Continuing our appointment with Dr. Maurizio Nudo. Today he will talk to us about Hyperhidrosis, Bromhidrosis, and Anhidrosis
A natural thermoregulator
This is the main function of sweat, which is responsible for ‘resetting’ the body temperature whenever an exogenous factor, such as physical exertion or excessive energy expenditure, environmental factors like significant temperature fluctuations, as well as endogenous factors including tension states and/or emotional factors, cause a significant increase in body temperature compared to the physiological 36°C on which the body is naturally ‘programmed’. Like a cooling system, even in the body, some ‘contacts’ in the correct mechanism of sweating can be skipped for reasons still to be clarified, causing the normal production of sweat to turn into massive quantities. And it becomes pathological when conditions of hyperhidrosis, bromhidrosis, or anhidrosis occur, each accompanied by implications, in addition to physical-aesthetic, also socio-relational and on the quality of life.
The mechanism
The forehead beading with sweat drops, hands getting wet, armpits, or feet sweating under the impulse of various states and conditions: all within the norm, almost always. “In the process of sweating – explains Dr. Maurizio Nudo, head of the dermatology unit at Humanitas Castelli di Bergamo – various types of sweat glands are involved: eccrine, mainly represented on the palm and sole surfaces, and apocrine, present to a greater extent in areas of the face, chest, and back. The latter also connected to sebaceous glands and all governed in their function and activity by the sympathetic or autonomic nervous system, clarifying that sweating is self-determined: it regulates and activates independently of our will.” Some control is possible: neither when sweat restores well-being to the body, bringing the temperature back to normal when it has risen due to some cause, nor when it generates embarrassment, with excessive exudative manifestations. As in the case of hyperhidrosis: “For the most part – continues the expert – it is essential hyperhidrosis, a condition that usually starts from a young age and implies the production of excessive sweat without specific causes. It more frequently affects the palm and armpit area with variable manifestations from mild to moderate, with more or less intense humidity conditions, up to severe forms with a real dripping of sweat, so much as to be disabling for the difficulties and discomfort it causes in interpersonal relationships, especially. Hands, in fact, are more exposed than any other part of the body to interpersonal contact, on occasions of professional and social life. Neither less ’embarrassing’ is the formation of drops on the forehead or wet patches on clothing due to excessive armpit or groin sweating. There is also secondary hyperhidrosis that can be associated with or be a symptom of certain pathologies: for example, malfunctioning of the thyroid, in forms of hyperthyroidism, alterations of the endocrine system, some types of neoplasms such as prostate cancer and lymphomas when sweating is nocturnal, psychiatric illnesses, metabolic disorders such as obesity. This condition can also be typical expressions of physiological states such as menopause, which induces profuse sweating especially in the central sternal and dorsal region, or be a consequence of specific therapies including hormonal therapy. Therefore, hyperhidrosis, after the correct patient history, can represent an ‘element’ of differential diagnosis.” Another variable can worsen this clinical picture: the onset of bad odor, characteristic of bromhidrosis, due to an alteration of the skin’s pH, which, strongly acidic, releases pungent odors. “The parts most affected by bad odor – continues Nudo – can be the armpits, the perineal region, more specifically the areas around the anogenital region especially in particular physiological states, for example in women during or the period preceding the menstrual cycle with the complicity of hormonal alteration, but also the hands and feet.” Science has investigated the manifestations of sweat, defining that when it reaches the skin surface it is very likely odorless; in this case, it would be attacked by bacteria hosted on the skin or in the body of different species depending on whether the sweat is produced by apocrine or eccrine glands, which in turn produce “volatile” chemical fragments that do not smell. In some cases and sites, such as for hands, for example, maceration of keratin induced by excessive sweating or in the case of feet, the interaction of the humid environment and the materials with which shoes are made, especially if rubber, or socks if made of acrylic, synthetic, or sponge fiber that, by retaining and creating a humid environment, favor not only the production of bad odor but also the formation of athlete’s foot, or the development of intertrigo from Candida, a saprophytic guest of the skin. Instead, at the opposite extreme, anhidrosis can occur: the absence or reduction of sweating. “This condition – clarifies the dermatologist – can also affect one or more areas of the body, mainly the palm and sole surfaces, on which a blistering dyshidrotic eczema manifests itself. Sweat glands, instead of expelling sweat to the outside, retain it, forming microbubbles that, by merging with each other, peel the skin like that of a snake. This condition feeds the formation of real desquamative dermatitis that upsets the skin mantle, promoting the triggering of strongly inflammatory and desquamative phenomena.” Even in the case of anhidrosis, there may be underlying pathological conditions, including ichthyosis, Fabry’s disease, Hashimoto’s disease, Parkinson’s disease, psoriasis, scleroderma, Horner’s syndrome, amyloidosis, multisystemic atrophy (MSA), small cell lung carcinoma, dermatitis, diabetes, skin infections, hypothyroidism, Ross syndrome, Sjögren’s syndrome, genetic syndromes, traumas, use of medications. Therefore, the diagnosis by an expert is essential for the correct clinical framing and the adequate therapeutic setting.
Therapeutic options
The therapeutic approach, from more conservative solutions, to the use of dedicated therapies up to resorting to surgery, is guided by the severity and extent of the phenomenon. “In case of hyperhidrosis – specifies Nudo – especially if it affects adolescents or young adults, treatment begins with a topical treatment with antiperspirant drugs based on 20% aluminum hydroxide in the form of creams or powder to be dissolved in water making packs on the affected area, alternatively, acetate can be used. In the case of more severe forms, moderate to severe, specific techniques such as radiofrequency can be used. The treatment is delivered through a special machine equipped with two manipulators, one unipolar and the other bipolar, used alternately each for 10 minutes. Sweat glands subjected to a continuous low-intensity current are somehow ‘defibrillated’: this action induces a balance of the positive pole and the negative pole of the sweat glands and the restoration of their correct functioning.” Among the conservative solutions, botulinum toxin is also included: “The treatment is indicated in axillary hyperhidrosis – comments Nudo – and involves the injection of the substance diluted by means of 10-15 small punctures with very thin needles, evenly distributed in the area. This induces the blocking of synapses that connect the nervous system and the terminal sweat glands, thus reducing visible symptoms within 7-10 days from the end of treatment with results maintained over time for about 5-6 months and a significant improvement in the quality of life.” Treatment of axillary hyperhidrosis with botulinum toxin is contraindicated in case of allergy to the toxin or to the components of the preparation, in pregnancy or breastfeeding, in patients with various types of muscle diseases and ongoing therapy with muscle relaxant drugs, or in case of previous surgical interventions in the axillary cavity. Mild side effects such as tiredness, fever, and muscle pain may occur, which resolve within a few days. Furthermore, the treatment is not suitable for plantar and palmar surfaces, highly sensitive areas due to the presence of very superficial receptors that would make injections rather painful. Finally, in the case of severe forms, surgery is resorted to: the intervention, under general anesthesia, involves the resection of the sympathetic system (sympathectomy) and the positioning of clips in specific sites: facial, axillary, or plantar. While therapy for bromhidrosis, in addition to some practical and personal hygiene advice, mainly resorts to the use of antiperspirant drugs and, where indicated, botulinum toxin. Finally, for anhidrosis, if the cause of the absence of sweating is associated with a specific drug, it will be possible, under medical advice, to proceed with the modulation of the dosage or with other therapy recommended by the expert and according to the cases.
Lifestyle
Acting preventively on sweating disorders is not possible, the solution, alongside targeted therapies, is to adopt correct behaviors in everyday life that limit the symptoms as much as possible: “For personal hygiene – Nudo recommends – weakly acidic detergents should be used in the acute phase to avoid ‘attacking’ and drying the skin, alternating with oily-based detergents to deeply moisturize the skin. In addition, and in the case of bromhidrosis, under medical prescription or on the advice of the pharmacist, a ‘key’ figure in managing the problem is the use of aspersive powders, inert, which keep the skin dry, preventing bad odor. Instead, classic talcum powder should be avoided, even mentholated, as they may worsen the clinical picture.” Regarding clothing, light-colored garments, preferably white, in natural fiber, preferably 100% cotton, are recommended, avoiding wool, acrylic, and elastic fibers that accentuate sweating and favor bad odor. As for socks, cotton ones should be chosen, white in color to be kept in contact with the skin, possibly overlapping (for a purely aesthetic effect), with a dark sock always made of cotton. In case of sports activities, sponge socks should be avoided as they create humidity, therefore hyperhidrosis and bad odor, a fertile habitat for the onset of fungi and mycoses. “Finally, regarding diet – concludes Nudo – there are no scientific demonstrations for or against the consumption of specific foods. However, it is advisable to reduce fatty foods and limit the use of spicy spices and flavors, such as garlic and onions, which could favor a modification of the skin’s pH and accentuate bromhidrosis”.
➡️ Thanks to Dr. Maurizio Nudo for the contents
➡️ For information ➡️ https://maurizionudo.it/
Ig – @fairness_mag
