Nothing but the truth! Palmar and plantar HH By Dr Davin Lim...
Cognitive Behavioural Therapy for Hyperhidrosis
Excessive sweating may be a symptom of social anxiety. Excessive sweating is a troubling and embarassing anxiety symptom for some social phobia sufferers.
Craniofacial sweating or hyperhidrosis is very common and may affect one in fifteen people. It can be one of the more irritating forms of excessive sweating as it cannot be disguised. Beads of sweat on the forehead, upper lip and face are very obvious, and unlike underarm sweating, can’t be easily hidden from view. Most cases represent Primary Hyperhidrosis, however in some cases it maybe a variation of a normal response to stress, anxiety, heat, exercise or embarrassment. What ever the trigger, this form of excessive sweating readily responds to treatment.
Facial sweating maybe an isolated condition, not related to flushing or blushing. Primary hyperhidrosis commonly affects facial and scalp areas due to the higher number of eccrine or sweat glands in these areas.
The simplest treatment is with antiperspirants such as Driclor. Caution must be used on these areas, as skin irritation may occur.
If topical solutions of antiperspirants are ineffective, sweat stopping treatments injections may decrease sweating in this area. Sweat stopping treatments is a muscle relaxant, but may also block the nerves which cause the sweat glands to activate. This is a highly effective treatment for craniofacial sweating, but the injection technique requires skill. Remember that the surrounding muscles are also affected by this treatment. sweat stopping treatments last between 3-4.5 months, it is not a permanent way of sweat reduction.
Tablets such as anticholinergic medication can be useful if there are extensive areas of sweating involving the face, head and scalp area. Side effects such as blurred vision, dry mouth syndrome and constipation may occur. They still remain an good way of treating facial sweating on a short to medium term basis.
Creams containing anticholinergics maybe used for facial sweating. The most commonly used chemical is Glycopyrrolate. This can be effective in up to 50% of patients, and can be less irritating than Driclor application.
This is an extremely common problem seen in young, middle age and older age groups. Blushing and flushing may occur on the upper chest area, and involve the neck and face. Certain triggers may worsen this condition, including social embarrassment, anxiety, and foods. Exercise may also act as a trigger. Facial sweating may also accompany flushing.
This condition is often underestimated by many doctors, and the impact to the patient can be significant. Patients are often embarrassed and it may have a significant negative social impact.
Most cases are idiopathic (unknown) and associated with age-related hormonal changes, or a skin condition known as Rosacea. Rare disorders such as Carcinoid syndrome, thyroid disease and neurological disease should be excluded. A test from a GP or a Specialist Physician can be useful.
Facial flushing and blushing can respond to drugs such as propanolol. Laser treatments can be successful in up to 60% of cases, especially if there is an element of rosacea involved. Surgical ETS can be considered if there is neck involvement or if medical treatment fail. Unfortunately facial flushing and blushing is very hard to treat associated with high failure rates. Facial sweating however can be treated with higher success.
Laser treatment can be helpful in up to 70-80% of cases of facial blushing and flushing. Laser does NOT treat the cause of this problem, but it may decrease the number of blood vessels under the skin. In theory, the lesser the number of blood vessels, the less severe flushing is.
Specialists at the Sweat Free Clinic are also laser specialists who perform vascular laser and BBL (Broad Band Light) for conditions such as facial blushing, flushing and rosacea.
Laser does not target the eccrine or sweat glands, and has minimal impact on facial sweating.
Excessive sweating on the face, and head areas is very common. Most patients have sweating on the forehead area, however other common areas include the scalp, and upper lip.
As with all sweat treatments we encourage the use of Driclor or aluminium chloride hexahydrate as the very first step! If you respond to this topical antiperspirant , look no further. Most patients find that this antiperspirant to be too irritating, if this occurs you may consider the new Rexona range of anti-sweat treatments.
The next step up from here depends on may factors including the extent of sweating, any associated flushing or blushing and the exact location of the problem. For example patients who sweat profusely on the upper forehead may benefit from sweat stopping treatments injections, whilst this treatment is not ideal for the upper lip. Severe suffers who have associated flushing may benefit from ETS endoscopic thoracic sympathectomy.
This area is one of the harder areas to treat, and an individualised approach is the best.