Primary Hyperhidrosis, silent disease

por | Nov 5, 2020 | Hyperhidrosis

Primary Hyperhidrosis has been keeping in silence per year. Why it continues being underestimated by patients and providers if affect seriously a great population and it leads them to serious limitations?  First of all, this is a disease which unfortunately has been considered only as kind of particular condition with too much sweating for ages, but this is not right. Primary Hyperhidrosis is more than excessive sweating. Specific features and presentation make this entity a complete disease. The excessive sweating is spontaneous, appears without physiological trigger or any predisposing physical conditions and both are only seen in Primary Hyperhidrosis, as we can see in “National Survey” published in 2018 by Glaser DA and Hebert A.  The sweating comes most of the time in unexpectant moments, affecting only hands or sometimes others specifics areas such as Feet, armpits, and face. As referred by Moraites E in the Journal of Dermatology Clinic 2014, an estimated 2.8 % to 4.8 % that means 7.8 to 15.3 million of the American population suffers from this entity. So, why this condition continues «In Silent» or underestimated for most patients and doctors if there are a lot of affected patients? Primary Hyperhidrosis is unregulated sweating of hands that continues been underestimated because of causes coming from patients, causes coming from providers and causes coming from judicialization in medicine nowadays.

First, Causes coming from patients

The most important causes come from patients but of course, they do not know that. They usually have an early presentation in life, accompanying patients in their growth and limiting them in whole life activities. This particular was discussed at the 77th Annual Meeting of the American Academy of Dermatology; Washington, DC 2019. Hands become too wet and cold to greet friends or to caress girlfriend/ boyfriend. Develop a lot of professions, sports or daily activities are frequently impossible to do because of excessive sweat. All those characteristics are only seen in Primary Hyperhidrosis and affect too much negative in the patient’s life because it leads to them to professional frustrations and inhibited their interpersonal relationships. Commonly, patients with those limitations develop progressively psychological and psychiatric symptoms at different levels of deep. Years after years, there is a sequence in symptoms leading them to think they have something rare, that only affects themselves. That is why they don’t want to say what they are suffering from. The reaction of dislike they usually receive from their interpersonal relationships makes them hide their symptoms too. Negative feedback is established in which patients don’t want anybody to know what is happening with them, as presented by Kamudoni P in the International Hyperhidrosis Official web site, 2017.

Second, Causes coming from providers

Per sure, health care providers and institutions of health can do much more for those patients than what they do. This is not including all doctor but this is just a call for attention. We are going to mention the mains reasons to say that. First of all, Palmar Hyperhidrosis is not included in any medical school program for a major part of universities in the world. Reference books of different medical specialties don’t include Primary Hyperhidrosis either. Consequently, taken both previous points, a large number of medical doctors have not enough knowledge or skill to manage those patients properly.  On the other side, most professionals recognize Hyperhidrosis as “a condition in which some patients sweat more than average because they are probably nervous “and this is not true.  Primary Hyperhidrosis is a “Complete disease” with predictable symptoms, signs, measurements, potential complications, more than one option of treatments and some collateral side effects coming from treatments. Statements like this one were presented by Nawrocki S in the journal of Am Acad Dermatol, 2019. The other thing related to medical causes that conduce to forgot about Hyperhidrosis is the absence of none 100 % effective treatment, taking into consideration the controversial side effect that can appear secondary to those treatments. The only curative treatment in these patients is surgery know as, “Endoscopic thoracic sympathectomy (ETS)”, cited in different publications like for example Jacob CI at American Journal of Management Care. Patients wake up from anesthesia with hands complete dry and this is a permanent outcome but they would present compensatory sweat of their back, thigs and buttocks as permanent too. This side effect occurs in 65 % of patients average. Anyway, they usually feel happy even this consequence or «new condition» because they feel it is better this one instead of the hands sweating condition, they had before. This point was demonstrated by authors Horslen LC, Wilshire CL and Louie BE in Journal Ann off Thoracic Surg in 2019 under the title “Long-Term Impact of Endoscopic Thoracic Sympathectomy for Primary Palmar Hyperhidrosis”. It is good to know that patients can feel good with this option but I refuse to think this is a final solution.  I can’t see this option completely safe while compensatory sweat exists. Nowadays a lot of investigations are still running and looking for better treatment than this, as was showed 12 months ago in the 77th Annual Meeting of the American Academy of Dermatology; Washington, DC by Glaser EN and other researchers.

The third, Causes coming from judicialization in medicine

In this third group, we can find controversial conditions that support our thesis because those interfere today in the development of better Hyperhidrosis management.  Legal and regulatory issues are today fully involved in medicine and this should be good. But lately, these regulations are getting the wrong way or at least interfering adversely in medicine. I became conscient of this for the first time, 5 years ago, during the 88 o Chilean Congress of Surgery. Ramirez MD, a General Surgeon, has a presentation of this topic that deserved tremendous praise and agreements. He said «I think this is a ballast in all medical fields» and «The 99. 9 % of doctors today act pending of this topic». The regulations are necessary but nowadays are leading to loss unfortunately, of the doctor and patient relationship’s essence. From the patient’s side, they are full pending to detecting whatever they consider bad in attention or praxis, what the doctor said or wrote or whatever to claim them with an attorney. From the doctors’ side, they stay predisposed about this and their decisions facing their fears. It is impossible to treat patients in this environment. Imagine in patients we are talking about. Primary Hyperhidrosis patients, who are in between ethical dilemmas because they need new approaches, experimental treatments or surgeries but at the same time, these treatments come with side effects. Current treatments are at a very subjective benefit/risk value. It was widely discussed by Lubarda J, Dermer S and other authors last year at 27th European Academic of Dermatology and Venereology Congress. Those patients usually come with kind of frustrations and/or anxiety. The sweating usually getting worse in years but they can continue living without treatment. They don’t like but nothing else happens if they do not treat the condition. On the other side, patients can access surgery (STE mentioned) in which surgeons eliminate hands sweating immediately but patients would start having compensatory sweating. The expectation of surgery for those patients is positive generally. Some studies like “Hyperhidrosis and its impact on those living with it” published in 2018 by Lenefsky M and others, give us confidence regarding this outcome. Patients normally being very happy as we saw in those investigations but nobody can assure that it will happen with 100 % of them. Only an excellent relationship between patients and doctors can make a difference around this management.  I think this is a big deal for everybody in the medical field today.

Conclusion

Concluding, Palmar Hyperhidrosis is more common than most people think and causes a lot of limitations and frustrations in the patient’s life. Nevertheless, these patients are not receiving proper medical care as presented by Lubarda J at the Dermatology Education Foundations. Some particular conditions maintain this entity in silence and the solutions available are just partially good or at least ethically controversial nowadays. Hyperhidrosis is particular excessive sweating of hands that continues been underestimated because of patient’s concerns, management by health care providers is not enough good and current judicialization in medicine which not help at all. Some points confirm these statements. In the first point, probably the most important, Palmar Hyperhidrosis interferes in all aspects of a patient’s life leading to psychological affections. Second place, just a call for attention, an important number of providers, do not manage properly this condition. third, providers could be too much worried about legal issues they would face if something would not be running as expected with Hyperhidrosis treatment outcomes. Today, some new options in treatment appear to be very interesting but those need to be more promoted and accessible. In the future, we can get better outcomes. we just need to revert all the reasons that keep Hyperhidrosis in «silence» and were mentioned. Patients and providers need to know more about Hyperhidrosis. Providers require to investigate current and other new options for treatments and new public and government resources should be open around Hyperhidrosis.

References

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