Hyperhydrosis is a condition in which the sweat glands are over productive resulting in excessive perspiration. This condition is most common in adolescents and young adults. Each of us has a set point for our metabolism. This set point is somewhat like the thermostat in our homes. Some folks have a higher set point than others. For some, this may be due to anxiety, stress, hyperthyroidism, hypoadrenalism or excessive fluid intake. For others, it's just their natural metabolic set point.

Bromhydrosis is a condition that occurs with excessive perspiration and a foul odor. The distinctive odor of smelly tennis shoes is actually caused by bacteria helping to decompose the perspiration and dead skin cells on the foot and those that are left in the shoe. Frank Zappa made fun of this condition years ago, but this is a condition that is bothersome to many. How many pairs of tennis shoes do you have in the garage or on the back porch due to bromhydrosis?

Disorders of the sweat glands are commonly grouped into a category of conditions referred to as dyshydrosis. Each of these conditions result in an unusual environment that the skin was not designed to manage. Several unique skin conditions occur as a result of dyshydrosis. One common condition seen in children is called toe box dermatitis. Remember the cute little rubber tipped tennis shoes kids wear when they first start to walk? That rubber toe box can contribute to dyshydrosis. Toe box dermatitis is characterized by peeling of the toes and occasionally, ingrown nails.

We've already mentioned hyperhydrosis, but we should also discuss anhydrosis, or lack of perspiration. A common example of anhydrosis is seen in diabetic patients. With the onset of change in the neurological system of diabetics, the autonomic nervous system becomes dysfunctional. The autonomic nervous system is that system that controls the 'behind the curtain' activity in our bodies such as salivation and bowel motility. A common complication with diabetic patients is the loss of perspiration (anhydrosis).

Those from the alternative side of the healthcare fence will be reluctant to inhibit perspiration. Their philosophy is that perspiration is a natural way that the body is ridding itself of toxic material. Inhibiting perspiration by any means will result in the accumulation of free radicals and other metabolic waste.

Treatment of hyperhydrosis and bromhydrosis

Remember, when treating hyperhydrosis, bromhydrosis and fungal conditions of the foot, these conditions will not be cured, but rather need to be managed over a patient's life. Some of the methods used to treat hyperhydrosis are really quite simple. Create and environment in the shoe that is cool, dry and accessible to UV light. Try these four simple tricks;

1. rotate your shoes every other day to allow them to dry thoroughly

2. avoid synthetic materials like rubber or vinyl, wear leather or cloth that can absorb moisture

3. frequent changes of socks to wick away moisture

4. use talc or baby powder daily to wick away moisture

Drying agents are useful to help control perspiration. Aluminum chloride is the most commonly used topical drying agent. Aluminum chloride is found in many under arm anti-perspirants and in several prescription strength medications used to treat hyperhydrosis. Formalin is used in other prescription strength medications. Antihistamine and anticholinergic medications are used in severe cases. These medications include Benadryl, Banthine or Pro-Banthine.

Severe cases of hyperhydrosis can also be treated with injections or surgery. Recently, injections of Botox, or attenuated botulism, has been used very successfully by dermatologists. Botox is used to paralyze the smooth muscle that regulates the sweat gland. Endoscopic excision of the dorsal root ganglion is a method used by neurosurgeons to create surgical anhydrosis by surgically removing that component of the nervous system responsible for autonomic functions.

Nomenclature:

Anhydrosis - loss of perspiration

Dyshydrosis - dysfunction of the sweat glands resulting in abnormal function

Hyperhydrosis - excessive sweating