2. Our bodies have two to four million sweat glands, most of
which are eccrine glands. It is found in almost all regions of
skin; their highest density is in the axillary region, on the palms
of the hands, and on the soles of the feet. They produce (odorless)
sweat that reaches the surface of the skin through coiled ducts
(tubes). Eccrine Glands
3. As sweat evaporates from the skin, the body cools, hence,
their main function is thermoregulation
4. Most of the apocrine glands in the skin are found in the
groin, aound the nipples and in the armpits These scent glands
become active during puberty and secrete a viscous fluid. They are
responsible for a persons "personal," occasionally unpleasant, odor
Apocrine Glands- (Scent)
5. Apo-eccrine Gland They develop during puberty from eccrine
like precursor glands and contribute heavily to overall axillary
sweating They are functionally and pharmacologically distinct from
apocrine glands
6. GENERALIZED HYPERHIDROSIS FOCAL HYPERHIDROSIS Excessive
Sweating or Hyperhidrosis
7. Excessive Sweating or Hyperhidrosis
8. Excessive Sweating or Hyperhidrosis Generalized congenital
acquired
10. Thermoregulatory sweating Thermoregulation is important to
maintain an even body temperature and thus homeostasis. It is
regulated by the sympathetic nervous system
11. . . Serves as a physical "feedback" signal Emotional
Sweating It is regulated by the neocortical and limbic centers
Maintains the trophic functions of the palms and soles
12. Is Hyperhidrosis Harmful?
13. 1-Social Embracement
14. Unpleasant Odor associated with axillary or plantar
hyperhidrosis is caused by the interaction of sweat and micro-
organsims Osmidrosis
15. Only sweaty clothes that are not changed that may become
smelly
16. 3.Skin Irritation & Diseases Hyperhidrosis
17. What are my Options?
18. Diagnosis and Management of Hyperhidrosis Medical History
Physical Exam Laboratory Test Gravimetry Evaporimetry Minors starch
iodine
19. SWEATING TURN BLACK PAINTING IODINE SOLUTION AREA ARE
MARKED STARCH Minors starch-iodine test Sweat Turns Black
20. The starch-iodine combination turns a dark blue color
wherever there is excess sweat
21. MINORS STARCH-IODINE TEST Assess the size of the surface
area involved, but it does not give any indication on severity
22. Routine photography of the starch- iodine can assist in the
follow-up
23. General Tips and Advice on Lifestyle Changes 1
24. Use a bland soap substitute such as an emollient
(moisturizer) ointment or cream General Tips and Advice on
Lifestyle Changes
25. If possible, avoid triggers, which can make things worse
such as heat or spicy food General Tips and Advice on Lifestyle
Changes
26. AVOID FABRICS MADE OF SYNTHETIC FIBERS SUCH AS LYCRA AND
NYLON
27. WEAR LOOSE CLOTHING UNDER THE ARMPITS
28. Avoid clothes that more easily show up sweat marks
29. AS A RULE, WHITE AND BLACK COLORED CLOTHES ARE LESS
NOTICEABLE
30. Wear loose clothing under the armpits or Dress a Sweat
Shields
31. FOR SWEATY FEET
32. Change your 100% cotton socks at least twice a day
33. USE AN ABSORBENT FOOT POWDER TWICE DAILY
34. BUY SHOES THAT ARE MADE OF LEATHER, CANVAS OR MESH, RATHER
THAN SYNTHETIC MATERIAL
35. AVOID SPORT SYNTHETIC SHOES
36. . Antiperspirants reduce the release of sweat, while
deodorants mask unpleasant smells
37. Treatment Options for Primary Focal Hyperhidrosis
38. Primary Focal Hyperhidrosis Topical AC Iontophoresis Botox
Oral Medications ? Surgery
39. Underarms Hands Feet face Antiperspirants are considered
the first line of treatment 2
40. Anti-prespirants (Clinical Strength) Over-the-counter
antiperspirants are now available in different strengths with
clinical strength products offering the most sweat protection
2
41. THE MOST WIDELY USED ACTIVE INGREDIENTS IN ANTIPERSPIRANTS
ARE METALLIC SALTS 2
42. 2
43. When your body senses that the sweat duct is plugged, a
feedback mechanism stops the flow
45. Glutaraldehyde solution 2% as Cidex, is not as effective
but less staining than10% dilution
46. 0.5% glycopyrrholate, an anticholinergic substance, may be
applied topically Gustatory Sweating
47. Intra-dermally 1.2-1.5 cm anhidydrosis Last 4-12 Month
4-Botox
48. How To Do It?
49. 1.5 to 2 U/cm2 with a mean dose of 100 U per palm increased
to 150U
50. . 1.5 to 2 U/cm2 with a mean dose of 150U per sole
increased to 200Usole
51. It is recommended to use the Minor iodine- starch test to
guide the range of injections
52. Occlusive wrapping is applied after Botox to enhance
absorption
53. Prevents calcium-dependent release of acetylcholine and
produces a state of denervation of cholinergic nerves in the sweat
gland
54. Injections of botulinum toxin must be repeated at varying
intervals to maintain long-term results
55. Botox Sweating Shields Focal Anal Hyperhidrosis Botox
intradermal injection of 1U /cm2 with an average dose of
40U/patient is effective therapy
56. Iontophoresis Water iontophoresis is the method of choice
for the initial treatment of palmar and plantar hyperhidrosis
4
57. 4 Iontophoresis Treatment involves putting the affected
areas (usually hands and/or feet) into a small container filled
with tap water with backing soda or anticholinergic
58. Reversible disruption of the ion transport in the secretory
tangle of the sweat glands, possibly owing to accumulation of
protons in the sweat gland ducts
59. Effective in up to 81% of patients Each treatment session
lasts 20-40 minutes At least three times per week Most people see
an improvement after 6-10 sessions . A maintenance treatment
required once every 1-4 weeks Iontophoresis4
60. Take a pill and Stop Sweating is not for every case 5 Oral
Medication
64. Surgical Treatment of Hyperhidrosis Endoscopic Thoracic
sympathectomy Endoscopic Lumbar sympathectoy Liposuction of
axillary sweat glands Ultrasound Laser Power 6
65. 6 ETS or VATS Only in severe unresponsive patients Not for
isolated armpit sweating only ?Surgical Risk Compensatory
Hyperhidrosis Endoscopic Thoracic Sympathectomy
66. . . Plantar hyperhidrosis Patients failed to response to
ETS The success rate is about 97% Lumbar Sympathectomy
67. Other Local Surgical Treatment of Axillary Hyperhidrosis
(AHH) (i) excision of subcutaneous glandular tissue only (ii)
excision of skin with its glandular tissue attached (iii) selective
sweat gland ablation using superficial, power, ultrasonic, laser ,
radiofrequency, and microwave
68. Ultrasound Power-Assisted Tumescent Liposuction of Axillary
Sweat Glands
69. Microwave Assisted Thermolysis (miraDry) Microwave
technology is well suited for targeting axillary sweat glands It
causes noninvasive focused heating of the tissue at the depth of
the axillary sweat glands with resulting thermolysis of sweat
glands It is not yet optimized for other areas such as palms and
soles
70. Microwave Assisted Thermolysis (miraDry) It is performed in
the physician's office and typically takes one hour. Local
anesthesia will be administered before starting Patients usually
experience little to no discomfort during the procedure and there
is minimal to no downtime afterwards.
