Anatomy and Physiology Lab Paper

Hyperhidrosis

The human body maintains homeostasis in several ways. Regulating body temperature is essential in homeostasis as not to overheat or get too cold. When cold, the skeletal muscles will be activated to generate more heat by and blood vessels constrict to keep the blood warm, and blood is diverted from the skin capillaries and is withdrawn to deep tissues. When the body is hot, sweat glands are activated to secrete sweat which allows the body to cool down. The skin blood vessels will dilate, the capillaries will become flush with allowing heat to radiate from the skin surface. In the skin there are three types of glands: eccrine, apocrine and sebaceous. Eccrine glands are unique to the other two types of glands in that they secrete onto the surface of the skin and not to a hair follicle (Letterman 1974). Eccrine glands are controlled by the sympathetic nervous system and these are the glands that are signaled by the imbalance in homeostasis to produce a thin layer of water.

These glands can be more active or less depending on the environment that they are in (Letterman 1974). Eccrince glands can become overactive in some people because of either genetics or some other underlying medical condition, and this is called hyperhidrosis. Patients with hyperhidrosis sweat profusely in any or all of the body areas where there are eccrine glands. This disease can be severally debilitating to young adults and even adults in social situations. Affecting palms, feet, face, scalp, underarms and the groin. Unable to shake a persons hand in a society where that would be deemed rude. There are several ways to treat hyperhidrosis. There are topical, oral medications, removing sweat glands, iontophoresis, Botox, and ETS (Endoscopic Thoracic Sypathectomy). The newest techniques in treating hyperhidrosis are using lasers, ultrasound, and microwave-based therapy. Using a Nd:YAG laser Bencini et al., demonstrated that in 5 individuals that were treated with this laser also had a reduction in their hyperhidrosis. The study showed that the 5 individuals went through a series of up to six laser treatments, had improvement with their hyperhidrosis as well as a reduction of the hair. Although the patients seemed to have a reduction in both hair and sweating, the real test would be to see what was happening to the eccrine glands. 3 subjects agreed to have punch biopsies of the skin before and after treatment to compare the eccrine glands.

There was no significant change in the amount of eccrine glands comparing the punch biopsies pre and post treatment (Latada 2012). Another technique that is very new is using an ultra sound device from Ulthera that is currently FDA approved for the cosmetic procedure of the “noninvasive lift”. The ultra sound device has been tested 2 separate times. The first trial was with 14 patients that received 2 treatments 28 days apart and say an 80% reduction in sweat production. The second test is still being conducted in which 20 patients were tested only once so far and have seen a reduction in sweat about 30%. The use of this laser is very new, the FDA has approved the use to help lift and firm the skin, not to reduce sweating. There will be more trials with this machine, but for now, Botox seems to be more effective for a longer period (Johnson). Another new technique is using microwave bases therapy. There is a device called the miraDRY that is using microwaves to destroy the sweat glands underneath the skin for a more permanent solution to hyperhidrosis. The sweat glands to not regenerate, but rather stay gone. The studies that have been done by the company show that through biopsy, after 6 months of being treated, the eccrine glands are no longer present.

Working in a plastic surgery and dermatology office has made me interested in the techniques that are being used to treat hyperhidrosis. Currently, using topical medication, oral medication and Botox, I knew there were other new ways to treat this problem that is so widespread. I wanted to researched the mechanism for Botox, but realized that this technique has been FDA approved since 2004, which brought me to discover other ways doctors are trying to solve this problem. We have patients that sweat over their entire body, and getting Botox is both expensive and very painful. I wanted to see what else was being done as to possibly bring this to the attention of my boss, Marc Yune, MD. There are and will be several new ways to treat axially hyperhidrosis. Seems like this is the easiest area to treat, because the eccrine glands are underneath the skin, and then there is a layer of fat before the muscle and the nerves. This is not the case in other areas like the hand and feet. So while there is still being research done to help the axially problem, there seems to be home for all different parts of the body.