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Gipergidroz. The increased perspiration.

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Under giperegidrozy (from Greek "hyper" - excessive, raised, "hidros" – sweat) in medical practice it is accepted to understand the plentiful sweating happening irrespective of physical factors: the increased physical activity, overheating, high temperature of the environment or others. Sweating is the physiological process of allocation by sweat glands of a watery secret (sweat) which is constantly happening in a human body. Process of sweating protects an organism from a hyperthermia (overheating) and helps to support its homeostasis (constancy): evaporating from skin, sweat, thereby, cools the surface of a body and lowers its temperature.

    Gipergidroz. The increased perspiration.

    Under giperegidrozy (from Greek "hyper" - excessive, raised, "hidros" – sweat) in medical practice it is accepted to understand the plentiful sweating happening irrespective of physical factors: the increased physical activity, overheating, high temperature of the environment or others. Sweating is the physiological process of allocation by sweat glands of a watery secret (sweat) which is constantly happening in a human body. Process of sweating protects an organism from a hyperthermia (overheating) and helps to support its homeostasis (constancy): evaporating from skin, sweat, thereby, cools the surface of a body and lowers its temperature.

    In an organism of the healthy person perspiration amplifies at temperature increase of the environment to 20-25 °C, and also at physical or psychoemotional activity. At increase in surrounding temperature to 36 °C and above by means of sweating thermal control of an organism is carried out, its overheating is not allowed. The raised thermolysis and cooling of an organism are promoted by low relative humidity and the active physical movement. On the contrary, in the damp environment process of evaporation of sweat does not happen to motionless air therefore long stay in a hot bath or a steam room is not recommended. The excessive use of liquid sharply increases perspiration, therefore, during the strengthened physical activity or indoors with high temperature of air it is not necessary to drink a lot of water. As a result of psychoemotional excitement skin receptors, reacting, stimulate release of sweat. Therefore increase in perspiration happens if the person experiences strong emotions, for example, nervousness, a fright or pain.

    Pathological violations of process of sweating are expressed in its excessive strengthening or, on the contrary, reduction, and also in change of a smell of sweat which becomes fetid. The increased perspiration can be the general when plentiful sweating happens practically on all surface of a body, and often accompanies functional violations of nervous, endocrine system and a number of infectious diseases. In cases when perspiration is limited to local parts of the body (soles, palms, axillary areas, elbow and knee bends), it is about the local gipergidroz caused by hypererethism of nervous system.

    Plentiful sweating or often causes to people serious discomfort, having an adverse effect on quality of their life. Knowing the problem, the person stays in constant tension, expecting that it can happen at the most inappropriate moment and will give an inconvenience to people around. This nervous expectation, in turn, provokes sweating even more. The circle becomes isolated, and an exit from it seems impossible. The symptomatology described above is signs of a gipergidroz.

    Each person reacts to strong emotional shocks in own way: someone – sharp pressure jump or an attack of gripes, and someone the increased sweating.

    Local it is shown by plentiful perspiration of palms, a foot, armpits, a forehead and other parts of the body, and both everyone, and all together. Generalized without the visible reasons demands immediate consultation of the doctor as can be a symptom of a serious disease.

    Causes of a gipergidroz

    Moist palms and soles, the becoming wet armpits, unpleasant pungent smell of sweat do not add to the person of self-confidence and are negatively perceived by surrounding. To understand factors of emergence of a gipergidroz, it is necessary to understand sweating process physiology in general.

    Sweating is one of the natural mechanisms providing cooling of an organism and removal from it to excess liquid, toxic agents, products of disintegration and water-salt exchange. Not incidentally, some medicinal substances, being brought out of an organism through skin, paint sweat in reddish, blue-green, yellowish shades. And wishing to lose excess weight, we go to gym – with a considerable part of weight is lost then.

    Sweat is produced by the sweat glands located in hypodermic and fatty cellulose. The greatest number of sweat glands is in axillary hollows, on palms and soles of legs. On the chemical composition sweat for 97-99% consists of water with impurity of salts (chlorides, phosphates, sulfates of sodium and potassium) and other complex organic substances. Existence and concentration of these substances in a stalemate secret at different people are not identical, from here and the individual smell of sweat inherent in different people. Besides, to composition of sweat the secret of sebaceous glands and a bacterium on a surface of integuments are added.

    Physiological sweating is an indispensable condition of clarification of an organism from slags and waste products. The bath, a sauna, a sweating room promote removal with then from an organism of these substances and to the general improvement. Even at the healthy person sweating amplifies at physical activity, and also at emotional experiences and nervous overloads.

    Gipergidroz can be one of symptoms of a number of psychological, somatic diseases or a consequence of non-compliance with rules of personal hygiene.

    Clinically distinguish primary and secondary . Primary meets at youthful age during rough puberty more often and occurs at 1% of people. Secondary , as a rule, is a consequence of a neurologic, endocrine or somatic disease. Identification of the factors causing predetermines the program of further inspection and treatment of the patient. So, at a generalized gipergidroz it is necessary to exclude, first of all, tumoral, endocrine and infectious diseases.

      Sweat glands form and excrete sweat through a time for the surface of skin, and normal regulation of sweating in a human body is provided by the autonomic nervous system which is responsible in a human body for processes of a metabolism, blood circulation, allocation, reproduction. The autonomic nervous system is subdivided into two parts: sympathetic and parasympathetic.

    Regulation of process of sweating is carried out by the sympathetic autonomic nervous system. At hyperfunction of sympathetic nervous system there is a change of normal functioning of sweat glands: at the slightest nervousness of people at once becomes covered then. But what is the trigger of these processes interconnected with each other and what causes of a gipergidroz – the modern medical science cannot give the exact answer to the matter yet.

    Methods of treatment of a gipergidroz

    Non-invasive treatment of a gipergidroz

    Before passing to the description of conservative methods of treatment of a gipergidroz, it is necessary to make several general recommendations to the people having this illness.

    As sweat is the biological liquid which is formed in a human body, it represents fine nutrient medium for reproduction of bacteria that leads to violation of protective functions of integuments and development of skin diseases: potnitsa, attritions and intertrigo of skin, and also fungal and pustulous diseases.

    Therefore careful observance of rules of personal hygiene has to become the main postulate in fight with gipergidrozy: follows daily (and sometimes and more than once!) to take a shower, to do warm trays for palms and feet (it is better with infusion of a camomile or oak bark), to do rubdowns. For destruction of a smell of sweat it is recommended to use deodorants. It is not recommended to wear clothes, especially underwear and socks, from synthetic fabrics as they are air-tight. To change linen, socks, tights follows as often as possible. Footwear has to be convenient, easy with special insoles inserts, and in the summer – open. It is necessary to limit, and whenever possible and to exclude from a diet absolutely, too hot, spicy food, alcohol, nicotine, coffee. Such products as onions and garlic, spices strengthen an unpleasant smell of sweat.

    If is not the symptom accompanying the main disease, then for its treatment in medical practice widely use the following types of conservative treatment:

    • psychotherapeutic methods
    • medicamentous therapy
    • antiperspirants
    • physiotherapeutic methods

    Psychotherapeutic methods of treatment of a gipergidroz, in particular hypnosis, are directed to elimination of psychological problems of the patient. Ability to keep the emotions and fears under control helps some people to cope also with a problem of a gipergidroz.

    For medicamentous therapy of a gipergidroz different groups of medicines depending on degree of expressiveness of a disease and contraindications are used. The medicines of a belladonna (belladonna) containing atropine influence sympathetic nervous system, reducing her excitability and reducing secretion of sweat glands.

    Sedative medicines (medicines of a valerian, motherwort, grass soothing collecting etc.) and tranquilizers are shown to people with labile, unstable nervous system. Lowering excitability of nervous system, they help to cope with daily stress as a factor of emergence of a gipergidroz. The doctor has to carry out selection of the correct medicine and its dosage.

    .  To a modern method of treatment of a gipergidroz it is possible to carry Botox injections. The pharmacological effect of this method of treatment is based on long-term (before half a year and more) blocking of the nervous terminations innervating sweat glands and considerable decrease in sweating.

    Antiperspirants possess local action and at the expense of the chemical composition including salts of zinc, aluminum, formaldehyde, salicylic acid, , ethyl alcohol, interfere with sweating. Causing narrowing or even full obstruction of output channels of sweat glands, medicines of this group block to sweat removal outside. Among side effects from their application it is necessary to call allergic reactions, dermatitis and even severe hypostases in places of drawing.

    Among physiotherapeutic methods of treatment are widely applied the balneotherapy (coniferous and salt medical bathtubs, a contrast shower) having the all-strengthening effect on nervous system. Salutary impact on nervous system is made also by an electrodream – a medical method of influence by pulse current of low frequencies on a brain. The medical effect of an electrodream is based on sedative action, strengthening of processes of braking, improvement of activity of the autonomic nervous system.

    The method of a medicinal electrophoresis is constructed on a combination of a direct current and ions of the medicinal substances reducing sweating. Local impact on a problem zone a current of constant frequency causes temporary (dehydration) of this site of skin. At the same time medicinal substances are deposited in skin and keep the pharmacological action up to 15-20 days.

    The combination of the whole complex of conservative methods of treatment (psychotherapy, medicines, antiperspirants, physical therapy), sanatorium treatment allow to reach more lasting clinical effect (up to 1 - 2 months).

    However, all conservative methods of fight with gipergidrozy only grant a temporary respite in fight against this illness, but do not solve a problem cardinally. To get rid of a gipregidroz once and for all, it is possible only having resorted to surgical methods of treatment.

    Local surgical treatment of a gipergidroz

    All surgical ways of treatment represent a certain risk therefore it is worth resorting to them only after performing conservative treatment, that case when it was inefficient and did not bring the expected results. Local ways of surgery in treatment of a gipergidroz assume operational impact directly in the field of the strengthened sweating and are the intermediate stage between conservative treatment and the central surgical method of fight with gipergidrozy (simpatektomiya).

    Conservative ways of treatment and prevention of a gipergidroz include the general hygiene of a body and places of the increased sweating, reception of medicines, use of antiperspirants, application of injections of Botox and the cosmetics used at a blashing-sidroma (with B3 and B5 vitamins), an ontoforez (ionoforez), the address to the psychologist.

    Often the problem of a gipergidroz or an erythrophobia happens decided by the person and is his psychological problem. In that case for treatment and correction it is worth addressing the psychotherapist. A lack of conservative treatment of a gipergidroz is the short effect demanding regular holding medical procedures: action of antiperspirants lasts till 6 o'clock, effect of Botox injections – up to 6 months.

    Now in expeditious treatment of a gipergidroz are successfully used:

       Use of the listed ways of surgical treatment is the safest, yields resistant positive result, does not cause fears of emergence of side effects. They are malotravmatichna and do not cause cosmetic defects since the procedure is carried out through small punctures by the size only in 10 mm. The technique of local methods of surgery assumes the reduction of number of sweat glands leading to sweating reduction. In 90% of cases the problem of a gipergidroz and an unpleasant smell of sweat completely is removed.

    Let's consider in more detail local surgical methods of treatment of a gipergidroz.

    Curettage. Operation assumes destruction of the nervous terminations and the subsequent removal of sweat glands in the place of the increased sweating. For more exact definition of a zone of a gipergidroz before the procedure iodine - starched test (test of the Minor) is carried out. Surgical manipulations are carried out under local anesthesia. 10 millimetric puncture (become at strongly expressed gipergidroz – 2 punctures) therefore there is a peeling of skin. Then "scraping" is carried out from within.

    Most often the curettage is applied at a gipergidroza of an axillary zone. The increased sweating and an unpleasant smell is eliminated. As complications can be followed by small bleeding and a hematoma, easily removable and safe. After several years during which the lasting positive effect remains the nervous terminations can be restored, and renewal of a gipergidroz is possible.

    Liposuction is shown for people with excess body weight. Process of sweating in an organism is controlled by the autonomic nervous system which part is the sympathetic nervous system. During operation nerves of a sympathetic trunk collapse and thus action of the nervous impulse causing sweating is stopped. During the operational actions test of the Minor for definition of a zone of a gipergidroz is carried out, the puncture becomes, the small tube is carried out to it, through it the nervous terminations of a sympathetic trunk collapse and axillary cellulose is removed. Both the operation course, and possible side effects are similar with curettages. Some decrease in sensitivity of skin in the place of influence, hemorrhage, hematomas is noted. If the hypodermic congestion of liquid is formed, it is removed by means of a puncture.

    Excision yields excellent results in treatment of a gipergidroz. However after holding a procedure, in the place of influence there is a small scar (about 3 cm) causing some constraint of the movement. Operation, as well as in the previous methods, is preceded by definition by means of test of the Minor of a zone of a gipergidroz and its further full excision. At all ambiguity, the high rate of efficiency of this method attracts to it keen interest.

    All given methods of local surgical treatment of a gipergidroz show high efficiency and safety.

    Simpatektomiya

    Gipergidroz is a disease which, as well as any other, reduces quality of life, causes physical and psychological discomfort. To cure a disease and to remove its symptoms, so to improve health and an emotional background of the person, a task quite possible at the modern level of development of medicine.

    Gipergidroz is local (local) at which the increased sweating in separate parts of a body (axillary hollows, areas of palms and feet) and the general is observed.

    Treatment of a gipergidroz should be begun with conservative methods. It is necessary to address for consultation the psychologist, to keep clean a body, to use antiperspirants. In some cases, with slight increase of sweating very effective is an application of an ionoforez and injections of Botox. In the absence of contraindications application of local surgical methods of treatment for decrease in sweating and to disposal of an unpleasant smell of sweat is possible. The curettage, liposuction and excision of skin of an axillary zone in most cases yield resistant positive result of treatment, do not cause serious side effects.

    In that case when these ways did not give the expected result, resort to treatment of a gipergidroz by means of a simpatektomiya – the surgical intervention called by the central method.

    Simpatektomiya is applied in treatment of a gipergidroz since 1946, and the technique of its carrying out is rather well fulfilled. This low-traumatic procedure guarantees positive result of treatment which remains for a long time. However it is necessary to resort to a simpatektomiya only in emergency cases at a severe form of the gipergidroz which is not giving in to treatment in other known ways. Impact on an organism by means of this method is fraught with such not palatable consequences as dryness of face skin and palms. Further the condition of skin is normalized. Serious caution to carrying out a simpatektomiya is the threat of development of a compensatory gipergidroz which it is impossible neither to predict, nor to influence it in any ways of treatment.

    There are several types of a simpatektomiya:

    Surgery in all listed cases is carried out under the general anesthesia. The operation purpose – violation of work of a sympathetic trunk by final or its partial fracture. The traditional simpatektomiya which was carried out through a section in a neck or a thorax gave way to more sparing and esthetic endoscopic way now. The endoscopic simpatektomiya is carried out by one of ways: or with destruction of a sympathetic trunk high-frequency current, or with imposing on it a special clip. Both ways are highly effective, with irreversible positive results of elimination of a gipergidroz.

    There is a risk of developing of bleeding, increase in sweating on a face after reception of spicy or hot food, omission of a century, narrowing of a pupil (Horner's syndrome). It is not possible to eliminate compensatory after destruction of a sympathetic trunk now. Compensatory in a pronounced form occurs only at 2% of the patients who transferred a simpatektomiya and consolatorier are forecasts in elimination of this side effect when imposing a clip.

    It should be noted that 95% of the people who resorted to a simpatektomiya do not test any troubles and remain happy results of treatment of a gipergidroz. They won against the illness and began new, full-fledged life.

    In the photo on the right: the patient with primary gipergidroz at rest at the room temperature. From above - the Iodine-starched test of the Minor on the back surface of palms - colors from light orange to violet. From below - the test repeats with the same patient on the same conditions 2 months later after a successful endoscopic chest simpatektomiya.

    Simpatektomiya complications - compensatory

    Operation of an endoscopic thoracic simpatektomiya (in abbreviated form ETS) in most cases – 95-98% - gives lasting long-term effect, however statistically at every tenth patient becomes complicated, a so-called, compensatory gipergidroz.

    So the human body is arranged that he constantly tries to fill the lost function by means of various compensatory mechanisms. Compensatory is a response of an organism to the sharp termination of function of sweating, habitual for it, on certain parts of the body. As its manifestations strengthening of intensity of sweating on other parts of the body not subject serves a gipergidroz earlier. So, for example, after a simpatektomiya of armpits or palms the breast or a back quite often begins to sweat, and at a simpatektomiya of feet – the lower departments of a trunk and hip.

    Manifestation of a compensatory gipergidroz cannot be counted in advance, however the surgeon is obliged to warn the patient who decided on this operation about probability of this side effect of a simpatektomiya. If the simpatektomiya was carried out by method of clipping of a sympathetic trunk, then with a compensatory gipergidroz it will be still possible to fight by repeated surgery (removal of a clip and restoration of an intercostal nerve) whereas after the electric destruction meaning final fracture of a sympathetic nervous trunk, correction of a compensatory gipergidroz is not represented possible any more. Unfortunately, in advance it is impossible to count probability of emergence of a compensatory gipergidroz after a radical simpatektomiya, but the modern medicine works on search of methods of forecasting of this complication.

    Manifestations of a compensatory gipergidroz owing to a simpatektomiya arises, as a rule, in the first months after operation. Eventually its manifestations can decrease considerably. Constant level of perspiration, is established within a year after operation and already practically does not change.

    Is especially expressed compensatory at the increased physical activity, visit of the pool, a bath or sauna, stay in the damp hot environment. At the same time in usual conditions sweating can be within physiological norm. It is possible to regulate the increased perspiration restriction of the use of coffee and spices, and also conditioning of the room.

    As the simpatektomiya is a radical surgical method of treatment and as any surgical intervention it is fraught with the mass of complications, it is worth resorting to it in extreme cases after all undertaken methods of conservative treatment show the inefficiency.

    Compensatory it can be shown in easy degree, and can be expressed enough considerably with plentiful sweating on other parts of the body.

    Compensatory can arise also at other methods of surgical intervention, such as liposuction or curettage, also directed to excision or blocking of sweat glands. However as a result of these manipulations, its manifestation will be not so expressed.

    It is important to both patient, and doctor to understand that the radical surgical simpatektomiya is operation of the choice and does not guarantee 100% result. First of all, weigh all "pro et contra" and decide that for you it is the least painful: to live with a usual gipergidroz or all life to fight against irreversible consequences of a compensatory gipergidroz.

    The newest techniques of treatment of a gipergidroz

    The latest word in cosmetology is the method of treatment of a gipergidroz by means of the laser. The laser SmartLipo technology familiar to some women which is successfully applied in treatment of cellulitis found application and in treatment of a gipergidroz. The unique laser machine for the first time appeared in 2007. Experts in the field of cosmetology expanded a range of indications to treatment with a laser beam, having included in it and . Impact of thermal energy of the laser on cells of a sweat gland leads to its full blocking and the termination of function. The full treatment from a gipergidroz which is not demanding additional interventions is caused.

        Manipulation is carried out in out-patient conditions under local anesthesia: through a micropuncture the cannula with a laser beam on the end is entered into skin and influences cells of gland. The procedure differs in small injury due to superficial intervention, takes 20-30 minutes, does not demand special preparation and the subsequent stay in clinic.

    The risk of emergence of complications after treatment by the laser is practically absent: there is no hyperthermia of fabrics, there are no hematomas in the place of a puncture, besides, laser radiation possesses additional bactericidal action on an intervention zone.

    Gipergidroz of axillary hollows is treated by means of the neodymium laser destroying to 70% of sweat glands. Literally for 1 session there comes full treatment of an axillary gipergidroz. As a result of the procedure the sweat gland is removed once and for all. Treatment of a gipergidroz by means of laser technology represents the latest method today and was not widely adopted enough in view of the high cost and the insufficient number of the trained experts.

    Gipergidroz. The increased perspiration. - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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