Author(s): Hemant H.Gangurde
Sweating is a physiological and vital process. Basically two types of sweating exist: thermoregulatory and emotional sweating. They are controlled by different centers like thermo regulatory sweating is regulated predominantly by hypothalamus, emotional sweating predominantly by limbic system. Palmar, plantar and axillary hyperhidrosis, though benign, may be burdensome and occupationally restrictive, even hazardous. Hyperhidrosis, a condition characterized by excessive sweating, can be generalized or focal. When generalized, it usually occurs in association with infectious, endocrine or neurological disorder. Focal hyperhidrosis is idiopathic and occurs in otherwise healthy individuals, affecting the palms, soles or axillae. Hyperhidrosis is a relatively unknown disorder to general public and healthcare professionals. The socially embarrassing disorder of hyperhidrosis and its treatment options are gaining widespread attention. In order of frequency, palmar-plantar, palmar-axillary, isolated axillary, and craniofacial hyperhidrosis are distinct disorders of sudomotor regulation. Diagnosis of these disorders is primarily from patient history and physical examination, whereas results of laboratory studies performed with indicator powder reveal distribution and severity of resting hyperhidrosis and document the integrity of thermoregulatory sweating. Treatment options lie on continuum based on severity of hyperhidrosis and the risks and benefits of therapy. In general, therapy begins with antiperspirants or anticholinergics. Iontophoresis is available for palmar-plantar and axillary hyperhidrosis. Botulinum toxin type A is effective for isolated axillary hyperhidrosis not responsive to topical antiperspirants. Endoscopic thoracic sympathectomy may be used for severe cases of palmar-plantar and palmar-axillary hyperhidrosis.