Hyperhidrosis

by developmentdruttamspecial | May 6, 2021 | Blog

It is normal to sweat during summers. But some people tend to sweat much more than average not only in summers but even during cold weather, and this can be very problematic.

Today, we’re going to discuss about Hyperhydrosis. Excessive sweating, in scientific terms is called Hyperhydrosis. We’re going to discuss its causes, medical treatment and finally, what are the home remedies available for hyperhydrosis. So, lets start.

Sweating is usually good for our body. For example, if our body is at a higher temperature than normal, the excess heat is released through releasing water from the body (in the form of sweat). And not only that, waste materials such as urea, ammonia are also excreted through sweat. So, if a person is not sweating normally, he/she has a high risk of suffering from Heat stroke.

But if someone sweats excessively, it becomes a cause of social embarrassment for them. Sometimes, due to excessive sweating, people cannot shake hands with others in public ; children face problems while writing in the examination ; or if there is excessive sweating from the axilla (armpit), the clothes tend to stain and smell bad.

What causes excessive sweating?

In medicine, we classify Hyperhydrosis into two types, Primary hyperhydrosis and secondary hyperhydrosis, both of which are explained below.

1.  Primary hyperhydrosis

In primary hyperhydrosis, there is excessive sweating without any cause. Normally, we sweat excessively when we do exercise or if we have fever. But in primary hyperhydrosis, the person will start sweating even when they are just sitting. This mainly affects the palms, soles of the feet, the underarms, or even the face, but not the entire body.

Now, why does this happen. There are sweat glands present all over out body and there are nerve supplying these sweat glands. In primary hyperhydrosis, these nerves in the affected areas  are overactive, that is, our body sends more signals to these nerves, which causes excess release of sweat from the sweat glands in these areas.

In most people Primary hyperhydrosis is seen, which means sweating without any cause.

2. Secondary hyperhydrosis

The second type is called Seconday hyperhydrosis. In this type, due to some disease (secondary cause), there is excessive sweating from our body.

Now, the diseases that can cause excessive sweating are as follows :-

• Thyroid disease – Hyperthyroidism can cause excessive sweating
• Diabetes
• Obesity
• Stress
• Anxiety
• Gout – excess uric acid in our body causes gout
• Tuberculosis
• Cancer – for example Hodgkin’s lymphpoma causes excess sweating

The first thing to do if you suspect a case of hyperhydrosis is to consult a dermatologist, who will be able to differentiate if it’s a case of primary or secondary hyperhydrosis.

There are some normal tests that are done to find if there is any secondary disease causing the excessive sweating, such as Thyroid tests or Uric acid tests or blood tests.

If no cause is found, it is diagnosed as a case of primary hyperhydrosis. One way to confirm it is by the Iodine Starch test, which will be done by the doctor.

TREATMENT

In medical science, there are various ways of treating hyperhydrosis. Your doctor will have to examine you to determine the best possible treatment for your case.

Treatment generally includes :-

1. Anti-perspirant containing Aluminum Hydrochloride, in 10-20% concentration – The aluminum in aluminum hydrochloride replaces the sodium ions in sweat and reduces sweating. These are available as roll on and ointments.
2. Iontophoresis therapy – The hands and sols of the feet are kept in water for 30 minutes, through which low voltage current is passed. Initially, the therapy is done thrice a week, then as sweating gradually decreases, frequency is reduced to twice a week, then gradually once a week or once in fifteen days for maintenance therapy.
3. Botulinum toxin injection – Multiple small injections given in the affected areas, such as palm or sole, where it reduces sweating by inactivating the sweat glands in that area. Once injected, It remains effective for 6-12 months after first dosage, but with subsequent dosages, the effectiveness period increase greatly. This is a very effective method of treating hyperhydrosis but it is very expensive.
4. Microneedling RF – This procedure selectively inactivates or destroys our sweat glands and is very effective. But it is a very expensive procedure as well.

Are there any oral medicines available for hyperhydrosis?

YES, and they are

1. Glycopyrollate
2. Oxybutinine
3. Propanthelin

*However, these medicines have a side effect, which is, it causes dryness of mouth.

The mechanism by which these oral medicines act is by reducing the secretions from the sweat glands. But, they also decrease the oral secretions, such as saliva, which causes dryness of the mouth and throat. This is seen as dry lips and excess thirst.

Therefore oral medicines are usually prescribed only in severe cases and when there is excess sweating all over the body. It’s dosage is dependent on the body weight of the patient.

HOME REMEDIES

Some general measures that can be taken are :-

1. Take bath twice daily – Sweat, if accumulates can cause growth of bacteria and fungi, and this may lead to infection, such as boils or tinea(fungal infections).
2. Apply talc powder after bathing – powder blocks the pores of the sweat gland thus reducing their secretion to some extent
3. Roll on deodorant are better than spray – roll on deodorant contains wax which blocks the sweat gland and reduces sweat secretion. On the other hand chemical spray deodorants irritates our sweat glands and causes increased sweating.
4. Use ice on the face – in case of excess sweating from the face. Ice inactivates our sweat glands. Girls can also use compact after bath, as it contains talc, which blocks the sweat glands. Boys can use Alum(phitkari) which contains aluminum that reduces sweating.
5. If your armpits are becoming dark due to excess sweating, Mix Aloe vera gel with Tea tree oil and apply over the skin.
6. A paste of Luke warm water + Apple Cider Vinegar + Honey can be used over the armpit. This helps get rid of any bad smell and as well as lightens the skin.

Some additional measures that can be taken to prevent/reduce sweating :-

1. Wear loose cotton dresses
2. Eat less onion and garlic, and spicy foods as well.

Blog by: Dr. Uttam Kumar Lenka, Consultant Dermatologist. Kolkata.

Lichen Planus

by developmentdruttamspecial | May 5, 2021 | Blog

It is a type of skin disease in which granular rashes appear in the skin, with violet or purple papules, along with intense itching.

It’s not limited to our skin only, and it may also affect our nails, hair, oral mucosa as well as private parts of our body.

Types of lichen planus :-

1. The most common and classical type of lichen planus is that which affects the skin only. It can occur anywhere in the body but usually affects the flexor aspect of the body and the back. Occurrence in the face is uncommon.
2. Nail lichen planus – affects the nail, may or may not involve other parts of the body. The skin adjoining the nail grows over the nail bed. Or the nail may split in two.
3. Lichen planus hypertrophicus – the affected area of the skin becomes thick. It usually occurs in the leg and the severity of itch is so high that immediate treatment is required.
4. Linear lichen planus –the granules of the rash are present in a linear fashion. This is due to Koebner’s phenomenon, which means that the rash tends to spread along the lines of trauma (scratch), which flares up and worsens the condition This phenomenon is also seen is case of Vitiligo, psoriasis etc.
5. Oral lichen planus – Occurs in the oral mucosal membrane. It shows white lines in a net like pattern (reticular lichen planus) or ulceration in the oral mucosa (ulcerative lichen planus). The patient usually complains of burning sensation in the mouth and difficulty in eating.
6. Bullous lichen planus – It’s a rare case of lichen planus and is charaterized by presence of vesicles or bullae. Usually present in areas affected previously by lichen planus lesions.
7. Palmoplantar lichen planus – Usually occurs in the palm of the hand and feet. The skin becomes thick and starts to peel off after intense episodes of itching. It can have symptoms like eczema.
8. Lichen planopilaris – usually affects the skin where there is hair.  It destroys the hair follicle and then replaces it with scarring, resulting in permanent hair loss. Hence early treatment is required to prevent excessive hair loss.
9. Lichen planus pigmentosus – it is not associated with itching, but the skin of the face or the body gradually becomes black, due to hyperpigmentaion, that is, excessive release of melanin pigment. It takes many years, even 5 to 10 years to get cured

EPIDEMIOLOGY – It is equally prevalent in both males and females, and it can occur at any age.

CAUSE

The exact cause of lichen planus is not yet known. However, it is said to be an auto-immune disease, which means that our body’s immune system acts against our own cells, causing inflammation and rashes in the affected area.

Oral lichen planus have been known to be caused after dental filling.

Another cause can be side effect of various medicines, such as :-

• Anti-hypertensive medicines – which are used to reduce our blood pressure, such as Propranolol
• ACE inhibitors and beta blockers
• Antibiotics such as penicillin
• Anti malarial, such as hydroxychloroquine
• Diuretics
• Painkillers etc.

There are many such medicines which can cause rashes. Thus, while visiting a dermatologist, it is recommended to carry your old prescription with you, as your past history of medicine intake can reveal a lot about your condition.

DIAGNOSIS

Usually, lichen planus can be easily diagnosed by clinical examination by a dermatologist, or with the aid of a dermatoscope.

For confirmation, a skin biopsy test can be done, in which a sample of the skin in the affected area is collected and observed under a microscope.

Other skin disease which presents similar symptoms as lichen planus and can be confused with it are :-

1. Psoriasis / Guttate psoriasis / Plaque psoriasis
2. Pityriasis rosea
3. Syphilis

TREATMENT

In case of localized lichen planus lesion, creams and ointments are given for treatment.

Medicines may include :-

• Anti itching / soothing creams
• Steroid creams (to be used as prescribed by the doctor only)
• In case of oral lichen planus, Tacrolimus ointment or any gel based cream may be prescribed.

In case of extensive lesions, that is covering the entire or most of the body, oral medications are prescribed.

• Immunosuppressive medicine, such as steroids, methotrexate, cyclosporine etc.

*steroids are to consumed only after being prescribed, and various tests are done to determine the adequate dosage of steroids that would suit the patient.

• Retinoids
• Anti histamine, such as cetrizine, levocetrizine, fexofenadine, bilastine etc., to reduce itching

PREVENTION

It is advised to not scratch the affected area too much, as this may cause the rash to spread and flare up. (Koebner’s phenomenon)

PROGNOSIS

Lichen planus is a disease, which is highly un predicatable to determine the exact duration to get completely cured.

In most cases, it is seen to be cured in 1 to 2 years. However, many patients have suffered even 5 to 10 years without getting cured. It is frustrating for both the patient as well as the doctor.

COMPLICATION

Post inflammatory hyperpigmentation – after the rashes are treated, the affected area turns black. This can take at least 1 to 1.5 years to get back to normal, maybe more in people with dark skin. Nothing can be done by the doctor, as the pigmentation is located very deep in the skin, the patient can only wait till it’s gone.

Blog by: Dr. Uttam Kumar Lenka, Consultant Dermatologist. Kolkata.