Oily Skin / Hyperhidrosis (Excess Sweating)

Hyperhidrosis is excessive sweating.

 classified as (a) generalised, and (b) localised

CAUSES OF EXCESS SWEATING ARE:

A.     Generalised hyperhidrosis or hyperhidrosis of a relatively large area

1.          Exercise

2.      Environmental exposure to heat

3.      Drugs and drug poisoning: Antipyretics, emetics, insulin, meperedine, antidepressants (cyclobenzaprine, fluoxetine), systemic cholinergic agents and prostigmine, or poisoning with mercury, arsenic, insecticides and herbicides.

4.      Systemic disorders

a.       Infection, e.g. febrile illnesses (defervescent phase), chronic illnesses (tuberculosis, malaria and brucellosis).

b.      Cardiovascular disorders, e.g. shock, congestive heart failure, endocarditis and vasculitis.

c.       Neurological disorders, e.g. Parkinsonism, post-encephalitic (‘sweating sickness’), dysautonomic states.

d.      Endocrine disorders, e.g. hyperpituitarism, hyperthyroidism, diabetes. Insipidus.

e.       Neoplasm, e.g. Lymphoma, carcinoid syndrome, insulinoma and pheochromocytoma.

f.        Nutritional and metabolic disorders and others: Diabetes mellitus, hypoglycemia, porphyria, obesity, gout rickets, infantile scurvy, debility, alcoholism. Drug  withdrawal in drug addicts, pregnancy, menopause and anxiety.

5.      Compensatory hyperhidrosis

a.       Diabetes mellitus with neuropathy.

b.      After sympathectomy.

c.       Associated with diffuse anhidrosis, e.g. extensive miliaria rubra.

d.      Perilesional hyperhidrosis surrounding an anhidrotic area, e.g. quinacrine dermatitis.

6. Associated with past history of spinal cord injuries

1. Autonomic dysreflexia.
2. Cervical spinal cord injury with orthostatic hypotension.
3. Post-traumatic syringomyelia.

7.      Associated with peripheral neuropathies

a. Hereditary sensory neuropathy type III (Familial dysautonomia or Riley-Day         syndrome).

2. Congenital autonomic dysfunction with pain loss.
3. Peripheral motor neuropathy with autonomic dysfunction on exposure to cold.

8.      Associated with probable brain lesions

a.       Episodic hyperhidrosis with hypothermia (Hines-Bannick syndrome).

b.      Episodic hyperhidrosis without hypothermia.

c.       Episodic hyperhidrosis with hypertension after brain injury.

d.      Olfactory hyperhidrosis (facial Sweating from perfume smells).

9. Associated with intrathoracis lesions Parosysmal unilateral byperhidrosis (caused by cervical rib, osteoma, pulmonary adenocarcinoma, bronchial carcinoma and mesotheliom).

10.  Others

Indiopathic, emotional, post-orgasmic, exposure to cold. 

B.     Localised hyperhidrosis or hyperhidrosis of a relatively small area

1. diopathic unilateral circumscribed hyperhidrosis (Fig.574).
2. Gustatory hyperhidrosis

a.       Physiological.

b.      Pathological: Associated with encephalitis, syringomyelia, Pancoast’s syndrome, cervical sympathectomy, upper dorsal sympathectomy, upper dorsal sympathectomy, diabetic neuropathies, herpes zoater of preauricular area, parotitis or parotid adscesses, fre’y syndrome.

3. Lacrimal sweating associated with Raeder’s paratrigeminal syndrome.
4. Emotioanl hyperhidrosis: Palms, soles or axillae.

5. Localises hyperhidrosis associated with sudoriparos angiomas, Maffucci’s syndrome, blue rubber bleb naevus syndrome, glomus tumour. POEMS syndrome, burning feetsyndrome, reflex sympathetic dystrophy, pachy-dermoperiostosis, pretibial mygenitaldema, vitiligo, Klippel-trenaunay syndrome, nail-patella syndrome, palmoplantar keratoderma, pachyonychia congenital, localised epidermolysis bullosa simplex (Weber-Cockayne), granulosis rubra nasi, rheumatoid arthritis, vasomotor disorders (Raynaud’s disease, cold erythema, erythromelalgia and AV fistula).

6. Postural and pressure hyperhidrosis.

Volar Hyperhidrosis (Hyperhidrosis fo Palms and Soles)

 Excessive sweating of palms and soles is often a cause of social embarrassment but can also be a source of disability at work, play or studies.

palmoplantar keratoderma with clinodactyly, nail-patella syndrome, Raynaud’s disease, erythromelalgia, AV fistula, cold injury and rheumatoid arthritis.

Axillary Hyperhidrosis

 Gustatory Hyperhidrosis

Auriculotemporal syndrome or Frey’s Syndrome

 Night sweat

INVESTIGATION OF HYPERHIDROSIS

sweat visualization methods

TREATMENT

Anticholinergic druss

 Propantheline bromide

 Calcium channel blockers

 Sedatives

 tranquilizers

Amitryptiline

 Clonidine hydrochloride

 Indomethacin

psychotherapy and biofeedback

Topical Treatment

 aluminium chloride hexahydrate in anhydrous ethyl alcohol,

 Local applications of anticholinergic drugs

Iontophoresis

 Tap water iontophoresis

 Surgical Treatment

 Hurley—Shelley surgical technique⁷²

 Odous in Human Skin

Bromhidrosis or osmidrosis is malodorous or offensive sweating.

 Axillarry

Keratinogenic

Plantar

Intertrigionous

 Metabolic

 Heritable aminoacidurias

Exogenous

Foods,

 drugs,

chemicals

 result from bacterial alteration of apocring sweat and is largely axillary in origin.

Scrupulous cleaning

germicida soap,

topical bacteriostatic or bactericidal agents

 metallic aluminum, zircominum, zinc salts or hexachlorophene.

 Topical

 aluminium

chloride Apocrine chromhidrosis (true chromhidrosis)is secretion of coloured apocrine sweat 

Topical Treatment

antimicrobials

Antiperspirants

topical antiperspirant

hexahydrated aluminum chloride in 20-25% solution in absolute ethanol.

Anticholinergic topical drugs

Iontopgoresis

Anticholinergic drugs

Ganglion-blocking drugs

Others

Ditiazem

Surgical treatments

Botulinum A toxin subcutaneous injection.

Skin Problems

Hair Problems

Nail Problems

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