Materiały źródłowe

• #1 Hyperhidrosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459227/

  Hyperhidrosis is a disorder of excessive sweating due to the overstimulation of cholinergic receptors on eccrine glands. This disorder is characterized by sweating beyond what the body uses for homeostatic temperature regulation. […] The acetylcholine negative feedback loop is likely impaired in these patients, which may help explain how a physiologic response can become pathologic. […] Hyperhidrosis involves hyperactivity of the sympathetic nervous system, causing excessive release of acetylcholine from the nerve endings. It is believed that the negative feedback mechanism to the hypothalamus may be impaired, causing the body to sweat more than what is needed to cool the body. This pathologic reaction can be triggered by medications that increase the release of acetylcholine from the neuron or systemic medical disorders, which also upregulate a sympathetic response.

• #2 Pathophysiology of hyperhidrosis – Choe – Shanghai Chest

  https://shc.amegroups.org/article/view/5204/html

  Primary hyperhidrosis is a pathologic condition that is characterized by excessive sweating beyond the physiological needs required for thermoregulation. […] The exact pathophysiology of primary hyperhidrosis remains unclear, but the prevailing theory of pathogenesis appears to be neurogenic hyper-excitability of the sympathetic nervous circuits innervating eccrine glands. […] The most probable explanation is neurogenic over-activity of the reflex circuits innervating the eccrine glands. Increased nervous impulses in the central nervous system can release excessive amounts of acetylcholine, which then increases sudoral response. […] Exact specifics and nature linking this neurogenic over-activity to primary hyperhidrosis are still unclear. […] Several studies have shown structural and histochemical changes in the sympathetic ganglia, most notably in the size and number of ganglia.

• #3 Hyperhidrosis: A Central Nervous Dysfunction of Sweat Secretion

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9884722/

  Hyperhidrosis (HH) is a central nervous dysfunction characterized by abnormally increased sweating due to a central dysregulation of sweat secretion. […] The central nervous system controls sweat secretion through the release of neurotransmitters into the autonomous nervous system (ANS) that activate the sweat glands. […] HH may thus be due to either a neuronal dysfunction of ANS regulation leading to a hyperactivity of the sympathetic nervous system, or to abnormal central processing of emotions. […] Various pathogenic mechanisms have been proposed to be involved in pathological sweat secretion in HH, ranging from structural changes within the ANS to increased expression of aquaporin 5 and upregulation of activin A receptor type 1 in eccrine sweat glands. […] Given the innervation pathways of the hypothalamus, primary HH can be understood to be a neuronal regulation disorder of the ANS involving pathologic hyperactivity of the sympathetic system that results in hyperstimulation of otherwise normal sweat glands.

• #3 Drug-induced hyperhidrosis

  https://dermnetnz.org/topics/drug-induced-hyperhidrosis

  Hyperhidrosis is excessive sweating due to the overstimulation of the eccrine sweat glands by a neurotransmitter, acetylcholine. […] Drug-induced hyperhidrosis is the most common cause of secondary hyperhidrosis. Drugs can act on the hypothalamus or at spinal thermoregulatory centres, at sympathetic ganglia or at the eccrine-neuroeffector junction. It results from the release of acetylcholine by medications that block the action of acetylcholinesterase, an enzyme that breaks down the neurotransmitter. […] Acetylcholine exerts its effect via receptors found on sweat glands. Due to impaired negative feedback to the hypothalamus, acetylcholine causes the body to sweat more than is needed for core temperature to reach homeostasis. […] Drug-induced hyperhidrosis is diagnosed clinically. Other causes of secondary hyperhidrosis should be excluded, such as an underlying infection, malignancy, neurological, or endocrine conditions.

• #4 SciELO Brazil – Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects

  https://www.scielo.br/j/abd/a/wWFVwn5VLVswDWrMpzMrscw/

  Electrophysiological studies show high skin sympathetic response in patients with palmar hyperhidrosis compared with healthy subjects. […] The main neurotransmitter of the neuroglandular junction of postganglionic fibers is the acetylcholine, unlike what happens in most of the nerve endings, whose neurotransmitter is the noradrenaline. Various stimuli, such as physical activity, hot environment, anxiety and stress, activate the preoptic area of the hypothalamus that, by sympathetic stimulation, release acetylcholine in the neuroglandular junction, increasing the response in the sweat gland and generating a retrograde stimulus to the hypothalamus through the afferents pathways, the negative feedback. The balance between the afferent and efferent pathways maintains homeostasis in the body. In individuals with PH, this system appears to be in focal imbalance, with amplification of efferent stimuli.

• #5 Hyperhidrosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459227/

  On histologic examination, eccrine glands appear normal in size and number compared to those without the disorder. However, the sympathetic ganglia in these patients are usually larger. This supports the theory that hyperhidrosis is a disorder of excessive cholinergic stimulation instead of a problem with the eccrine glands.

• #6 Pathophysiology of hyperhidrosis – Choe – Shanghai Chest

  https://shc.amegroups.org/article/view/5204/html

  A cross-sectional study using immunohistochemistry by de Moura Jnior et al., which demonstrated an increased expression of acetylcholine and alpha-7 neural nicotinic receptor subunit in the sympathetic ganglia of patients with hyperhidrosis compared to the control group, which supports the theory on hyperactivity of the central portion of the sympathetic nervous system. […] Hyperhidrotic glands appeared to be larger than in the control group. […] In addition, under electron microscopy, these eccrine glands appeared to mainly have features of hyperactivity due to exposure from prolonged stimulation without any structural defects, such as devesiculation of granular cells, distended basal infoldings, canaliculi between non-granular cells, and contracted myoepithelium. […] They outline that the etiology of primary hyperhidrosis may be related to a hereditary genetic trait with pathological alleles in some chromosomes, or histological changes observed in the sympathetic ganglion cells (number, size and thicker myelin sheath) or the higher expression of acetylcholine receptor subunits in the sympathetic ganglia of patients with hyperhidrosis. […] Pathophysiologic characteristics of primary hyperhidrosis are not well understood, but may be largely caused by the dysfunction of the sympathetic nervous system.

• #7 Hyperhidrosis: A Central Nervous Dysfunction of Sweat Secretion

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9884722/

  Crucially, the increased sweat secretion in patients with HH is not due to abnormalities in the sweat glands per se, but to regulatory processes that affect the sweat production of the glands. […] However, while Du et al. found no significant differences in the morphological characteristics or the number of sweat glands between axillary HH patients and healthy subjects, the authors did detect a significantly higher number of secretory granules in patients who exhibited hypersecretion of axillary sweat glands. […] Lin et al. found that activin A receptor type 1 (ACVR1) is upregulated in the sweat glands of patients with primary axillary HH compared to control subjects. […] Upregulation of the cholinergic receptor nicotinic alpha-1 subunit (CHRNA1) is a typical feature of sweat glands in patients with primary focal HH.

• #8 Pathophysiology of Excessive Sweating – International Hyperhidrosis Society | Official Site

  https://www.sweathelp.org/about-hyperhidrosis/pathophysiology-of-normal-sweating.html

  Sweat glands in patients with hyperhidrosis are not histopathologically different from those in normal patients, nor is there an increase in the number or size of glands. The condition is caused by hyperfunction of the sweat glands rather than hypertrophy. […] Patients with primary hyperhidrosis have a higher-than-normal basal level of sweat production as well as an increased response to normal stimuli such as emotional or physical stress. […] One of the underlying mechanisms for a lowered threshold and exaggerated response in hyperhidrosis patients may be excessive sympathetic activity. […] This study suggested that increased sympathetic activity through the T2-T3 ganglia causes palmar hyperhidrosis. […] A recent study of recovery of excitability of the sympathetic sudomotor skin response in patients with hyperhidrosis and in normal controls found significant differences.

• #9 Hyperhidrosis and Its Impact on Those Living With It

  https://www.ajmc.com/view/hyperhidrosis-and-its-impact–on-those-living-with-it

  The central mechanism of primary hyperhidrosis is largely unknown. It is speculated that primary hyperhidrosis is a combination of a lowered threshold and exaggerated response to sweating. The sweating pattern in primary hyperhidrosis is often focal. While generalized sweating can occur, it appears to be less common. […] In contrast, secondary hyperhidrosis (which can also be focal or generalized) is due to other modalities, such as medications, malignancies, endocrine disturbances, or other CNS issues. Hyperhidrosis negatively affects the mental health of patients. The prevalence of anxiety and depression was 21.3% and 27.2%, respectively, in patients with hyperhidrosis compared with 7.5% and 9.7% in those without the disease. Constant sweating leads to embarrassment for many patients. Other feelings caused by excessive sweating include anxiousness, sadness, anger, and hopelessness. Excessive sweat causes constant wetness and skin macerations that lead to sore or cracked skin and thus to conditions such as athletes foot. Hyperhidrosis is considered a predisposing factor for both bacterial growth and the dermatologic condition known as pitted keratolysis. In a retrospective case-control study, the overall risk of any cutaneous infection was significantly increased in patients with hyperhidrosis compared with control patients (odds ratio [OR], 3.2; 95% CI, 2.2-4.6). Risks of fungal (OR, 5.0), bacterial (OR, 2.6), or viral infection (OR, 1.9) were also all significantly increased. The International Hyperhidrosis Society (IHHS) reports that those with hyperhidrosis have a 300% greater risk of skin infections than those not experiencing the disease.

• #10 Botox injections one way to treat hyperhidrosis sweating | UCLA Health

  https://www.uclahealth.org/news/article/botox-injections-one-way-treat-hyperhidrosis-sweating

  Hyperhidrosis is a disorder in which the sweat glands become overactive. The result is excessive perspiration that is not associated with exercise, temperature or any other typical triggers. […] The reason this disorder occurs is not fully understood. However, it is believed to be linked to a glitch in the workings of the sympathetic nervous system, which oversees the body’s fight-or-flight response and acts as its thermostat. […] It appears that when someone has primary hyperhidrosis, the brain is sending signals that activate the sweat glands, even though the conditions that would require the cooling effects of sweat are not present. […] Botox injections have come to be widely used in managing primary hyperhidrosis when topical treatments have failed. The treatment works by blocking the nerve signals that instruct the sweat glands to become active. […] According to the International Hyperhidrosis Society, people who receive Botox injections have found excessive sweating decreases by more than 85%.

• #11 Hyperhidrosis: A Central Nervous Dysfunction of Sweat Secretion

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9884722/

  Several studies suggest that primary HH has a genetic component as demonstrated by the high frequency of positive family histories for individuals with primary axillar or palmoplantar HH. […] Overall, findings in genetics suggest considerable heterogeneity in the disorder, and it is likely that HH is a multifactorial disorder.

• #12 Hyperhidrosis – Wikipedia

  https://en.wikipedia.org/wiki/Hyperhidrosis

  The other main surgical option is endoscopic thoracic sympathectomy (ETS), which cuts, burns, or clamps the thoracic ganglion on the main sympathetic chain that runs alongside the spine. […] Hyperhidrosis can have physiological consequences such as cold and clammy hands, dehydration, and skin infections secondary to maceration of the skin. […] Those with hyperhidrosis may have greater stress levels and more frequent depression. […] Excessive sweating or focal hyperhidrosis of the hands interferes with many routine activities, such as securely grasping objects. […] It is estimated that the incidence of focal hyperhidrosis may be as high as 2.8% of the population of the United States. […] In 2006, researchers at Saga University in Japan reported that primary palmar hyperhidrosis maps to gene locus 14q11.2q13.

• #13

  https://journals.lww.com/jfmpc/fulltext/2023/12120/primary_hyperhidrosis__from_a_genetics_point_of.4.aspx

  To identify the disease locus, genome-wide DNA polymorphic markers were used, and haplotype detailed analysis revealed primary palmer hyperhidrosis (PPH) loci which are positioned at 14q11.2-q13 to an interval between D14S1070 and D14S990. […] The putative gene mapped by Higashimoto et al. may be the major gene, but because of the genetically heterogeneous nature, the existence of other gene loci surely modifies the expression pattern of the identified gene. […] Another contradictory study revealed a hyperhidrosis locus on chromosome 2q31.1, providing strong evidence of different genetic variants. […] The cellular process in sweat glands is controlled by ITPR2 gene, which codes for 2 inositol 1,4,5-trisphosphate receptor (InsP3R2) and is associated with human disease known as anhidrosis (inability to sweat).

• #14

  https://journals.lww.com/jfmpc/fulltext/2023/12120/primary_hyperhidrosis__from_a_genetics_point_of.4.aspx

  Hyperhidrosis is a multi-factorial complex genetic disorder, and understanding the genetic patterns of inheritance may help researchers to apprehend the underlying mechanism of hyperhidrosis. […] Hyperhidrosis is a genetically transmitted disorder. However, it is still unclear whether primary hyperhidrosis is a single gene defect or a multi-factorial disorder. […] From the genetic analysis, Ro et al. argued that primary hyperhidrosis is hereditary in nature with a variable degree of penetrance and is a sex-independent condition. […] Another study revealed a positive family history of hyperhidrosis in 62% of patients, and the trait had skipped a generation, signifying either autosomal dominant transmission with reduced disease penetrance or an autosomal recessive disease with a high disease allele frequency.

• #15

  https://link.springer.com/article/10.1007/s13555-022-00885-w

  Hyperhidrosis (HH) is a central nervous dysfunction characterized by abnormally increased sweating due to a central dysregulation of sweat secretion. […] HH may thus be due to either a neuronal dysfunction of ANS regulation leading to a hyperactivity of the sympathetic nervous system, or to abnormal central processing of emotions. […] Various pathogenic mechanisms have been proposed to be involved in pathological sweat secretion in HH, ranging from structural changes within the ANS to increased expression of aquaporin 5 and upregulation of activin A receptor type 1 in eccrine sweat glands. […] Given the innervation pathways of the hypothalamus, primary HH can be understood to be a neuronal regulation disorder of the ANS involving pathologic hyperactivity of the sympathetic system that results in hyperstimulation of otherwise normal sweat glands.

• #16

  https://journals.lww.com/jfmpc/fulltext/2023/12120/primary_hyperhidrosis__from_a_genetics_point_of.4.aspx

  Primary hyperhidrosis is a disorder of profuse sweating which negatively influences a patient’s quality of life and is caused because of over-activation of the sympathetic nervous system. […] It has been found that people with a positive family history of primary hyperhidrosis are likely to suffer from this condition, suggesting a strong genetic basis. Genetic analysis has revealed a dominant autosomal pattern of inheritance with a variable degree of penetrance and is a sex-independent trait. […] The exact origin of hyperhidrosis is still unclear. It is proposed to result from the over-activation of the sympathetic nerves. […] The expression study of neuregulin-1 (Nrg-1) revealed an over-expression of Nrg-1 messenger ribonucleic acid in hyperhidrosis patients, which results in hyper-methylation of the axons of the sympathetic ganglia and seems to cause over-activation of the thoracic sympathetic system.

• #17

  https://journals.lww.com/jfmpc/fulltext/2023/12120/primary_hyperhidrosis__from_a_genetics_point_of.4.aspx

  It has been shown that missense mutation (p.G2498S) may induce isolated anhidrosis, which is localized within the pore-forming region of the mice and lacks the functional InsP3R2, with compromised Ca2+ production, resulting in the decrease of sweat production, and holds a potential pharmacological target in the treatment of hyperhidrosis. […] FoxA1 gene, which codes for Forkhead transcription factor, plays a significant role in sweat regulation through bestrophin 2 anion channel and NaKCl cotransporter. […] Understanding the relationship between anxiety and hyperhidrosis-causing genes will help to devise better anxiolytics, which in turn helps in controlling the condition by breaking the vicious hyperhidrosis sweat cycle. […] Further research is required to provide evidence characterizing the exact mechanism of pathogenesis and to identify the putative gene or network of genes causing primary hyperhidrosis.

• #18 Hyperhidrosis: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/1073359-overview

  Hyperhidrosis may be idiopathic or secondary to other diseases, metabolic disorders, febrile illnesses, or medication use. […] Generalized hyperhidrosis may be the consequence of autonomic dysregulation, or it may develop secondary to a metabolic disorder, febrile illness, or malignancy. In its localized form, hyperhidrosis may result from a disruption followed by abnormal regeneration of sympathetic nerves or a localized abnormality in the number or distribution of the eccrine glands, or it may be associated with other (usually vascular) abnormalities. […] Essential hyperhidrosis, a disorder of the eccrine sweat glands, is associated with sympathetic overactivity. […] Palmoplantar hyperhidrosis may be inherited in an autosomal dominant manner.

• #19 Primary and Secondary Hyperhidrosis: Causes

  https://www.verywellhealth.com/hyperhidrosis-causes-4777757

  Excessive sweating due to hyperhidrosis can arise as a stand-alone condition or be related to a secondary medical condition, such as thyroid disease, cardiovascular conditions, or menopause. […] Hyperhidrosis is classified as either primary focal hyperhidrosis or secondary generalized hyperhidrosis, both of which have numerous individual possible causes. […] Primary idiopathic hyperhidrosis: Idiopathic means the disease has an unknown cause or mechanism of origin. Most cases of primary hyperhidrosis are idiopathic. […] Secondary generalized hyperhidrosis refers to sweating that occurs all over the body and may include night sweats (sweating while asleep). It usually develops in adulthood and is caused by a secondary or underlying disorder affecting any of several systems in the body or by other factors.

• #20 Hyperhidrosis – Wikipedia

  https://en.wikipedia.org/wiki/Hyperhidrosis

  Use of selective serotonin reuptake inhibitors (e.g., sertraline) is a common cause of medication-induced secondary hyperhidrosis. […] Symmetry of excessive sweating in hyperhidrosis is most consistent with primary hyperhidrosis. […] Excessive sweating affecting only one side of the body is more suggestive of secondary hyperhidrosis and further investigation for a neurologic cause is recommended. […] Antihydral cream is one of the solutions prescribed for hyperhidrosis for palms. […] Prescription medications called anticholinergics, often taken by mouth, are sometimes used in the treatment of both generalized and focal hyperhidrosis. […] Injections of botulinum toxin type A can be used to block neural control of sweat glands. […] Sweat gland removal or destruction is one surgical option available for axillary hyperhidrosis (excessive underarm perspiration).

• #21 Hyperhidrosis: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins

  https://www.mdpi.com/2072-6651/5/4/821

  Hyperhidrosis (excessive sweating) is a chronic autonomic disorder that can be debilitating leading to emotional and social embarrassment, as well as occupational, physical and psychological disability. In a majority of cases, the cause of hyperhidrosis is unknown. Primary hyperhidrosis starts in childhood and affects 0.6%–1% of the population. A familial variant with autosomal dominant inheritance is now recognized with some families linked to an abnormality of chromosome 14q. The diagnostic criteria for hyperhidrosis includes excessive sweating that lasts at least six months without any obvious cause and has at least two of the following features: impairs daily activities, a bilateral and relatively symmetric pattern of sweating occurring at least once per week, an age of onset younger than 25, cessation of focal sweating during sleep, or positive family history. Secondary hyperhidrosis can be drug-induced (for example with sertraline), toxin-induced (acrylamide), caused by a systemic illness (endocrine and metabolic disorders, neoplasms, spinal cord lesions), by congenital disorders such as familial dysautonomia (Riley-Day syndrome) or it can be compensatory. Compensatory hyperhidrosis is a phenomenon in which there is increased sweating in parts of the body unrelated to the location of treatment or in the case of surgery, unrelated to surgery or anatomy. It is often seen in segments below the level of sympathectomy, which is performed for treatment. Gustatory hyperhidrosis (usually involving the face) can be familial or occur in association with trauma or other local insults. One epidemiologic survey in 2004 estimated that as many as 0.5% of the US population may be suffering from the debilitating effects of hyperhidrosis with major interference in daily activities.

• #22 Compensatory hyperhidrosis – Wikipedia

  https://en.wikipedia.org/wiki/Compensatory_hyperhidrosis

  Compensatory hyperhidrosis is a form of neuropathy. It is encountered in patients with myelopathy, thoracic disease, cerebrovascular disease, nerve trauma or after surgeries. The exact mechanism of the phenomenon is poorly understood. It is attributed to the perception in the hypothalamus (brain) that the body temperature is too high. The sweating is induced to reduce body heat. […] Compensatory hyperhidrosis is aberrant sympathetic nervous system functioning. The only study evaluating the total body sweat prior and shortly after sympathectomy concluded that patients produce more sweat after the surgery, just not so much in the areas treated by the surgery. […] The term 'compensatory’ is largely misleading, as it indicates that there is a compensatory mechanism that takes effect after sympathectomy, in which the body 'redirects’ the sweating from the palms or face to other areas of the body. Sweating after sympathetic surgery is a reflex cycle between the sympathetic system and the anterior portion of the hypothalamus. Reflex sweating will not happen if hand sweating can be stopped without interrupting sympathetic tone to the human brain.

• #23 SciELO Brazil – Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects

  https://www.scielo.br/j/abd/a/wWFVwn5VLVswDWrMpzMrscw/

  The sympathetic ganglia are distributed longitudinally on each side of the spine and are connected by interganglionar pathways. […] The sympathetic motor pathway consists of three neurons. The first neuron has its cell body located in sudomotor nerve centers and hypothalamic vasomotor and its axon is moving downwards by dorsal longitudinal and spinal vestibular fascicles of the spinal cord, causing synapse with the second neuron. […] When the lesion of the thoracic ganglia T2, T3 and T4 is performed, the efferent stimulus transmitted to sympathetic ganglia would be amplified to the periphery by the loss of the negative stimulus to the hypothalamus by afferent pathways. Because the amplified stimuli do not reach the sympathectomized areas, there may be increased sweating in other regions. […] Although the exact mechanism of CH remains unknown, there is a hypothesis to occur as a reflex mediated by the hypothalamus after the procedure on the sympathetic chain.

• #24 Treatment Options for Excessive Sweating and Hyperhidrosis

  https://www.skintherapyletter.com/family-practice/treatment-options-fp/

  Excessive production of sweat, or hyperhidrosis, affects millions of people worldwide. […] However, it is not necessarily hyperhidrosis, which is defined as nonphysiological, excessive sweating that is not caused by physical activity and occurs symmetrically in a localized fashion. […] Several forms of treatment are now available for the management of PFHH. […] When injected by experienced physicians, it can be highly effective for the cessation of sweat production in areas of administration. […] It works by blocking acetylcholine release, a neurotransmitter secreted by the sympathetic nerves innervating the sweat glands. […] Surgical removal of the sweat glands in the axillae, or ablating the sympathetic chain supplying the sweat glands can also be performed for selected patients.

• #25 An evolving answer to excess sweating | Drug Discovery News

  https://www.drugdiscoverynews.com/an-evolving-answer-to-excess-sweating-15965

  The cause of hyperhidrosis, an excessive sweating condition, is enigmatic, but treatment options are plentiful and growing. […] Genetics likely play a role, but the exact cause remains unclear. What researchers know is that signals from the nervous system send sweat glands into overdrive. […] One way to block excessive sweat is simply to stifle the body’s sweat-inducing communication with the sweat glands. Botox, the brand name for the botulinum toxin, is among the most common methods for doing so because it blocks neurons from releasing acetylcholine. […] Acetylcholine stimulates nerves and signals to muscles to contract. In the same way that Botox cosmetic injections temporarily paralyze forehead muscles, Botox hand injections block the neuromuscular stimuli that drench people’s palms with sweat.

• #26 An evolving answer to excess sweating | Drug Discovery News

  https://www.drugdiscoverynews.com/an-evolving-answer-to-excess-sweating-15965

  The neurotoxin is a sledgehammer in theory, but in practice, targeted injections leave the sweat glands alone while halting the signals to them. […] The effect fades, however. Most people sweat more within a couple of months after treatment and go back to square one within the year, so patients must repeat injections indefinitely. […] Another strategy is to scorch the sweat gland directly. MiraDry, a handheld device approved by the FDA in 2011, delivers microwave radiation to the underarm. […] It literally fries the sweat glands with microwaves. […] During surgery, thoracic surgeons like Ferguson snip the sympathetic nerves near the ribs to halt their ability to signal to the sweat glands. […] The nerves don’t regrow, and Ferguson estimates an 80 percent success rate in underarms and up to a 99 percent success in hand sweating.

• #27 Hyperhidrosis: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins

  https://www.mdpi.com/2072-6651/5/4/821

  The effective dose for A/Ona, A/Inco and A/Abo is in the range of 50–75, 100–200 and 50–75 units per axilla respectively. The effect after one injection can last 3–9 months. Most BoNT practitioners find BoNT injections also fairly effective for PH. The limited number of blinded studies in the literature combining BoNT use via injection and iontophoresis in PH indicate level B evidence (probably effective) for A/Ona and A/Abo, insufficient evidence for A/Inco and level C evidence (possibly effective) for B/Rima. More systemic side effects are reported with B/Rima injections, an issue that deserves further investigation.

• #28 Treatment Options for Excessive Sweating and Hyperhidrosis

  https://www.skintherapyletter.com/family-practice/treatment-options-fp/

  Oral anticholinergics such as glycopyrolate can offer mild-to-moderate relief for some patients suffering from PFHH. […] The mechanism of action is unknown, however, it may involve plugging the eccrine sweat gland pores. […] Surgical ablation of the sympathetic nerve chain supplying the sweat glands to the hands can also be performed for selected patients. […] For most patients, antiperspirants containing aluminium salts are the first-line treatments.

• #29 Hyperhidrosis (Excessive Sweating) | Doctor

  https://patient.info/doctor/hyperhidrosis

  Hyperhidrosis (excessive sweating) may be either focal or generalised, and either primary (no underlying cause) or secondary (underlying cause identified). Common triggers include emotion and spicy foods. […] Generalised hyperhidrosis affects the entire body and is usually caused by medical conditions or drugs. […] The mechanism of compensatory hyperhidrosis is not clear, but it seems to be associated with compensation for thermoregulatory function. […] Oral antimuscarinics, such as glycopyrronium bromide and oxybutynin, decrease sweat secretion by competitive inhibition of acetylcholine at the muscarinic receptors near eccrine sweat glands (off-label indications). […] Sympathectomy (division of the sympathetic chain over the neck of the ribs under general anaesthesia) is the most commonly performed procedure.

• #30

  https://link.springer.com/article/10.1007/s00403-023-02587-5

  Sweating is a physiologic mechanism of human thermoregulation. Hyperhidrosis is defined as a somatic disorder where the sweating is exaggerated in an exact area because the sweat glands are hyperfunctioning. The acetylcholine negative feedback loop is likely impaired in these patients, which can clarify how a physiologic response can change into pathological. Oxybutynin administration is associated with a low HDSS score, a decrease in the incidence of psychosocial functioning impairment, and an improvement in quality-of-life score. These effects contribute to the actual action of oxybutynin as it plays on the underlying mechanisms of HH. It contra verse acetylcholine receptors, especially muscarinic receptors M1, M2, and M3. By this antimuscarinic effect, it reduces sweating by limiting the role of acetylcholine on sweat glands. A systematic review conducted by Cruddas et al. reported that anticholinergic therapy does not induce tachyphylaxis, which supports the effectiveness of oxybutynin in long-term usage. However, there is dreadful concern regarding oxybutynin since it is associated with CNS events that are favored by the ability to pass through the blood-brain barrier. Adverse events from oral oxybutynin activity include dry eyes, mydriasis, headache, gastrointestinal symptoms, urinary retention, and orthostatic hypotension, but dry mouth is by far the most common side effect affecting 73.4%, 38.6%, and 68.8% of patients treated orally with oxybutynin. However, our meta-analysis found no significant difference between the oxybutynin and placebo groups regarding the incidence of dry mouth. Until the development of higher-quality evidence, we recommend the use of oxybutynin in patients with HH. […] Our study suggests that using oxybutynin is significant and needs to be highlighted for clinicians. However, more clinical trials are needed to grasp the optimum benefit.

• #31 Surgery for Hyperhydrosis | CTVS Central Texas – CTVS Texas

  https://ctvstexas.com/about-ctvs/our-services/thoracic-services/surgery-for-hyperhidrosis/

  Sweating is the body’s natural mechanism of releasing excessive heat and cooling the body. However, in about one percent of the population, parts of the body (such as the hands, feet, face, and armpits) sweat profusely. This condition of excessive sweating, known as hyperhidrosis, is often brought on by stress and may be inherited. […] The body’s sympathetic nervous system controls sweating. When this automatic, involuntary system does not function properly, the body may produce more perspiration than necessary to cool itself. An overactive sympathetic nervous system can be treated through surgery. […] Two types of glands produce sweat: eccrine glands and apocrine glands. The portion of the sympathetic nervous system that controls these glands is called the thoracic sympathetic ganglion chain, which runs along the vertebra of the spine inside the chest cavity. These are the glands affected by surgical treatments for hyperhidrosis.

• #32 Surgery for Hyperhydrosis | CTVS Central Texas – CTVS Texas

  https://ctvstexas.com/about-ctvs/our-services/thoracic-services/surgery-for-hyperhidrosis/

  Since nonsurgical treatments of hyperhidrosis have only limited success, surgery is the only true cure for this condition. The surgical treatment for hyperhidrosis is a procedure called Endoscopic Thoracic Sympathectomy, sometimes called ETS. The procedure has about a 98% success rate in curing cases of overly sweaty palms, although the same procedure will treat hyperhidrosis in all areas of the body. […] Simply put, the sympathectomy procedure severs, or interrupts, the nerves connected to the affected sweat glands. The procedure is performed through small incisions in the underarm area. The surgeon then locates and operates on the sympathetic nerves, located in the chest. This minimally invasive approach allows for relatively quick healing and recovery time. Recent advancements in imaging and instruments have also improved the precision of the procedure.

• #33 Hyperhidrosis Treatment in St. Louis Region | Division of Cardiothoracic Surgery | Washington University in St. Louis

  https://cardiothoracicsurgery.wustl.edu/patient-care/thoracic/hyperhidrosis/

  Hyperhidrosis (excessive sweating) is a serious medical condition in which the bodys cooling mechanism is overactive. […] Treatment usually begins with medical remedies, which do not involve surgery. […] If medical treatments fail, some positive results have been reported with local injections to block the sweating nerves. […] Generally, surgery is considered only after less invasive treatments have failed to relieve symptoms. […] The operation, which removes about three to four inches of nerves that control the sweat glands, doesnt affect the patients muscle function or sensation but greatly reduces sweating in the hands and/or the armpits. […] The most common potential side effect of the VATS sympathectomy is compensatory sweating, which occurs in up to 60 percent of patients. […] Although the operation prevents sweating in the hands and/or the armpits, it is possible that patients will notice more sweating on their backs, legs and other regions of their bodies.

• #34 Iontophoresis

  https://dermnetnz.org/topics/iontophoresis

  Iontophoresis is a procedure in which an electrical current is passed through skin soaked in tap water (not distilled water), normal saline (0.9%), or a solution containing an anticholinergic medication, which allows ionised (charged) particles to cross the normal skin barrier. It reduces sweating and enhances the delivery of drugs and macromolecules into and through the skin. It is safe, effective and inexpensive. […] The mechanism of action of iontophoresis in reducing sweating is not completely understood. Sweat forms in response to an electrical gradient produced by sympathetic nerve activity on the cells of the sweat gland. There are several theories as to how a change in the electrical gradient reduces sweat production. […] Ions produced by iontophoresis may physically block the sweat ducts in the stratum corneum. […] The external electrical current may disrupt normal sympathetic nerve transmission. […] The pH drops in the sweat gland due to an accumulation of hydrogen ions.

• #35 Hyperhidrosis Treatment Reading – Causes, Symptoms & Treatments | Derma

  https://www.dermareading.co.uk/hyperhidrosis

  There are also treatments that use controlled microwave technology to destroy the overactive sweat glands without the need for surgery, but they may not be appropriate for every patient. […] In some rare cases in patients with severe hyperhidrosis, surgery is necessary to treat the condition, but this would only performed when all other avenues have been exhausted.

• #36 An evolving answer to excess sweating | Drug Discovery News

  https://www.drugdiscoverynews.com/an-evolving-answer-to-excess-sweating-15965

  The best candidates are those whose symptoms are focal, daily, spontaneous, and develop at a young age. […] The side effect is no joke. According to Pariser, patients call his society’s helpline almost weekly expressing thoughts of suicide because they sweat so much more than before. […] Oral anticholinergics, for example, prevent receptors in the nervous system from accepting acetylcholine. […] Those are good for some people, Ferguson said, but oral anticholinergics dry out the whole system. […] Topical anticholinergics can skirt systemic side effects, so some patients use bladder controlling gels off-label. […] Researchers, including Pariser, are investigating topical anticholinergics further for treating hyperhidrosis. […] Improvements may even be on the horizon in surgery. Surgeons claim to have improved the thoracic surgical procedures by, for example, placing a clip on nerves instead of cutting them. […] Whatever the approach, hyperhidrosis researchers relish any uptick in awareness of the disease, especially because the demand for new drugs is so real.

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