Unfortunately, there is no rationale or theory provided that explains this observation. 
* Stefaniak T, et. al. Innov Clin Neurosci 2013
 
 
A recently published study* provides evidence that surgery or endoscopic transthoracic sympathectomy - E.T.S. (the usual procedure used to surgically arrest excessive sweating) is somewhat disappointing in treating plantar hyperhidrosis
An Italian group of researchers examined the results of 41 individuals undergoing this procedure for palmar and axillary hyperhidrosis. More than half (26 individuals or 63%) were also affected by excessive sweating of the soles. 
The condition affecting their feet improved in 14 individuals, that is, about half. This improvement was partial in 80% and resolved in 20% of these individuals. In other words, only about 1 in 5 people with plantar hyperhidrosis opting for surgery will have a successful result. Also keep in mind the significant possibility of developing compensatory sweating, secondary to surgery.  
* Paliogiannis P, et.al.  Ann Ital Chir. 2013 Jul 28;84. pii: S0003469X1302126X. [Epub ahead of print]


Next Month: the influence of thoracic sympathectomy on the tendency to cry. I don't make these things up, I just report them! 
 
 
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A new surgical technique is using the umbilicus, better known as the belly button, as a port of entry for a procedure to help fight excessive sweating. While the surgery, known as thoracic sympathectomy is not new, the access to the nerves that control the excessive sweating certainly is. 
In a study published last month*, Chinese researchers describe their novel technique as well as the results from patients post-surgery. While general anesthesia was still required, only a small 5 mm incision was performed. 
The study involved a total of 35 individuals and results were determined one year after the surgical procedure. The success rate was higher for palmar (hand/palm) than axillary (underarm) hyperhidrosis (97% vs 72%).  

While quality of life improved and most were satisfied with the results, compensatory sweating remained a problem in close to 30% of individuals. Compensatory sweating is a condition often associated with thoracic sympathectomy. While the surgery is able to curb the sweating from a specific region (e.g. palms of the hands), it will develop in another area such as the groin. Feel free to visit our page on compensatory sweating for more information on this condition.
Zhu, LH et. al. J Thorac Cardiovasc Surg, 2014

Next month, we will have a closer look at a very interesting Austrian study. It follows sympathectomy individuals over the course of 5 years. 
This group of individuals actually developed recurrences of their condition....more on this in our next edition of Sweating Matters. 
 
 
Hard to believe, but localized excessive sweating or focal hyperhidrosis is a condition that is grossly undertreated. Despite its impact on lifestyle, individuals with excessive sweating are unlikely to seek treatment. In recent study in Japan confirms this. A survey was conducted in 20 schools and companies among a large number of people aged 5 to 64 years of age. 
Almost 6000 responses were analysed. A little over 5% reported palm hyperhidrosis, while 2.8%, 5.8% and 4.7% reported excessive sweating of the feet, underarms and head/scalp respectively. What is more alarming is the fact that only 6% had seeked some form of treatment. This was also corroborated in a large survey of 150,000 households in the US. Authors of this survey cited the fact that individuals were unaware that their condition was treatable. 
.
The truth is that many treatments are available. Like all medical treatments, pros and cons are associated with these. Some are more effective, some cause more adverse reactions, and some are more expensive. Don't let cost misguide you into thinking that a higher spend will result in a more effective treatment. For a quick comparison different treatments, feel free to visit our Pros and Cons page. 

Happy New Year to all our Readers!
 
 
Unless you're a healthcare professional, you probably are not aware of the serotonin syndrome. Pharmacists in particularly familiar with the syndrome and screen patient medication profiles for potential occurences. Serotonin is a naturally occuring substance responsible for signaling between neurons or generating impulses that travel throughout the nervous system. Serotonin is involved in processes such as gastrointestinal motility, uterine contractions, bronchoconstriction and thermoregulation to name a few. 

Many drugs such as antidepressants work by increasing the availability of serotonin within the brain and nervous system. This can become problematic when one or more drugs that cause increases in serotonin are taken together. Excessive increases in serotonin can lead to unwanted adverse reactions such as agitation, tremor, muscle rigidity, hyperthermia, flushed skin and excessive sweating

In rare or more severe cases, the syndrome can actually be life-threatening. Drug classes implicated in this syndrome include antidepressants (e.g. fluoxetine, paroxetine, venlafaxine), analgesics (e.g. meperidine, tramadol, fentanyl), lithium, cough preparations containing dextromethorphan (e.g. Benylin DM), and St John's wort. The elderly are particularly more prone to this syndrome if dosages are not adjusted accordingly. Fortunately, the condition and its symptoms are easily managed by discontinuing the involved medications. The syndrome can also be reversed with antidotes (e.g. cyproheptadine). 
 
 
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Granulosis rubra nasi. The medical term for an excessive sweating condition limited to the central part of the face, particularly the tip of the nose. As such, it is also referred to as 'hyperhidrosis of the nose'. It is also characterized by skin redness over the nose, cheeks, chin and upper lip. It's an inherited condition that more frequently appears in children (as early as 10 months of age) but can also be seen in adults. There are no statistics related to its prevalence but we do know that it is a relatively rare sweating disorder. 

Thankfully the condition usually resolves at puberty, but is some cases, it can last into adulthood. In many individuals, hyperhidrosis of the palms and soles is also present. Granulosis rubra nasi can be confused with other conditions such a s lupus erythematosus and rosecea, so it is important to consult a healthcare professional to confirm the correct condition.
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A typical case of granulosis rubra nasi. Its incidence peaks between the ages of 7 to12 and usually resolves at puberty
 
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