Hyperhidrosis sweating

1. HYPERHIDROSIS
DISORDER OF SWEAT GLAND
 PRESENTED BY :-KEVAL KHADELA
 SABMITTED TO : - DR.NISHANT

2. IT’S INCLUDE :--
 Introduction
 Clssification
 Cause
 Sign and symptoms
 Compication
 Diagnosis
 Treatment

3. INTRODUCTION:
 Hyperhidrosis is a medical condition in which a person
sweats excessively and unpredictably.
 People with hyperhidrosis may sweat even when the
temperature is cool or when they are at rest.
 It is associated with a significant quality of life burden
from a psychological, emotional, and social
perspective.
 As such It has been referred to as the “ silent
handicap”.
 Beside disrupting normal daily activites hyperhidrosis
can cause social anxiety or embarrassment.

5. CLASSIFICATION
1. According to area of body parts affect:
⇒Generalized hyperhidrosis : whole body or larger
areas of the body may be affected
• It is also khown as secondary hyperhidrosis
⇒Localized hyperhidrosis : palms, face, soles,
armpits may be affected
• It is also khown as focal, primary, essential,
idiopathic hyperhidrosis

6. 2.According to name of the body parts affect
⇒Palmar hyperhidrosis : palms of the hands
affect
⇒ Plantar hyperhidrosis : soles of the feet
affect
⇒ Armpit hyperhidrosis : underarms affect
⇒ Palmoplantar hyperhidrosis : palms and feet
together affect
⇒ Facial/scalp hyperhidrosis : face or scalp
affects

7. Palmar
Hyperhidrosis
Facial
Hyperhidrosis
Armpit or
axillary
Hyperhidrosis

8. PATHOPHYSIOLOGY:-
 Normally, Sweating is our body's mechanism to cool
itself.
 Our nervous system automatically triggers our sweat
glands when our body temperature rises.
 Sweating also normally occurs especially on our palms,
when we're nervous.
 In hyperhidrosis, the nerves responsible for
triggering our sweat glands become overactive and
call for more perspiration, even when it's not
needed.
 Specifically, acetylcholine, a chemical in the body
that transmits nerve signals, is released from nerve
endings and stimulates secretion of sweat.

9.  The problem of worsens if patient is under stress or
nervous.
 Other factors can play a role; certain foods and
drinks, nicotine, caffeine and smells can trigger a
response.

10. A common complaint of patients is they get
nervous because they sweat, then sweat more
because they are nervous...!!!!!

11. CAUSE :--
 No clear cause of hyperhidrosis has been
identified to date.
 It is caused by sympathetic over activity
 Nervousness or excitement can exacerbate
the situation for many suffer. Other factor can
play a role certain food & drink, nicotine,
caffeine & smell can trigger a response.

12.  Humectants such as glycerin, lecithin, &
propylene glycol draw water into the outer
layer of skin.
 Glycerin, lecithin & propylene glycol are found
in vaseline hypothetically excessive use of
vaseline over time may be one cause of
palmer hyperhidrosis.

13. PRIMARY HYPERHIDROSIS CAUSE :-
 Genetic trait:-
⇒ It is known that hyperhidrosis is caused by a
genetic trait but patients can be genetically
predisposed to different illiness or trait.
⇒ The location of the gene which is responsible for
abnormal sweating.
 Psychological or spschosomatic interference:-
⇒ Another potential is physical cause are emotional
factors like stress, depression, anxiety as a
secondary cause.

14. ⇒ Some psychotropic drug( mostly antidepressant)
can evoke heavy perspiration as a side effect
 Alimentation & characteristics:-
⇒ People who eat an unbalanced diet often suffer
from a vitiated metabolism in consequence of this
symptoms of hyperhidrosis show up
⇒ But it does not have to be that drastic. The
prefered eating of several herbs or hot spices might
be enough to start severe sweating for dispositional
people

15. 1. Hyperhidrosis of a relatively small area (localized
hyperhidrosis / primary hyperhidrosis)
 Most common type
 May be genetic = family history
 Idipathic
 Gustatory
• Physiological
• Pathological : Associated with
 encephalitis
 Diabetic neuropathies
⇒ Syringomyelia
⇒ Herpes zoster (shingles)
⇒ Parotitis
⇒ Parotid abscesses
⇒ Thoracic sympathectomy
⇒ Auriculotemporal or Frey's syndrome

16.  Emotional
• Palms
• Soles
• Axillae
 Associated with
• Vitiligo
• Rheumatiod arthritis
• Burning feet syndrome
• Trench feet
 Brain tumor
 Injury to spinal cord or nerve
 Miscellaneous
⇒ Lacrimal sweating (due to postganglionic
sympathetic deficit, often seen in Raeder's
syndrome)
⇒ Harlequin syndrome

17. SECONDARY HYPERHIDROSIS CAUSE:-
 Affected nerve:-
⇒ Nerve & nerve track –especially as a part of the
sympathetic nervous system are present all over the
body and they are responsible for transmitting right
signals
⇒ Concerning the bodily temperature to the brain. The
sympathetic chain is responsible for controlling the
sweat gland all over the body. In some cases an
affected functioning of the nerve information leading
to excessive sweating
⇒ A major part of the central nervous system is a spinal
cord which when affected by tumor or lesion may
trigger the response.

18.  Menopause :-
⇒ changes of the hormone level are a frequent cause
of severe sweating. This typically occurs as an
unpleasnt side effect of the menopause
⇒ Reason for that are perceptible changes of the
female osterogen level
 Adolescense sweating:-
⇒ Due to physical maturation, hormonal changes
starting usually it increase the production of sweat
and body odour
⇒ The notable increase production of ostrogen &
testoterone effect the acivity of the sweat gland

19.  Obesity:-
⇒ Obesity can be another trigger of excessive
sweating. In general that both the skinny and the
obes can simillarly suffer from hyperhidrosis
 Other cause :-
⇒ Fever
⇒ Parkinson’s disease
⇒ Congestive heart failure
⇒ Autoimmune disorder

20.  Hyperhidrosis of large area:--
 In people with past history of spinal cord injuries:
⇒ Autonomic dysreflexia
⇒ Orthostatic hypotension
⇒ Post traumatic syringomyelia
●Associated with peripheral neuropathies
⇒Familial dysautonomia (riley- day syndrome)
⇒ Congenital autonomic dysfunction
⇒ Exposure to cold ( cold induced sweating)

21.  Associated with problem brain lesion
• Associated with intrathoracic neoplasms or
lesions
• Lymphoma
• Insulinoma
 Associated with systemic medical problems
⇒ Pheochromocytoma
⇒ Parkinson's disease
⇒ Thyrotoxicosis
⇒ Diabetes mellitus
⇒ Congestive heart failure
⇒ Anxiety
⇒ Menopausal state

22.  Associated with toxins
 ⇒ Infantile acrodynia induced by chronic low-dose
mercury exposure.
 Systemic disorders
• Infections : Malaria, tuberculosis(Night sweats)
 Drugs and poisons
• Drugs : antipyretics
Emetics
Insulin
Antidepressants

23. SIGNS & SYMPTOMS:--
 Vary depending on the body area affected
 In palmar hyperhidrosis : palms of the hands are
excessively wet or moist. And also cold to the
touch.
 In axillary hyperhidrosis : excessive sweating in
the underarm area occurs, leaving large wet
marks and staining clothes

24.  In scalp / facial hyperhidrosis : excessive
sweating of the face and scalp occurs, as
well as moderate to severe facialblushing.
 In plantar hyperhidrosis : the soles of the
feet sweat excessively. This condition is
often associated with hyperhidrosis in other
body areas.
(Commonly with palms)

25. COMPLICATION:--
 Fungal infections : people who have hyperhidrosis
haven increased risk of developing fungal infections.
Particularly around feet.
• Excessive sweat combined with socks and shoes
creates a warm and moist environment.
• This provides an ideal surrounding for fungi to grow.
There are two most common fungal infections to affect
people with hyperhidrosis.

26. • Fungal infection can be treated with
antifungal creams and by lifestyle
modification.
• More severe cases may require antifungal
tablets or capsules.
 Physiotherapy treatment is also given.
 Skin condition : Excessive sweat can also
make more prone to certain skin conditions.
• Such as : Warts, eczema, boils

27. WARTS
•These skin conditions are treated by medication,
physiotherapy nd lifestyle modifications.

28.  Body odour : The apocrine sweat glands,
which are usually unaffected by
hyperhidrosis, are responsible for producing
most of the unpleasant smelling sweat that is
associated with body odour.
• The sweat that is associated with
hyperhidrosis usually comes out of the
eccrine glands and it does not smell.
Due to eating spicy food and drinking alcohol
can make sweat smell, secreted from the
eccrine gland.
• This can be prevented or eased by following
lifestyle modification advice.

29.  Social impacts : having clammy or dripping
hands. Perspiration-soaked clothes can be
embarrassing.
 Emotional impacts : Pt feeling unhappy,
down, depressed or hopeless, which is affected
pt's mental condition
 Occupational impact : palm sweat can soak into
paper-work, affecting occupational and educational
pursuits.
 Dehydration : due to loss of body fluid throughout
excessive sweating.
Pt is adviced to drink water as much as possible.
(atleast 8 to 10 glasses)
 Drying of skin : due to dehydration.

30. Epidemiology
 Approximately 3% of population affect
 It affects men & women equally
 People of all ages are affected but, Most
commonly occurs among people aged 25-
64 years
 Some may have been affected since early
childhood
 About 30-50 % have another family
member afflicted, implying a genetic
predisposition

31. How to diagnose hyperhidrosis
clinically???
• Hyperhidrosis is diagnosed by physical
examination.
• Tests : Following some clinical tests are
included as diagnosis of hyperhidrosis :

32. DIAGNOSIS:-
 Several tests may be performed including:-
 Starch – iodine test:
⇒ An iodine solution is applied to the sweating
area and starch is sprinkled ever the iodine
solution.
⇒ The starch- iodine combination will turn a
dark blue color indicating where there is
excess sweat production.

33.  Paper test:-
⇒Special paper is placed on the affected area to
absorb sweat and then weighed to determine the
amount of sweating that occurs.
 Laboratory test:-
⇒Such as thyroid function test, blood glucose and
uric acid level measurement and urine samples
are performed to rule out more serious medical
conditions that may be associated with excessive
sweating .
 Sweat test:-
⇒ This involves coating some of their skin with a
powder that turns purple when the skin gets wet.

34. TREATMENT:-
1. Topical / Antiperspirants
2. Botulinum toxin type A
3. Surgery & medication
4. Physiotherapy
⇒Electrotherapy
⇒Exercisetherapy
⇒Other advice

35.  Topical treatment (antiperspirants):-
⇒The application of aluminum chloride
hexahydrate has been used to reduce
sweating by approximately 50% for mild
hyperhidrosis sufferers ( axillarly /underarm
region)
 Botulinum toxin type A:-
⇒ Botox injections are appropriate for moderate
to severe hyperhidrosis sufferers.
⇒ Injection is done into the affected area and is
effective for as long as the nerve to the sweat
glad is deadened
⇒ The average duration of effect is 7 months
until symptoms recur.

36.  Surgery:-
⇒This is a last resort for people whose
lifestyle are seriosly affected by
hyperhidrosis and for whom other more
conservative methods have failed.
⇒ ETS (Endoscopic thoracic
sympathectomy)is done commonly
⇒The procedure tuens off the signal that tells
the body to sweat excessively
⇒ ETS does not work as well for those with
excessive armpit sweating

37.  Medication:-
Taken orally...
Anticholinergics drugs such as glycopyrrolate (Robinul)
help to prevent the stimulation of sweat glands.
Sedatives / tranquilizers are used in stressed and
emotional condition.
Calcium channel blockers are also used.
Beta blockers or benzodiazepines may help to reduce
stress-related sweating.
 Side effects
⇒ Drowsiness
⇒ Visual symptoms
⇒ Dryness in mouth and other mucous
⇒ Problems with urination
⇒ constipation

38. PHYSIOTHERAPY
MANAGEMENT
3 ways of treatment
(1)General PT management
(2)Pre-operative PT management
(3)Post-operative PT management
General PT management includes,
a) Electrotherapy
b) Exercisetherapy
c) Counselling of patient

39. GENERAL
PT MANAGEMENT
AIMS :
 1) Short terms :
 To reduce or decrease excessive sweating
 Provide relaxation to the patient
 Provide psychological suppert
2) Long terms :
 Cure and prevent complications
 Cure causes responsible for hyperhidrosis
 Counsel the patient
 Help pt to return back in normal life (ADL)

40. • Assessment : it is important to know
proper cause of hyperhidrosis, which
helps the therapist to make treatment
plan.
• It is also imp to checkout complications,
which are needed to treat.
Subjective assessment :
• Name, age, gender, address, occupation, c/c

41. • History taking :
 Present illness history
 Past illness history
 Medical history
 Family history
 Surgical history
 Drug history
 Personal history : sleep, appetite, addiction
 Mental condition : stress, anxiety

42.  Objective assessment
• Observe and examine obesity --> BMI
• Observe skin marks or skin condition or
fungal infections
• Therapist should ask following questions to
the patient
 Location : where does sweating occur???
 Time pattern : does it occur at night??
- did it begin suddenly??

43.  Triggers : Does the sweating occur when you
are reminded of something that upset
you??? (Such as traumatic event)
 What other symptoms do you have???
For example: increase heartbeat, cold or
clammy hands, stress, fever, lack of appetite
• Diagnosis and other invastigation

44.  Electrotherapy :-
⇒Iontophoresis:-
⇒ Iontophoresis is the transfer of the ions of
drugs into the body through the skin by the use
of a constant direct current
It is used for plantar, palmar and palmoplantar
hyperhidrosis.
⇒ For treatment of hyperhidrosis tap water
iontophesis is used
⇒ Tap water iontophoresis has been
demonstrated to be an effective treatment for
excessive sweating of hand and feet, without
causing any side effects.

45. • Patient position :
• sitting on stool or chair
• Patient should never lie or stand with full body
weight on an electrode. This creates pressure and
an ischemic condition that can lead to a burn.
 The treatment involves passing a low-level electric
current through the skin in order to inhibit sweat
glands and prevent body from sweating.
• The principle is that the sympathetic nervous
system activates sweat glands and the main
transmitter substance is acetylcholine.
• Therefore introduction of an anticholinegic
compound reduces activities of the glands.
• Such compounds may simply be applied to the skin
but their effectiveness as dependent on the amount
of absoption
•

46.  through the epidermis to the dermis in which the
glands are situated.
• Glycopyrronium bromide administered as an
anticholinergic compound.
• Tap water is containing glycopyrronium bromide
and field in two shallow pans.
• During treatment, both hands in pronated
position are immersed in tap water.
 The palms are placed flat and incontact with a
felt pad or electrodes that are connected to a
galvanic current (DC) device.
• The current intensity is adjusted according to
the degree of tingling sensation in the palms to
suit each pt's maximum tolerance level.
• For feet procedure is same.

47. • Treatment time :
 Hands only = 20 minutes
 Feet only = 30 minutes
 Both hands and feet = 40 minutes
 3 days per week for at least 4 to 8 weeks,
when the sweating gradually starts to return.
• Side effect : dryness of the mouth
- Sips of water during the treatment may be
helpful.

49.  Dangers:-
⇒Shock
⇒ Burns
⇒ Skin irritation
⇒ Skin sensitivity
 Contraindication:-
⇒ Open skin
⇒ Infection
⇒ Bony areas
⇒ Loss of sensation
⇒ Dry scaly skin
⇒ Skin lesions

50. Exercisetherapy
• Patient is adviced to do exercise in open
and air-conditioned environment (if
possible) to prevent sweating.
• Relaxation :
 Best way to reduced stress, and thus stress-
induced sweating.
 It teaches proper breathing to patient, which
is imp to come down sweat gland's over
activity.

51. FOR EXAMPLE :
MITCHELL METHOD
SAVASANA (JACOBSEN)
DEEP BREATHING EXERCISE

52. • Yoga :
 One of the best natural ways to control
excessive sweating.
 This works through meditation, calming down
the nerves and subsequently lessening
sweat production.
 For example :
• Pranayamas
• Suryanamaskaras

53. PRANAYAMAS
Chandranuloma
viloma
(left nostril
breathing)
Suryanuloma viloma
(Right nostril
breathing)

54. SURYANAMASKARA (12 STEPS)

55. • Do the yoga once in every four hours at
home/ garden for two months.
• Choose open and air-conditioned area to do
relaxation and yoga, because it is provided
proper oxygenated and enough air to pt
which is enough to circulate around skin and
decreases sweating.
• One can continue till lifelong, because it is
very benificial.

56.  Counselling of patient
• Firstly give them psychological support and
counsel about the condition to handle it.
• Then give them following advice.
 Drink more water
Because it regulate body temperature, thus
prevent body sweat.
Prevent dehydratiom.
Allow toxins to be flushed from the body

58. Water:-
Drinking plenty of water to stay
hydrated. It is the easiest and
simplest way to reduce sweat.
When your body is properly
hydrated, it won't have to work so
hard to regulate your body
temperture.
Yoghurt:-
Yoghurt is a good source of
calcium which help you sweat
less. Calcium acts as a
temperature regulator. Few foods
that are rich in calcium are dairy
products, almonds, baked beans,
and fortified milk.

59.  Olive oil:-
 Olive oil When your body
works hard to digest, it
causes excessive
sweating. Olive oil is
delicious and easy to
digest. Moreover, they are
one of the best oils to use
for cooking
 Whole grains:-
 Whole grains B- complex
vitamins are very important
for the normal metabolic
functioning. Some other
Vitamin B rich foods are
breads, fish, eggs, nuts,
meat and vegetables.
Show Thumbnail

60.  Oatmeal oats:-
 Oatmeal Oats are rich in fiber
and low in fat content. It will
digest fast and will help
maintaining your overall health.
Prefer oatmeal because
increased fat content in your
food will cause excessive
sweating.
 Peppermint:-
 Peppermint tea or juice can
help regulate sweat by calming
the nerves and providing a
cooling effect to the body.
Some other herbs with same
effects are sage and
asparagus.

61.  Tomato:-
 Many vitamins and minerals
such as potassium and
magnesium, are found in
tomato juice. Start taking raw
tomato daily or drinking a glass
of tomato juice to reduce
excessive sweating.
 Almonds :-
 Almonds are a rich source of
magnesium which improves
digestion and strengthens
immune system. Other
magnesium rich foods that can
reduce sweating are pumpkins,
spinach and soy beans.

62.  Sage :-
 It helps regulate the nervous
system thereby control the
production of sweat. Drink two
cups of sage tea for a few days
and you will notice a
tremendous change. You can
take it in tincture or in extract
form as well.
 Watermelon:-
 Taking watermelon is an
excellent idea because it is a
good source of fiber and water.
The fruit is easy to digest and
the water content keeps you
hydrated. Vitamin B in
watermelon is good for
maintaining efficient metabolic
functioning in the body.

63. • Foods to be avoid include
Spicy dishes, garlic, onions, processed foods,
processed and highconcentration of
hydrogenated oil.
 Foot care
• Bath feet every day
• Pat them dry, especially between the toes
• Use foot powders
• Wear sport socks or cotton socks
• Change socks twice a day

64. • Choose leather or meash canvas shoes.
 Do yoga, relaxation & breathing ex. Regularly
 Do favorite activities to reduce stress : dancing,
playing music, play game
 Keep your bed cool
 Take zinc supplement
 Apply lemon juice & baking soda
 Drink sage tea
Avoid alcohol, smoking, nicotine Tea and caffeine
 Loss weight : diet, basic aerobic or cardio ex.
 Be on time
 Avoid taking hot bath and hot drinks
 Take cold shower
 Shave and clean underarms regularly
 Drink tomato juice
 &

65. Preoperative PT management
• To prevent chest complication after surgery
teach pt :
- coughing-huffing techniques
- breathing exercise
• To prevent thrombosis :
- ATM
- hip, knee-quadriceps exercise
• Muscle strengthning exercise of upper limb
• To decrease anxiety teach pt general relaxation
technique

66.  Postoperative PT management
• To prevent or reduce respiratory complication :
- deep breathing exercise
- coughing-huffing techniques
- blowing ex
- spirometry ex
• To prevent or reduce oedema & bed sore :
teach proper positioning
 To prevent or reduce DVT : ATM
 To improve the joint range of motion:-
⇒ Passive exercise( few day after surgery)
⇒ Active assisted
⇒ Active exercise
• relaxation : general and local

67. • UL active movement and active-assisted
exercise
 Shoulder flexion-extension, medial-lateral
rotation
 Shoulder girdle exercise : protraction,
retraction, elevation, depression, rotation
 Elbow flexion-extension
 Wrist flexion-extension, supination-pronation
 Finger and thumb movement
• Muscle strengthening exercise of UL

68. THANK YOU