Definition And Description

Hyperidrosis is a terra used to designate the condition characterized by excessive sweating. It may be either general or local, that is, the patient's entire body may be bathed in pro-fuse perspiration not due to the effects of heat or violent exercise, or half his body may be so affected, or single parts, as the hands or feet, may alone be involved. The general form occurs in connection with Phthisis, malaria, certain debilitating diseases, etc., and does not specially concern us from a dermatological standpoint. The more localized forms, however, as of the feet and hands, not infrequently demand attention. The char-acteristic symptom is of course the presence of an excessive amount of fluid on the affected surfaces, and is usually accompanied with a sensation of coldness in the parts. In addition they sometimes exhibit the macer-ated and wrinkled appearance that is common in washerwomen, etc., after prolonged immersion of the hands in water. In some instances the hyper-idrosis is not accompanied with the development of any bad odor; in others the perspiration appears to undergo rapid decomposition, and we have, in addition, the affection termed bromidrosis, which has already been considered.

Diagnosis And Prognosis

The diagnosis of hyperidrosis is of course simple, and its prognosis is usually favorable, that is, the condition can generally be relieved, if sufficiently active measures are adopted.

Etiology

In general hyperidrosis depending on Phthisis, etc., the etiological factor seems to be general debility. In localized hyperidrosis, however, the connection between it and internal conditions is not so clear. According to Adamkiewicz,* localized sweating may be produced, as, for instance, on the paw of a cat, by faradization of the sciatic nerve, and even after the cat has been killed. This would indicate what we very well know, that the perspiratory, like the other secretions, is under the control of the nervous system. Beyond that statement, however, we cannot go; we are as yet unacquainted with the nature of she derangement a of special nerves that are capable of inducing localised hyperidrosis. If we did we might possibly devise remedial measures that would seem more rational than those at our present command.

Treatment

In Belladonna or its alkaloid, Atropia, we have a drug which, given in sufliciently large doses will probably control, tetnporarily, at least, any case of general or local hyperidrosis that we are likely to en-counter. The question of the expediency of giving this drug, however, must be determined by the circumstances of each particular case. The temporary suppression of the perspiration may be doubtless maintained for a considerable period by repeated large doses, but whether it is desirable to keep the patient in a state of chronic belladonna poisoning, each practitioner must judge for himself. Personally I have never attempted it, and have never seen the administration of belladonna in this connection at the hands of others, followed by permanent good results. In direct contrast with belladonna, Ringer has seen semilateral sweating, and Engel general hyperidrosis controlled by Jaborandi (see Pilocarpus, p. 86), administered in small doses.

* Die Secretion des Sehweisses, u. s. w., Berlin, 1878.

Leaving general hyperidrosis, and turning our attention to the localized form, we find that the whole array of astringents have been employed, but, as a rule, with but very moderate success.

The writer, however, has used, during the last eighteen months, with very satisfactory results, local applications of freshly precipitated silicic hydrate, as mentioned in connection with bromidrosis.

Hebra. states that he has obtained uniformly good results in hyperidrosis of the feet by a method devised by himself, and described as follows:

"A certain quantity of the simple diachylon plaster (Emp. Plumbi) is to be melted over a gentle fire, and an equal weight of linseed oil is then to be incorporated with it, the product being stirred till a homogeneous mass is produced, sufficiently adhesive not to crumble to pieces. This is then to be spread over a piece of linen, measuring about a square foot. The foot of the patient, having been first well washed and thoroughly dried is now to be wrapped in the dressing thus prepared. Pledgets of lint, on which the same ointment has been spread, are also to be introduced into the space between each pair of toes, to prevent their touching one another; and care must be taken that the foot is completely covered, and that the dressing is accurately in contact with the skin. When this has been done an ordinary sock or stocking may be put on the foot, and outside this a new shoe which must be light, and should not cover the dorsum of the foot. After twelve hours the dressing is to be removed; the foot is then not to be washed, but must be wiped with a dry cloth, or some of the above named" (absorbent) "powders may be applied to it. The dressing is then to be renewed in the same way as before, and its application is afterward to be repeated twice a day.

"This procedure must be continued for from eight to twelve days, according to the severity of the case. During this time, however, the patient need not keep his room, but may go on with his business as usual. At the end of this period the dressings and pledgets are to be removed, the foot is again to be rubbed with some pulverulent powder substance, and the patient may then be allowed to wear his ordinary shoes and stockings.

"In the course of a few days it will be found that a brownish yellow layer of cuticle, about one-half line thick, is beginning to peel off from all those parts of the skin which were before affected with the disease, and a healthy, clean, white surface of epidermis is exposed, as this substance separates.

"When this layer of cuticle has been completely detached, the foot may, for the first time, be washed, but it will be for some time advisable to dust some pulverulent substance into the stocking, or rub it into the skin of the foot.

"After the lapse of a fortnight or three weeks from the first application of the dressing, the hyperidrosis will generally have disappeared, and the cure will last for a year or longer, or may even be permanent. In quite exceptional cases, however, it will be found that a single course of this treatment is not sufficient to effect the complete removal of the complaint. The whole procedure must then be gone through a second time; but this will, and without exception, brine about a cure."

Solutions of chloral hydrate, and absorbent powders containing salicy-lie acid have also been found useful.