Focal Hyperhidrosis – Everything you need to know

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A brief overview of focal hyperhidrosis

Focal hyperhidrosis refers to the condition wherein a person experiences excessive sweating in some parts of the body. The excessive focal sweating can occur in any area, and it is usually the areas such as underarms, soles, palms, groin, and face that are affected the most. The pattern of sweating could either be bilateral and symmetrical, or it could occur in a single arm alone. The latter is a rare occurrence. Another complaint which is rarely registered by people suffering from the condition is night sweats. The onset of the condition is typically before 25 years of age, and it is not uncommon to have the condition run in the family.

Focal Hyperhidrosis can affect many parts of the body.
Focal Hyperhidrosis can affect many parts of the body.

According to reports, it affects around 3% of the general population with the ratio between men and women being nearly similar. Profuse sweating is mostly seen in the region of underarms along with the feet, palms, and facial region being affected in the mentioned order.

The thing about focal hyperhidrosis is that it can lead to the quality of life is affected to a large extent. This is because people suffering from the condition are found to suffer from social, psychological, emotional, and professional repercussions. Thus, you would find the condition being referred to as a silent handicap. On the outlook, it might not come across something that would cripple someone, but the reality is somewhat different. The good thing is that the condition can be treated. Before we move on to discuss the course of action that can be taken to treat focal hyperhidrosis, let us first elaborate on the condition and the various aspects associated with it.

The types of focal hyperhidrosis

The condition can broadly be divided into two categories, based on which the doctors can determine their causes and then work out a treatment plan that ought to be followed. The two types of hyperhidrosis include Primary Focal Hyperhidrosis and Secondary Generalized Hyperhidrosis. It is rather important that one understands the cardinal differences between the two variants.

Primary focal hyperhidrosis

This refers to the condition wherein the focal hyperhidrosis is not caused by a medical condition, and neither is it a side effect of any medication that you might have taken. It is a medical condition on its own and not a symptom of some other disease that you might have. The sweating occurs in specific areas and is symmetric. However, while the excessive sweating is localized, it usually occurs in more than one area. Thus, if someone has excessive sweating in the underarms, in all probability, they would have sweaty feet as well.
The condition tends to develop at an early age, either during childhood or adolescence. This is particularly true for the hyperhidrosis of hands and feet. While it is common for people suffering from the condition to experience the episodes at least once a week, you would rarely hear them complaining of sweating excessively while sleeping. There is a great chance that the condition runs in the family, but this is not something that is often shared between family members as they are embarrassed about it, thereby leading to individuals suffering alone.

Secondary focal hyperhidrosis

Hands and palms can be affected by Focal Hyperhidrosis, also called Excessive Sweating
Hands and palms can be affected by Focal Hyperhidrosis, also called Excessive Sweating

This is another variant of hyperhidrosis wherein the excessive sweating occurs owing to another known medical condition or as a side effect of some drug. This is the reason that it is referred to as secondary since it occurs in association with some other condition. People suffering from secondary hyperhidrosis tend to experience the excessive sweating on larger areas of the body. Another significant difference between primary and secondary hyperhidrosis that one needs to know is that the latter can lead to excessive sweating while sleeping. The secondary condition tends to develop in adulthood, later than primary hyperhidrosis. The treatment of the condition involves first finding out the medical condition that led to it. You need to eradicate that cause if you want to get rid of the excessive sweating, and thus diagnosing the condition which is responsible for it is of immense importance.

Focal hyperhidrosis causes

Primary hyperhidrosis is idiopathic, and thus no known cause of the condition is to be found.
Localized hyperhidrosis can be caused by various diseases. The majority of the cases of secondary hyperhidrosis stem from either neurologic injury or dermatologic syndromes among other things.

Acute spinal cord injury can also lead to excessive sweating. Usually, one would expect the site of injury to lose the capability to sweat. However, the truth is that it can also lead to hyperhidrosis in localized areas and the condition can develop over a period of months to years following the injury. If it is indeed spinal cord injury which is responsible for the excessive sweating, there would be quite a few other symptoms that the patient would be presented with. They might complain of skin irritation or bowel distension. Patients would also experience flushing of the face, headache, and nasal congestion in addition to the sweating.

Orthostatic hypotension that occurs in patients with cervical spine injury can also lead to hyperhidrosis in regions such as the face, neck, and upper trunk.
Focal hyperhidrosis can also be caused by post-traumatic syringomyelia, which refers to a fluid-filled cavity present in the spinal cord.

Certain injuries of the central nervous system including the likes of strokes can result in hemispheric or medullary infarcts which can then lead to excessive sweating either on the ipsilateral or the contralateral side depending on the region of infarction.

Hyperhidrosis can also be caused by the injury to the cranial part of the sympathetic chain by the cervical ribs. The areas commonly affected include the face, neck, and shoulders. Similarly, excessive sweating can also occur owing to the intrathoracic tumor that impinges on the sympathetic trunk or the postganglionic nerves that lead to the excessive sweating.

The affected area in reflex sympathetic dystrophy can also experience excessive sweating.
It is seen that when there is an injury to a large portion of the sympathetic chain in the spine or the central nervous system, there is the development of widespread anhidrosis. In such cases, compensatory hyperhidrosis is seen in the innervated areas. The same can also occur in other conditions including the likes of diabetic neuropathy, Ross syndrome, and thoracic sympathectomy among others.

Palmoplantar hyperhidrosis can occur owing to conditions such as Raynaud’s disease, erythromelalgia, arteriovenous fistula, cold injury, and rheumatoid arthritis among others.
Frey’s syndrome often referred to as the auriculotemporal syndrome, is another condition that can lead to focal hyperhidrosis. The patient in this condition also experiences gustatory sweating along with salivation. There is excessive sweating on the areas such as cheek and mandible. This syndrome tends to occur after surgery involving the parotid gland wherein the cross-linkage between the regenerating nerves and the sympathetic nerves lead to excessive facial sweating.

Gustatory sweating can be triggered owing to ingestion of certain food items including the likes of coffee, chocolate, hot foods, alcohol, and sweets among other things.

Diagnosis of focal hyperhidrosis

To determine the treatment of the condition, it is first essential to understand the type. Thus, if you are confused as to whether it is primary or secondary hyperhidrosis that you have, there are certain questions that you need to ask yourself which would make things a whole lot easier for you. The first thing that you need to decide is how long you have been experiencing the excessive sweating. It is not uncommon for people to misinterpret the sweating owing to heat as unexplained excessive sweating. Therefore, the duration is something that you need to pay attention to. At the same time, you need to make sure that there is no apparent cause of the sweating that you can uncover.

If you have been sweating excessively for at least six months without being able to identify a reason for the same, there are some other things that you need to look out for.
Is the excessive sweating bilateral? Do you think that it is symmetrical? To put it in simple terms, you need to observe if the sweating is present on both sides of the body.
Has the sweating become so excessive that your daily activities are being interrupted? Is your quality of life being compromised owing to it? What is the onset of the condition? Is it earlier than 25 years of age?
Is there anyone else in your family who has been on the receiving end of the same problem? Is the family history for excessive sweating positive?
Do you experience the excessive sweating while sleeping or it stops as you doze off?
If the answer to at least two of the above questions is in affirmative, it points to the fact that you might be having focal hyperhidrosis for which you would need to meet up with your dermatologist so that the treatment plan can be decided on. However, if it is secondary hyperhidrosis that you have, it is a general physician that you would need to consult as the condition responsible for the hyperhidrosis needs to be diagnosed.

Focal hyperhidrosis treatment

While there’s no denying that hyperhidrosis tends to have a huge impact on the quality of life and can make someone suffer quite a bit, the truth is that most of the people suffering from the condition never seek treatment. This is because they are too embarrassed about it or do not realize that this is something that can be treated. This is especially true for those with primary focal hyperhidrosis. Since in this case, the condition develops at an early age, as people have been living with it for so long, they become adjusted to it, not realizing that this is a problem for which a remedy is available.

Let us now proceed to shed some light on the treatment options that you have if you are diagnosed with hyperhidrosis. Keep in mind that the success rates of the treatment options we present vary in individuals. However, there are various medications and procedures that have proven to be highly effective.

Primary focal hyperhidrosis treatment

The first instinct whenever you face any problem is to opt for over-the-counter medications. The over-the-counter antiperspirants can prove to be quite effective in some cases. All that you need to do is apply them to the areas that have excessive sweating such as hands, feet, and armpits and you would find the sweating subside to a large extent. If your sweating does get controlled with these medications, you would not need to acquire any consultation with a doctor for the problem. You can also use these before sleeping.
Another set of drugs that can prove to be of value to you are the ones that are prescribed by a doctor. It is quite common for the over-the-counter antiperspirants to fail in controlling the sweating in which case you would need to consult a doctor. He would then prescribe you a drug which is higher in strength. It is the aluminum salt-based antiperspirant that can provide you with the relief that you are looking for. These are found to be effective in mild cases of hyperhidrosis.

If you do not get any relief from such medications, it is a dermatologist that you would need to consult with who would then provide you with advanced treatments for controlling the condition. They are the people you should seek if your sweating becomes severe. Let us now take a look at the advanced treatment options that are suggested by them and which have proven their efficacy in getting rid of the condition.

Iontophoresis is one option that you have. In this case, the hands and feet of the patient are soaked in a basin of water in which an electric current of mild intensity is passed. Multiple sittings might be required before you get the results that you seek but the treatment has been successful in quite a few cases.

Another effective option that can serve to be of assistance in reducing the sweating problem that you have been experiencing is botulinum toxin type A (Botox). This is more often referred to as the anti-wrinkle drug. The drug serves to turn off the sweat glands for months. Thus, it makes for a rather effective medication for treating the condition of excessive sweating. However, you need to keep in mind that these injections could be somewhat painful which is why local anesthesia might be required at times.

A device called the miraDry system is also among the treatment options used by doctors for the condition. This device makes use of the electromagnetic energy to get rid of the underarm sweat glands permanently. However, you need to keep in mind that the device should not be used in other areas of the body, thereby restricting the efficacy that it has to offer you.

Certain oral hyperhidrosis medications can also provide you with the relief that you need from the excessive sweating. However, they need to be used with caution as they carry a list of probable side effects. Thus, they should only be used when prescribed by the doctor, and you need to acquire complete information about the side effects that can incur owing to them. This would make sure that you are observant and can seek prompt help in case of any problem.

Surgery is the last resort to get rid of hyperhidrosis. It is the option recommended by the doctors when everything else fails. One procedure that could prove to be of assistance if you have been experiencing excessive sweating in your armpits is to remove the sweat glands in the area. An endoscopic thoracic sympathectomy is also a surgical option that you can make use of. In this surgery, the nerves that carry messages to the sweat glands are severed.

There are times when people do not feel like making use of medical treatments to get rid of the condition. They are wary of the treatment plans owing to the risks involved or the side effects that can be incurred. If that is the case, there are certain home remedies that you can use to reduce the sweating.

Bathing daily tends to be effective as it gets rid of the bacteria. You should endeavor to make sure that you wear shoes and socks that are made using natural materials. You also need to make it certain that your feet get some room to breathe. Thus, make use of shoes that have breathable mesh and do not opt for a size that is too tight.

Secondary focal hyperhidrosis treatment

The treatment of this condition largely involves treating the underlying cause. You need to eradicate the cause if you want to get rid of the excessive sweating and thus diagnosing the condition which is responsible for it is of immense importance. However, the temporary solution is similar to that of primary focal hyperhidrosis treatment.
All in all, hyperhidrosis is a condition that can be treated if assistance is sought from the right person. Therefore, do not allow your quality of life to be compromised and seek the help that you need to get rid of the problem of the excessive sweating effectively.

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