DISEASE

DEFINITION  Localized idiopathic hyperhidrosis is a non-generalized excessive perspiration without a known cause.

 

EPIDEMIOLOGY  The targeted population is usually young, starting puberty. Relatively high frequency (125,000 cases a year in France alone).

 

CLINICAL SYMPTOMS   This is a real disease, often misunderstood.

 

1 - EXCESSIVE PERSPIRATION

 

2 - LOSS OF HEAT to the skin of the hands and feet, which will stimulate the sympathetic nervous system and worsen the hyperhidrosis symptoms.

 

3 – EMOTIONAL EFFECTS

It is absolutely not an illness caused by the psyche.

But hyperhidrosis can have consequences.

People suffering from hyperhidrosis often desperately try to conceal their disorder using a plethora of systems. From constantly carrying tissues to changing one’s socks and shoes multiple times a day, up to total social avoidance.

The emotional impact is usually most important with teenagers.

In our society, a physical disorder such as this one can be a great social handicap. 

Plantar hyperhidrosis (feet) can often cause awkward social situations because of the bad odors associated with it.

But it is mostly palmar hyperhidrosis (hands) that causes the greatest social handicap, the handshake being an omnipresent and inevitable tool in daily social interactions.

However, studies in the field of psychology did not show a significant statistical increase in anxiety levels in people suffering from hyperhidrosis.

 

4 – PROFESSIONAL HANDICAP

Palmar hyperhidrosis can cause a real handicap for people working in human relations, or having a “hand-on” profession.

This can be a very disabling condition, to the point where it can impossible to even hold a pen.

Many different professions can be affected by a serious palmar hyperhidrosis: office work, arts, electronics, metal and clockwork craftsmanship, music, students, etc… 

 

5 – ASSOCIATED DERMATOLOGICAL SYMPTOMES

-  Dyshidrosis :  The appearance of small blisters or vesicles on the edges of the fingers can often be associated with hyperhidrosis. 

- Acrocyanosis :  Quite frequently associated with hyperhidrosis and tends to worsen it. This is a permanent but non painful and uniform blue discoloration of the extremities, of variable color and intensity. Usually come with an arterial deficit. 

A capillaroscopy of the nail bed can diagnose the acrocyanosis by revealing cyanosed capillaries that can be dilated or ramified and a slowed down circulation.

- Infections: fungal or bacterial, especially on the feet due to them constantly basking in humidity  

- Bromhidrosis : This symptom is defined by a foul smell in the sweat coming from decomposing bacteria. 

 

TOPOGRAPHY

Hyperhidrosis is usually bilateral (both sides)

The most affected organs are the palms of the hands, followed by the soles of the feet, followed by the armpits. 

More rarely, the neck, trunk, legs and face are affected as well.

It happens that it is the palm of the hand as well as the fingers that sweat the most.

It is hence unusual to find a foot as badly affected as a hand.

           - Palmo-plantar hyperhidrosis: high frequency

           - Axillary hyperhydrosis : due to the hyper-reactivity of the eccrine sudoferous glands. Apocrine glands aren’t responsible for that which explains the usual absence of odor from this type of sweating. Only 25% of patients affected by an axillary hyperhidrosis suffer from a palmo-plantar hyperhidrosis. 

 

FACTORS INFLUENCING HYPERHYDROSIS 

-Palms and soles don’t sweat during sleeping or sedation. 

-Sweating is not increased by raising the outside temperature.

-Excess sweating is mainly caused by emotional stress.

 

DIFFERENTIAL DIAGNOSTIC

If the diagnosis for essential hyperhidrosis is an exclusion diagnosis, it will not be a difficult clinical case. The very numerous causes of secondary hyperhidrosis are usually present with evident clinical characteristics. 

In practice, a bilateral palmo-plantar hyperhidrosis stimulated by emotional stress in a healthy teenager will leave no doubt as to what the diagnosis is.