Research Ideas

[Amherst]

Many of you in this forum have expressed your frustration with the current state of hyperhidrosis research. I actually have an opportunity to present ideas for future research to several doctors and academics carrying out medical research into the pathogenesis of hyperhidrosis and treatments. I'm starting to put together a list of my own suggestions as well as my criticisms of existing paradigms in the field, e.g. if hyperhidrosis is the result of an "overactive sympathetic nervous system," then shouldn't the entire sympathetic nervous be affected (which it doesn't seem to be)? I'll post some of these ideas in the coming weeks. If you have ideas percolating, please feel post them on this thread.

I do have to be a bit careful, since one major focus of my academic work is the problem of researcher bias - and my findings do not always go over too well with some researchers for obvious reasons.

Ideas?

 

[Sprawling]

I'd love to hear more of your ideas. I'm a non-medical person, just an HH sufferer. So what's your theory on "overactive sympathetic nervous system?"

 

[Amherst]

A quick reply: the sympathetic nervous system helps govern so many functions in the body - blood pressure, dilation of the eyes, constriction of blood vessels, sweating, digestion, to name but a few. If sweating were simply the result of an "overactive sympathetic nervous system," you would expect to see dysfunction in many or all of these functions. But that just isn't the case for most of us sufferers, as far as we know.

 

[Englishman]

A quick reply: the sympathetic nervous system helps govern so many functions in the body - blood pressure, dilation of the eyes, constriction of blood vessels, sweating, digestion, to name but a few. If sweating were simply the result of an "overactive sympathetic nervous system," you would expect to see dysfunction in many or all of these functions. But that just isn't the case for most of us sufferers, as far as we know.

Totally agree. Good luck man, it's time that us hyperhidrosis suffers gained some hope.

 

[Sprawling]

In my personal case it does seem to go beyond sweating. I believe that having fibromyalgia plays a role within the sympathetic nervous system. This is probably an area that you haven't explored. Fibro effects how ionto works, blood pressure, and how my body over heats. I'm a male, so I can't blame it on just hormones. Unfortunately I haven't yet many people who have both fibro and HH. Us HH people seem to know how to be elusive and do a very good job at it.

 

[Amherst]

Sprawling - you mention one of the ideas I want to run by these specialists. Are there types of "secondary hyperhidrosis" that at first glance mirror "primary hyperhidrosis?" What types of secondary hyperhidrosis present patterns of sweating that outwardly look just like that of "primary hyperhidrosis" with a focal distribution on the armpits, hands, feet, etc. instead of being spread out over the entire body? I raise this since we know a bit more about how some of these secondary conditions like Parkinson's and diabetes operate than we do about how "primary hyperhidrosis" works - and perhaps some of the mechanisms might be similar.

That said, I wouldn't be surprised to find out that what is thought of as "primary hyperhidrosis" is actually a conglomeration of a number of distinct dysfunctions - with somewhat different causes. This is actually one of the real problems in a lot of medical research. Scientists come up with an artificial category and name to describe a problem and lump everything into that category, regardless of whether it fits.

I can relate on the overheating: it would be so nice to actually feel cold. I can be out in 10 degree weather and still feel warm. I can go running in shorts in 40 degree weather and feel perfectly comfortable.

 

[0707129r]

I don't sufficient study has been carried out on the potential role of anticholinergic drugs in treatment of HH. Sure we all know about robinul, oxybutynin etc, but there is a whole host of others that may have longer lasting, fast acting effect. Glyco is highly effective and works on M1-M3 receptors, as does many others. I feel further investigation is warranted. I've tried several, and it is interesting that some (vesicare) have no noticeable effect. On a personal note I've wanted to try Benzatropine, as I think some anticholinergics can have a positive effect on social anxiety, by increasing the level of dopamine in the brain.

Also the use of botox by iontophresis seems promising but research in this field is non existent.

I agree that labelling it a result of 'overactive sympathetic nervous system' is a bit of a cop out. Although interestingly I have found that drugs that dampen CNS (alcohol, benzos etc) do decrease the degree of HH.

 

[Amherst]

That is a great suggestion. There are several additional anticholinergics that like glycopyrrolate do not generally cross the blood-brain barrier. I haven't come across research into the effects of darifenacin, tolterodine and trospine on reducing sweating, though that doesn't mean that the research isn't out there. Most studies look only at glycopyrrolate or oxybutynin.

 

[Amherst]

One additional idea I've found intriguing: I'd love to see a comprehensive study comparing placebo effects for various treatments for HH. Many double-blind peer-reviewed studies compare a sham treatment with a real treatment and faithfully record the effects of both. If the mind alone can bring about a 20 or even 40 percent reduction in sweating, that alone should be able to give us a lot of hope.

There is also the evil twin of placebo, the nocebo, in which the mind can bring about nasty physical changes in the body. For ethical reasons, researchers don't generally touch this - but it does make me wonder how much we worsen our conditions by fretting about it.

 

[Sprawling]

I should have mentioned that I was most likely born with HH. My hands and feet have always been sweaty, extremely bad by age 6. Fibromyalgia did not hit till after a bout of mononucleosis at about age 21, then again at 50. So I wouldn't consider HH secondary. It's still interesting how fibromyalgia plays into the HH. Both seem to effect the sympathetic nervous system.

 

[hydroman123]

I wish there had been more research in to tap water iontophoresis because I really think it might be the MOST effective treatment for HH....paricularly palmar HH which is probably the most socially crippling form. I am a doctor practicing in Sri Lanka (a tropical country where the temp. is >28 degrees and humidity over 80% almost every day) and you have NO IDEA the agony I went through each day as a med student having to examine patients with dripping hands. The locals dermatologists have no clue when it comes to HH. I researched my condition on my own and got an ionto machine down. The recommended schedules for ionto are rubbish and no one knows the mineral composition of the most effective water for treatments. It took me months and months of trying to get it to work and it's been perfect (knock on wood) for two years. I know this will work for everyone and it pisses me off that a solution exists for most of you'll but you just don't know it.

 

[Sprawling]

That's awesome Hydroman123 that you followed through with med school despite having dripping hands. Your an inspiration for those on this group suffering, yet you didn't let it stop you.

Unfortunately, ionto doesn't work for everyone. Water quality is only one part of the equation. Medication, along with various other health conditions can have a major effect on how on the outcome of ionto success. Fibromyalgia impacts my ionto success at times. Prior to relapsing with fibro ionto worked very consistently.

 

[hydroman123]

Hi Sprawling. To be honest I didn't have an option.....it was either grit my teeth and get through it or lose the one thing in my life that held some worth. My knowledge of fibromyalgia is rudimentary at best because it's even less common than HH where I live. Is it the pain that stops you doing the treatments or do exacerbations of fibromyalgia coincide with worsening of HH regardless of whether or not you do your ionto?

 

[Jezza]

Though I also don't buy the overactive symphatetic nervous system line I must admit that my blood pressure is too high for my age/weight/no smoking status, my heart rate is usually fast unless I'm really really relaxed (to the point of momentarily not sweating) and apart from sweaty, my limbs are also usually cold to the touch and blueish, as in poor circulation (which figures with the overactive SNS as of course it redirects blood out of the extremities and to the core of your body and your brain). I have also been told on several occassions that my pupils looked really dilated (and yes I do live in the Netherlands but that couldn't have had anything to do with that at the time). The latter though may be due to poor eyesight in the dark as I don't see too well in the dark but then again I also definitely need to wear sunglasses in the summer because of sensitivity too light (maybe too because of dilated pupils? who knows)...

I've also read two studies that mention some minor abnormalities in heart function between HH sufferers and controls (that were conducted to check this overactive SNS theory). From memmory one of them mentioned something about altered left ventricular heart function (and that it could possibly lead to atrophy in old age) and the other found some very minor however statistically significant changes in one of several parameters they measured for heart function.

My guess however is that this whole thing is a lot more complex than 'overactive SNS'. There's a whole balance to that SNS-PNS system and if one thing goes wrong the whole thing goes out of whack and you can have counterintuitive events because the system is overcompensating. Compare it with a tankslapper in a car...Eventhough you might break traction pointing towards the right side of the road you may crash on the left side because you're trying to save the car and overcompensate, which together with the momentum in the vehicle may result in fiery death...

 

[hyp-hi]

Hydroman, what is your ionto schedule? I use ionto but lately, it has not been working that well for me.

 

[aries86]

Over the years I've thought of hundreds of ideas for research and treatment ideas in my mind. Sometimes I feel almost obsessed with finding out what causes HH and how to effectively treat it. I agree with your ideas about hyperhidrosis not being the result of just an "overly symphathetic nervous system". I think there is much more at play. I've also heard of a lot of different ideas that honestly don't make a lot of sense. One thing that I think I'm interested in is why HH presents itself in different parts of the body for different people. It would seem as though that this would be a standard disorder, but its not. Some people have sweaty hands, others sweaty armpits etc. This might not seem like a big deal, but it seems like something is there. I also think it would be interesting to look into the genetics behind this. I know this has been done before, but I think there is something there also.

 

[Sprawling]

Hi Sprawling. To be honest I didn't have an option.....it was either grit my teeth and get through it or lose the one thing in my life that held some worth. My knowledge of fibromyalgia is rudimentary at best because it's even less common than HH where I live. Is it the pain that stops you doing the treatments or do exacerbations of fibromyalgia coincide with worsening of HH regardless of whether or not you do your ionto?

Oddly enough when I do ionto treatments it helps control the fibro pain up till maybe an hour after treatment and definitely during treatment. I do not notice any residual side effects of Ionto treatment upon the fibro.

Since I started last year using pulsed current I experience basically no pain during ionto treatment. Fibro continues to worsen whether I do treatment or not. HH has always been bad, but now ionto treatment of HH may or may not work depending on how bad the overall fibro has been reacting to various parts of my body.

I used to do treatment on both hands and feet every 9-11 days, 1/2hour each side, switching polarities at 15 minute intervals. I had to adjust treatment many times to compensate for the fibro.

Treatment now is as follows:

Day 1: Rt hand, Lft foot, 30 minutes single polarity
Day 2: no treatment
Day 3: no treatment
Day 4: Lft hand, Rt foot, 30 minutes single polarity
Day 5: no treatment
Day 6: no treatment
Day 7: Rt hand, Lft foot, 30 minutes single polarity
Day 8: no treatment
Day 9: no treatment
Day 10: Lft hand, Rt foot, 30 minutes single polarity

This repeating cycle is what gives ME the best HH results.

 

[hydroman123]

Hydroman, what is your ionto schedule? I use ionto but lately, it has not been working that well for me.
Hi, my schedule's a bit extreme. Ionto didn't work well for me at first and after months of trying I though F*** it and did twice daily treatments for about two weeks till the sweating jut stopped like magic. Each treatment consisted of around 12 minutes at one polarity followed by 12 minutes on the next polarity. I only treat my hands and the voltage I start off at is 14.5 mV (it slowly climbs during the course of the treatment). Maintenance consists of one such treatment per day for two consecutive days followed by a rest day. It amounts to 4-5 treatments per week which sounds time consuming but for me is a small price to pay for getting a life worth living.
One thing you must remember is that the sweating increases substantially when you start doing the treatments. Then it suddenly stops. I really believe that the way ionto works is by initially hyperstimulating the sweat glands till the little bastards get bombarded into submission. Yeah, I don't particularly care for my sweat glands. Anyway this is temporary and my sweating came back when I went abroad and couldn't do treatments for three weeks. Hence ionto is not a cure but a very effective method of control.

 

[Amherst]

On a purely statistical note, I'd be curious to know what percentage of "primary focal hyperhidrosis" (confined to one or several regions) progress to become generalized. One problem with a lot of the research (and this is understandable from the standpoint of a medical researcher) is that many patients seeking treatment tend to be younger and that one won't have the follow-up time of ten or twenty years that one would ideally need.

I also personally think that the frequency of hyperhidrosis is modestly understated - for two diametrically opposed reasons. The best and most comprehensive study states that 2.7 percent of the American population suffers from hyperhidrosis. As a social scientist, I would note that a certain percentage of survey respondents, especially younger respondents, will be too embarrassed to own up to their own excessive sweating. On the other hand, a certain percentage of older respondents, like many of my family members, will say: "Yeah, I sweat, but so too does everyone. Mine isn't anything unusual." I suppose that a more accurate way to gauge the incidence of axillary hyperhidrosis would be to go to several dozen dry cleaners to see how many shirts have visible sweat stains under the arms.

 

[Amherst]

A quick postscript to my last post: getting an accurate estimate of the frequency of hyperhidrosis is actually extremely important. The higher the frequency, the better the case you can make for getting outside funding for research.