HYPERHIDROSIS: A Comprehensive Review

1. HYPERHIDROSIS:A Comprehensive Review Dina Hamadi, R.N., B.S.N. Alverno College: Master’s of Science in Nursing

2. Navigating the Tutorial • will take you to the next slide • will take you to the previous slide • will take you to the home page

3. Objectives • Understand the pathophysiology of sweating • Identify diagnostic criteria for Hypherhidrosis • Identify treatment options for the Hyperhidrosis patient

4. Choose the Topic! • Sweat glands • What makes me sweat? • What is Hyperhidrosis? • Treatment Options

5. Sweat Glands • The human body has 2-5 million sweat glands • Two main types: Click on the different sweat gland types to learn more! ECCRINE APOCRINE Source: www.sweathelp.org Click the “Home” button after viewing both types

6. Eccrine Sweat Glands • Approximately 3 million eccrine sweat glands • Secrete a clear, odorless fluid • Aid in regulating body temperature • Areas of concentration: • Facial, plantar, and axillae CLICK HERE Source: www.sweathelp.org

7. Apocrine Sweat Glands • Inactive until puberty • Produce thick fluid • Secretions come in contact with bacteria on the skin and produce characteristic “body odor” • Found in axillary and genital areas CLICK HERE Source: www.sweathelp.org

8. Sweating • The hypothalamus serves as the thermoregulatory center • It controls both blood flow and sweat output to the skin’s surface Source: www.sweathelp.org

9. Sweating • The hypothalamus can be triggered by: EXERCISE STRESS TEMPERATURE CHANGE HORMONES Source: www.sweathelp.org

10. Sweating Once triggered, the hypothalamus sends messages down the spinal cord via neurotransmitters. Source: www.sweathelp.org

11. Sweating The neurostransmitters travel down the spine via ganglion or sympathetic nerves These ganglion travel to nerves, which reach the skin’s surface Source: www.sweathelp.org Photo used with permission: The Whiteley Clinic,2007

12. Neurotransmitters Neurotransmitters act as “vehicles,” transmitting information from the hypothalamus to the skin’s surface. Photo used with permission: The Whiteley Clinic, 2007

13. Neurotransmitters The neurotransmitters can “exit” at various places along the spinal cord. The “exit” determines the location of skin innervation.

14. Spinal Cord Innervations T2-T4 innervate the skin of the face T2 – T8 innervate the skin of the upper limbs T4-T12 innervate the skin of the trunk T10-T12 innervate the skin of the lower limbs Source: www.sweathelp.org

15. Neurotransmitters Acetylcholine innervates Catecholamines innervate Eccrine Sweat Glands Apocrine Sweat Glands Source: www.sweathelp.org

16. Sweating Once innervated, the apocrine and eccrine glands will produce …. SWEAT! Source: www.sweathelp.org Click on the picture to take the “Sweating Quiz” Click on the “Home” button to return to the topic choices

17. Question 1 What serves as the body’s thermoregulatory center? • The hypothalamus • The adrenal cortex • The frontal lobe

18. CONGRATULATIONS! The hypothalamus regulates sweat output and blood flow to the skin’s surface! Take me to question 2!

19. SORRY….TRY AGAIN! What regulates blood flow and sweat output to the skin’s surface? • The hypothalamus • The adrenal cortex • The frontal lobe

20. Question 2 What neurotransmitter innervates eccrine sweat glands? • Acetylcholine • Catecholamine • Glucose

21. You’re Right!! Take me to question 3!

22. Try Again! Hint: Catecholamines innervate apocrine sweat glands! Let me try question 2 again!

23. Question 3 The hypothalamus can be triggered by all these except: • Stress • Exercise • Obesity • Temperature change

24. CORRECT!! You have successfully completed this section of the tutorial. Return home!

25. Try Again! Return to question 3!

26. Hyperhidrosis Hyperhidrosis is a state of excessive sweating of the axilla, palms, soles, or face that interferes with daily activities Haider & Solish, 2004 Photo used with permission: University of Miami Cosmetic Center, 2007

27. Two Types • Primaryor idiopathic • Secondary: Resulting from respiratory/heart failure, malignancy, drug/alcohol abuse, hyperthyroidism, infection Haider & Solish, 2004

28. Fun Facts • Diagnosed in 2.8% of the U.S. population • 70% of those with symptoms do not consult a physician • Peaks in early adulthood Haider & Solish, 2004

29. Diagnostic Criteria:Primary Hyperhidrosis MUST HAVE 1. Focal, visible, excessive sweating 2. 6 months duration 3. No apparent cause TWO OR MORE: 1. Bilateral and symmetric sweating 2. Impairment of daily activities 3. At least one episode per week 4. Onset of less than 25 years 5. Positive family history Hornberger, 2004

30. What is Hyperhidrosis? • Involves the eccrine sweat glands, however: • Sweat glands are NORMAL • No change in size • No change in shape • No change in number Haider & Solish, 2004

31. Cause • Exact cause is unknown • Familial or genetic? • Excessive Sympathetic Activity? Click on the raindrops to learn more about this theory!

32. Excessive Sympathetic Activity The eccrine sweat glands are excessively stimulated by acetylcholine Increased SWEAT production Hornberger, 2004

33. Excessive Sympathetic Activity Because the sweat glands are continuously stimulated, they are stuck in the position Hornberger, 2004

34. QUIZ TIME! Those diagnosed with hyperhidrosis have abnormal eccrine sweat glands. TRUE FALSE

35. GOOD JOB! The sweat glands are normal, with no variance in size, shape, or number! Take me to Question 2!

36. SORRY! Try again…. Click on the sad face to try again!

37. Question 2 Hyperhidrosis involves which sweat gland type? Apocrine Eccrine

38. Oops! Take me back to the question!

39. YES!! Hyperhidrosis involves the eccrine sweat glands! You have successfully completed this section of the tutorial. You may return Home!

40. Treatment Options Rules to Follow: • Different treatment for areas affected • Always start with least invasive treatment option

41. Treatment Options Topical Click on the first treatment option to begin! Systemic Iontophoresis Botox Local Excision Thorascopic Sympathectomy

42. Topical Treatment • First line treatment • Aluminum Chloride Hexahydrate • antiperspirant of choice • Most beneficial for axillary hyperhidrosis • Can be used for plantar and palmar Photos used with permission: www.feelbest.com Hornberger, 2004

43. Topical Treatment:How Does it Work? The metal ions in the topical antiperspirant damage the lining of the sweat gland. As damage continues, a PLUG is formed over the sweat gland. www.sweathelp.org

44. Topical Treatment • Sweat production never ceases, the gland is simply plugged • Sweating will return as the skin undergoes regeneration or shedding • Therefore…topical treatment is NOT a cure! Photo used with permission: Neurosurgical Medical Clinic, Inc Hornberger, 2004

45. Topical Treatment:How to Use • Best to apply before bedtime • Allow to remain on skin for 6 – 8 hours • Apply every 24 – 48 hours until sweating diminishes • Maintenance applications needed every 1-3 weeks Hornberger, 2004

46. Topical Treatment: Pros and Cons Non – invasive Itching and burning of skin at application site & Time-consuming & Temporary relief Hornberger, 2004

47. Topical Treatment:Effectiveness 88% effective for Axillary Hyperhidrosis 66.6% stop using due to the “CONS” Naumann, Hamm, & Lowe, 2002

48. QUICK REVIEW! Fill in the Blank! Topical Treatments work by ________ sweat glands. Destroying Plugging Melting

49. That’s Right! Topical Treatments PLUG the sweat gland Take me to the next treatment option!

50. Sorry! HINT: Sweat production never stops, the output is simply blocked! Take me back to the question!