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Sweating a lot: what to do and how to treat hyperhidrosis

It’s summer, it’s hot and we all sweat. Some more than others, it’s true. “All people sweat to maintain their basal temperature”, explains Dr. Alfredo Daniel Agullo, dermatologist of the Ribera health group in the Department of Health of Dénia. Although, he adds, “not all of them dissipate heat with the same efficiency, and not all of them have the same basal hypothalamic temperature, which may mean that some need to release more water to keep their temperature constant”, he says. However, there is a point at which sweating is considered excessive, in some cases generalized and in others localized to certain areas of the body. It is known as hyperhidrosis.

“Hyperhidrosis is considered well-localized or generalized excess sweating that escapes the usual control mechanisms,” explains Dr. Agullo. And it doesn’t have to be hot or we’re practicing some kind of sport. It can also appear in cold environments and it is very common for excess heat to accentuate the symptoms.

Sweating isn’t the problem. It is that this physical reaction occurs excessively and without control, because it can condition our daily activities and also our mental health. The specialist in Dermatology of the Department of Health of Dénia assures that there are cases in which this excessive sweating “can seriously affect both the social and professional life of those who suffer from it, limiting their interpersonal relationships and conditioning professional activities, with the consequent repercussion on the person’s state of mind and mental health”.

Why does hyperhidrosis or excessive sweating occur?

Our specialist explains that the control of sweat secretion occurs via nerve stimuli, the main regulatory center of which is in the hypothalamus, “although stimuli from the cerebral cortex and the spinal cord also contribute and local skin receptors”.

And the fact is that we have sweat glands all over the body. “Sweat is generated in glands called eccrine. These are composed of an orifice independent of the pilosebaceous system. The eccrine glands are distributed practically throughout the body, with particular concentration in the palms of the hands and the soles of the feet, which is why it is the body region most frequently affected”, says Dr. Agullo, who adds that in the axillary region , the second in frequency in these cases, “we find a variant known as apoecrine glands, which are considered responsible for axillary hyperhidrosis”.

How to treat excessive sweating

The dermatologist from the Ribera health group at the Department of Health in Dénia explains that “we usually use topical treatments from the start, and if they don’t work, we consider iontophoresis, botulinum toxin infiltrations, completing with topical treatments if needed, and as a last option the surgery”.

Topical treatment is the least invasive. Dr. Agullo explains that aluminum salts are used that obstruct glandular secretion. In addition, he explains, “its long-term use ends up producing glandular atrophy, which also helps control hyperhidrosis.”

If this treatment does not work or does not give the desired results, it goes to another level, in this case to iontophoresis, which consists of passing a low-intensity electric current through the hands, which works by blocking the glandular duct. There is a specific device for this treatment which, in general, needs 6 or 7 sessions only in the first week, and a maintenance of 1 or 2 weekly sessions to maintain the effects.

The next level is the botulinum toxin infiltrations, which block the release of acetylcholine, explains Dr. Agullo, inhibiting the contraction of the myoepithelial cell and thus blocking the outflow of sweat. “The effects appear from the first week, achieve very high rates of reduction in sweating and the effect is maintained for 6 months”, he says. The use of surgery, he concludes, is reserved “as a last option due to the consequences: scars, alterations of motility and contractures, among others”.

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