1. An Embarrassing disease which affects the Quality of Life

2. Why Do we Sweat? Sweating is a natural body function. Sweating acts as a cooling system so that our brains do not overheat and damage. On sweating the surface of the skin is cooled and the skin is able then to cool the blood headed to the brain.

3. Sweat Glands The sweat glands are responsible for the secretion of the sweat. they are located between the dermis and the dermis fat/tissue. There are two components to the sweat glands: I. Apocrine glands : contribute the odor component to the sweat and are associated with hair follicles. II. Eccrine glands: are the actual glands responsible for the secretion of sweat on the skin There are 5 million sweat glands over the body,2-4 million of these glands are found deep in the skin of the palms of the hands, in the soles of the feet and under the axillary skin These glands secrets a very dilute solution of urea and lactic acid.

4. What Is Hyperhydrosis? Hyperhydrosis is a condition in which the sweat glands are over productive resulting in excessive perspiration It may be general or confined to the palms,soles, axillae, inframammary regions or groin. the sympathetic nervous system is in charge of this secretion. Palmar hyperhydrosis is the most prevalent.

5. What is Bromohydrosis? It is a condition in which there is a fetid odor of the skin caused by decomposition of the sweat and cellular debris by bacteria and yeast.

6. What is Anhydrosis? It is a condition of lack of perspiration

7. Types of Hyperhydrosis. Primary Hyperhydrosis: of unknown cause, usually starts during adolescence and is lifelong. Secondary Hyperhydrosis: part of an underlying medical condition The medical condition should be treated first

8. Etiology Since hyperhydrosis is a very non specific symptom, there could be many causes. 1. Physiological causes 2. Infection 3. Non –infective causes 4. Genetic

9. Treatment options For secondary hyperhydrosis the underlying medical condition should be treated first. For primary hyperhydrosis it includes the following: Antiperspirants Iontophoresis Drugs Botulinum toxin injections Surgery [ETS]

10. Antiperspirants Simple treatment Safe Works for mild to moderate hyperhydrosis Most effective agent is Aluminium Chloride Aluminum chloride prevents the sweat from escaping the pores.

11. Iontophoresis It is a second line treatment. Method : Application of low intensity electric current to the hands or feet immersed in an electrolyte solution containing Glycopyrronium bromide [anticholinergic drug] The anticholinergic drug is taken up into the skin and blocks the autonomic nerve supply to the sweat glands. Side effects: Systemic effects such as dry mouth, and eye symptoms

12. Drugs Oral Anticholinergic drugs, but they are not recommended for the treatment of hyperhydrosis because they have several side effects including dry mouth, blurred vision and sedation.

13. Botulinum Toxin Inj. It is a group of related toxins produced by Clostridium Botulinum bacteria. It is one of the most lethal poisons known, interfering with the effect of the transmitter substance acetylcholine at the synapses [contact point of a nerve ending with another nerve cell or a muscle] The toxin paralyzes the sympatheitic nerve that causes sweating. Side effects:  Painful  Less effective with repeated injections [patients develop immunity]  Temporary [has to be repeated]  Expensive  The injection placement is very sensitive

14. Surgery Sympathectomy is a procedure to cut the nerves that transfers the signals to the sweat glands. The nerves that triggers the sweat glands in the hands, face and feet are located in the chest cavity where they exit the spinal cord. Advances in endoscopic surgery now permit surgeons to cut these nerves with small scopes inserted into the chest through incisions under the armpits, similar to that used in arthroscopic knee surgery. This procedure is termed Endoscopic Thorascopic sympathectomy

15. What are the side effects of surgery ? Risks of thorascopic surgery include infection, blood less, neuralgia (chronic pain), and injury to structures in the chest including the lung and nervous tissue. These complications are extremely rare. Heart rate changes can happen in a small number of cases. Gustatory sweating, a condition is which sweating increases while eating or smelling certain foods develops in uncommon cases. The major complications of the procedure are a Horner’s syndrome and compensatory sweating. These two side effects deserve particular mention. Patients with a Horner’s syndrome will notice a lazy eyelid and a small pupil After ETS surgery, patients may experience compensatory sweating of the chest, abdomen, thighs and legs. This occurs in 30-50% of patients.

16. SUNSOLA 60 ml CONCENTRATE A CURE FOR EXCESSIVE SWEATING & BLUSHING

17. How does SUNSOLA 60 ml Concentrate work?  It acts by reflux entrance into the terminal intra-epidermal eccrine ducts  It slowly combines with the intraductal keratin to produce a fibrillar contraction of keratin and hence functional closure.

18. BENEFITS  No more embarrassing hand-shakes,underarm stains, wetness or body odor.  Demulcent, non –irritant and gentle to the skin  Refreshing with cooling sensation Easy to apply  Has antiseptic effect.  Cost effective

19. Administration & Dosage  Few drops from the concentrated solution to be applied on the clean affected area at night before bed time once a day for one month or twice a week if necessary

20. Clinical trials. Journal :Acta Derm venereol, 1975;55(4):241-60 Journal :Acta Derm venereol, 1975;55(4):241-60 Author: Shelly WB, Harley HJ Jr. Author: Shelly WB, Harley HJ Jr. Methodology: review article of studies on topical antiperspirants control of axillary hyperhydrosis Methodology: review article of studies on topical antiperspirants control of axillary hyperhydrosis Results: complete anhydrosis could be achieved within 48 hours by: Results: complete anhydrosis could be achieved within 48 hours by: 1. A saturated solution of Aluminum chloride hexahydrate.. 2. Application to the dry axillae at times of sleep. 3. Water vapor occlusion of area for 6 - 8 hours

21. Clinical trials Journal: Acta Derm venereol 1978 ;58(5):461-5 Journal: Acta Derm venereol 1978 ;58(5):461-5 Author: Brandrup F, Larsen PO Author: Brandrup F, Larsen PO Methodology: Methodology: 11 women (gp I) with axillary hyperhydrosis were treated with Aluminum chloride hexahydrate 25 % in absolute ethanol plastic foil occlusion during 2 succesive nights once a week. Study period 24 weeks.p the 11 women (gp I) with axillary hyperhydrosis were treated with Aluminum chloride hexahydrate 25 % in absolute ethanol plastic foil occlusion during 2 succesive nights once a week. Study period 24 weeks.p the 12 women (control gp II) untreated during the initial 1-2 weeks as a control then were treated for up to 12 weeks with aluminum chloride hexahydrate but without using plastic foil occlusion. 12 women (control gp II) untreated during the initial 1-2 weeks as a control then were treated for up to 12 weeks with aluminum chloride hexahydrate but without using plastic foil occlusion. Results: an immediate reduction in sweat production of the treated axillae was found in both groups. All patients in gp I had discontinued the occlusion and had individualized the treatment two patients in gp I had to stop the treatment because of unbearable itching. Results: an immediate reduction in sweat production of the treated axillae was found in both groups. All patients in gp I had discontinued the occlusion and had individualized the treatment two patients in gp I had to stop the treatment because of unbearable itching.

22. Clinical trials JOURNAL: British medicine journal,1978 Jul 8;2 (6130):84-5 JOURNAL: British medicine journal,1978 Jul 8;2 (6130):84-5 Author: Scholes KT et al Author: Scholes KT et al Methodology : 65 patients with axillary hyperhydrosis. Methodology : 65 patients with axillary hyperhydrosis. treatment: Aluminum chloride hexahydrate(20 % in alcohol) treatment: Aluminum chloride hexahydrate(20 % in alcohol) Application :topically each night for a week and then when necessary Application :topically each night for a week and then when necessary Results : excellent control of sweating was achieved in 64 patients and no troublesome side effects were reported. Occlusion of the area was found to be unnecessary Results : excellent control of sweating was achieved in 64 patients and no troublesome side effects were reported. Occlusion of the area was found to be unnecessary