Hyperhidrosis Unit

Also known as idiopathic hyperhidrosis, this form has no clearly identifiable underlying condition that explains its origin. It affects specific areas of the body, such as the armpits, palms of the hands, soles of the feet, craniofacial region and groin. Symptoms are often exacerbated by stress, anxiety, fear, heat or vasodilatory stimuli (such as alcohol consumption, hot drinks, spicy or heavily seasoned foods). Primary hyperhidrosis can lead to skin maceration and increase the risk of skin infections and unpleasant body odour due to sweat accumulation in skin folds.

Secondary hyperhidrosis is caused by underlying diseases or clinical conditions that trigger an abnormal response of the sympathetic nervous system, resulting in excessive sweat production. This response may be related to hormonal or endocrine disorders such as hyperthyroidism, diabetes, respiratory failure, certain types of cancer, or alcohol and/or drug withdrawal syndromes. Secondary hyperhidrosis often affects the face and upper trunk.

Generalised hyperhidrosis is a consequence of an underlying medical condition and affects most of the body surface.

Although referred to as paediatric hyperhidrosis, this type most commonly manifests during preadolescence and adolescence. Prior to this stage, excessive sweating in children—although sometimes striking—is usually normal and reflects the need for effective thermoregulation. Paediatric hyperhidrosis typically affects the palms of the hands, armpits and feet. It significantly interferes with school performance and often causes considerable difficulties in the child’s social environment.

Antiperspirants

Topical antiperspirants used to treat hyperhidrosis contain aluminium salts formulated in solutions with a variable proportion of alcohol. They act by obstructing the pores of the sweat glands and causing atrophy of the sweat-secreting glands.

The product should be applied according to the instructions of the dermatologist specialising in hyperhidrosis, who typically prescribes a daily regimen until the patient progressively improves. From that point onwards, a maintenance regimen is implemented, usually consisting of applying the antiperspirant two or three days per week.

Oral and topical medicines

There are various oral and topical medicines that the dermatologist specialising in hyperhidrosis may prescribe to treat generalised excessive sweating.

These active ingredients may act directly either on sweat production itself or on factors that favour this mechanism (anxiety, nervousness, vasodilation, etc.), and they must be supervised at all times by the hyperhidrosis specialist to avoid unwanted side effects affecting other body functions.

The Grupo Pedro Jaén Hyperhidrosis Unit has extensive experience in the use of individualised pharmacological treatments for hyperhidrosis—an aspect of vital importance, particularly when certain medicines are involved.

Iontophoresis is a transcutaneous treatment for hyperhidrosis that consists of inducing an electrical current to pass through the skin. To do this, the treatment area must be submerged in water, so that the electrical current mobilises sodium ions and reduces the activity of the sweat glands, thereby decreasing sweat production.

Although it is a safe, non-invasive and generally well-tolerated option, it has now become a secondary treatment because more effective and longer-lasting alternatives are available. For this reason, its use is usually reserved as an adjunctive therapy or for selected cases, and regular maintenance sessions are required to preserve results.

It is also important to bear in mind that this treatment can only be applied to areas that can be easily immersed in water, which means it cannot be used to treat axillary hyperhidrosis, for example. In addition, treatment must be administered by a specialist with experience in this type of therapy, as inappropriate use may cause burns or skin necrosis.

This therapy can only be used when the skin is intact — that is, in the absence of lesions or irritation. This is not always possible in patients with hyperhidrosis, as maceration and fissures are common in skin folds where sweat tends to accumulate.

Finally, iontophoresis cannot be used in patients with a history of heart disease, in those with pacemakers, or in patients with glaucoma, an eye condition characterised by increased intraocular pressure.

Injecting medication that produces neuromuscular relaxation has represented a true revolution in the treatment of hyperhidrosis, thanks to its effectiveness and its high safety profile. The Grupo Pedro Jaén Hyperhidrosis Unit is a pioneer in the use of this injected treatment for hyperhidrosis, having been the first private centre to implement this procedure more than twenty years ago.

This hyperhidrosis therapy consists of injecting small doses of the active ingredient following a pattern of points spaced approximately 1.5–2 centimetres apart, previously marked on the treatment area. The medicine inhibits the release of acetylcholine at the neuromuscular level and blocks sweat production in the sweat glands.

It is a quick procedure performed in the clinic, with no specific prior preparation required and no recovery time or time off work. A reduction in sweat production is usually noticed a few days after the active ingredient is injected and lasts for several months—between six and nine, depending on the patient. After this period, the treatment can be repeated.

The main advantages of treating hyperhidrosis with these injections are their high effectiveness, their excellent safety profile, and the ability to adjust the amount of product injected according to the level of sweating to be controlled in each area, which helps avoid systemic side effects. Thanks to these advantages, the treatment can also be used in selected cases of paediatric hyperhidrosis, depending on the dermatologist’s judgement and the patient’s degree of impairment.

Injectable treatment for primary hyperhidrosis is particularly suitable for reducing excessive sweating in the armpits and palms of the hands. However, injections in the palms can be uncomfortable and painful, as multiple injections are required in a delicate, sensitive area.

The Grupo Pedro Jaén Hyperhidrosis Unit has addressed this issue by using nerve trunk blocks in the hand—a resource applied prior to the injections—which has expanded the therapeutic options for a large number of patients. It is essential that this type of anaesthesia is administered by sufficiently experienced specialists, in order to avoid undesired effects on hand sensation and strength.

Surgical treatment for hyperhidrosis is known as thoracic sympathectomy and consists of cutting, electrocoagulating or clipping the sympathetic chain located in the posterior thorax, accessed through small incisions made in the chest or near the armpit. This is a minimally invasive procedure that nevertheless requires general anaesthesia and a recovery period of several days.

This technique is used in severe cases of primary focal hyperhidrosis affecting the palms and armpits and is usually performed on both sides of the body. Surgical treatment reduces sweating radically and immediately in most cases.

However, a high percentage of operated patients develop compensatory sweating in other areas of the body (upper back, buttocks, groin, thighs, etc.). This side effect may resolve spontaneously after a few months or, alternatively, persist permanently. In such cases, it is necessary to use other treatments for hyperhidrosis, mainly periodic injections of the medicine mentioned above.

Is hyperhidrosis due to poor hygiene?

No. Excessive sweating is not related to poor hygiene, nor is it necessarily related to body odour, which may be due to other factors such as sweat accumulation in skin folds or the presence of bromhidrosis, a clinical condition characterised by an unpleasant odour of body sweat. In fact, people with hyperhidrosis often have stricter personal hygiene habits than those who do not live with this problem.

Does hyperhidrosis cause body odour?

No—at least not always. In fact, sweat itself has no smell. The odour results from the accumulation of sweat in certain areas of the skin and the breakdown of some sweat components by skin bacteria.

Which specialists can treat hyperhidrosis?

Hyperhidrosis should be treated by a dermatologist with specific knowledge of this condition, as this specialist understands the structures and functioning of the entire dermis, as well as non-dermatological mechanisms that can contribute to excessive sweating. Nevertheless, general practitioners, neurologists or internists may contribute to both diagnosis and follow-up.

Does hyperhidrosis go away over time?

No. Hyperhidrosis usually appears in childhood and generally worsens during puberty and adolescence. In some cases it improves later in life, but this pattern is not fixed and does not occur in all cases.

Does anxiety or stress cause hyperhidrosis?

No. Although stressful situations can increase sweating and hyperhidrosis tends to worsen when the patient is nervous, stress or anxiety are not direct causes of hyperhidrosis, a clinical condition that is due to other factors that are often not identifiable.

Is a deodorant the same as an antiperspirant?

No. Deodorant is a mainly cosmetic product used to neutralise body odour. Antiperspirant is used to control sweat production by acting on the sweat glands.

Is hyperhidrosis inherited?

Primary hyperhidrosis (not due to any underlying factor or disease) has a clear genetic component. It is estimated that approximately two thirds of patients with hyperhidrosis have family members affected by the same disorder. This does not mean that parents will inevitably pass hyperhidrosis on to their children, but rather that there is a higher predisposition.

Can I prevent hyperhidrosis?

Primary hyperhidrosis cannot be prevented. However, it is possible to control circumstances and diseases that trigger secondary hyperhidrosis, as well as manage everyday factors that favour sweat production, such as increased body temperature, clothing choices and the consumption of certain foods.

Below are some recommendations that may be helpful for patients with hyperhidrosis:

• Follow the hyperhidrosis treatment prescribed by your dermatologist and do not stop it without consulting the specialist first.
• Try to keep the skin dry and avoid sweat accumulation in skin folds to prevent fungal or bacterial overgrowth.
• Wear clothing made from natural fabrics—preferably cotton—that allow the skin to breathe. Avoid synthetic fabrics in direct contact with the skin. Change clothes as often as you need.
• Wear cotton socks and footwear that allows the feet to breathe. Change shoes and socks several times a day and keep your feet bare for as long as possible.
• Shower once a day—twice if you need to. Use hygiene products designed to help control odour and excessive sweating. Ask your dermatologist about the most appropriate active ingredients (chlorhexidine, aluminium chlorohydrate, antibacterial agents, etc.).
• Shave or remove underarm hair.
• Limit alcohol, spicy or heavily seasoned foods, caffeine, etc., as these can promote sweating.
• Manage stress to help prevent the situation from worsening.

The content of this page has been prepared by the Communication Department and the Medical Team of Grupo Pedro Jaén, in line with our editorial commitment to ensuring the accuracy and up-to-date nature of the information provided.

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