A09 Sweating problem (ICD-10:R61)

Introduction

Excessive sweating, also known as hyperhidrosis, is a common condition that can significantly impact a person’s quality of life^[1]. This guide aims to provide healthcare professionals with a comprehensive approach to diagnosing and managing sweating problems. By understanding the symptoms, causes, and appropriate diagnostic steps, healthcare professionals can develop an effective treatment plan for their patients^[2].

Codes

• ICPC-2 Code: A09 Sweating problem
• ICD-10 Code: R61 Hyperhidrosis

Symptoms

• Excessive sweating: Sweating that is beyond what is necessary to regulate body temperature^[3].
• Sweating in specific areas: Excessive sweating may occur in specific areas, such as the underarms, palms, soles of the feet, or face^[4].
• Interference with daily activities: Sweating may interfere with daily activities, causing embarrassment, discomfort, or difficulty in social situations^[5].

Causes

• Primary hyperhidrosis: This is the most common cause of excessive sweating and is not associated with any underlying medical condition. It is believed to be caused by overactive sweat glands^[6].
• Secondary hyperhidrosis: Excessive sweating may also be a symptom of an underlying medical condition, such as menopause, hyperthyroidism, diabetes, or certain medications^[7].

Diagnostic Steps

Medical History

• Obtain a detailed medical history, including information about the onset, duration, and severity of sweating.
• Ask about any associated symptoms, such as fever, weight loss, or palpitations.
• Inquire about any medications the patient is currently taking.
• Assess the impact of sweating on the patient’s daily activities and quality of life.

Physical Examination

• Perform a thorough physical examination, paying particular attention to the areas where excessive sweating is reported.
• Look for any signs of underlying medical conditions, such as thyroid enlargement or skin changes.
• Assess the patient’s vital signs, including heart rate and blood pressure.

Laboratory Tests

• Blood tests: Consider ordering blood tests to evaluate for underlying medical conditions, such as thyroid function tests, blood glucose levels, or hormone levels^[8].
• Sweat test: In some cases, a sweat test may be performed to measure the amount of sweat produced by the patient’s body^[9].

Diagnostic Imaging

• Diagnostic imaging is typically not necessary for the diagnosis of excessive sweating.

Other Tests

• In certain cases, additional tests may be necessary based on the clinical presentation. These may include skin biopsies, autonomic function tests, or specialized sweat tests.

Follow-up and Patient Education

• Schedule regular follow-up appointments to monitor the patient’s progress and adjust the treatment plan as needed.
• Provide patient education on the condition, including lifestyle modifications and treatment options.
• Address any concerns or questions the patient may have.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for excessive sweating:

1. Antiperspirants (e.g., Aluminum chloride hexahydrate):
   • Cost: Over-the-counter antiperspirants are typically less than $10.
   • Contraindications: Hypersensitivity to the product.
   • Side effects: Skin irritation, itching.
   • Severe side effects: None reported.
   • Drug interactions: None reported.
   • Warning: Avoid applying to broken or irritated skin.
2. Anticholinergic medications (e.g., Glycopyrrolate, Oxybutynin):
   • Cost: Generic versions can range from $10 to $50 per month.
   • Contraindications: Glaucoma, urinary retention, gastrointestinal obstruction.
   • Side effects: Dry mouth, constipation, blurred vision.
   • Severe side effects: Increased heart rate, urinary retention.
   • Drug interactions: Other anticholinergic medications.
   • Warning: Use with caution in elderly patients.
3. Botox injections (Botulinum toxin type A):
   • Cost: The cost can range from $500 to $1000 per treatment session.
   • Contraindications: Hypersensitivity to botulinum toxin, infection at the injection site.
   • Side effects: Injection site pain, bruising.
   • Severe side effects: None reported.
   • Drug interactions: None reported.
   • Warning: Effects are temporary and may require repeat injections.
4. Systemic medications (e.g., Clonidine, Propranolol):
   • Cost: Generic versions can range from $10 to $50 per month.
   • Contraindications: Hypotension, bradycardia, heart failure.
   • Side effects: Drowsiness, dry mouth, low blood pressure.
   • Severe side effects: Slow heart rate, heart block.
   • Drug interactions: Other blood pressure medications.
   • Warning: Use with caution in patients with underlying heart conditions.
5. Surgical interventions (e.g., Sympathectomy):
   • Cost: The cost can range from $5000 to $10,000.
   • Contraindications: None reported.
   • Side effects: Compensatory sweating, Horner’s syndrome.
   • Severe side effects: Pneumothorax, nerve damage.
   • Drug interactions: None reported.
   • Warning: Surgery should be considered as a last resort.

Alternative Drugs:

• Glycopyrronium tosylate (Qbrexza): A topical anticholinergic wipe that can be applied to the underarms. Cost: Approximately $600 for a 30-day supply.
• Iontophoresis devices: Devices that use a low-level electrical current to reduce sweating. Cost: $500 to $1000 for a device.
• Oral antiperspirants: Prescription-strength antiperspirants that can be taken orally. Cost: Approximately $100 to $200 per month.
• Gabapentin: An anticonvulsant medication that may help reduce sweating. Cost: Generic versions can range from $10 to $50 per month.
• Clonidine patches: Transdermal patches that deliver clonidine to reduce sweating. Cost: Approximately $100 to $200 per month.

Surgical Procedures:

• Sweat gland removal: Surgical removal of sweat glands in the affected areas. Cost: $2000 to $5000.
• Laser therapy: Laser treatment to destroy sweat glands. Cost: $500 to $2000 per session.

Alternative Interventions

• Acupuncture: May help regulate the body’s energy flow and reduce sweating. Cost: $60 to $120 per session.
• Hypnosis: Can be used to help manage stress and reduce sweating. Cost: $75 to $150 per session.
• Biofeedback: A technique that helps individuals learn to control their body’s responses, including sweating. Cost: $75 to $150 per session.
• Herbal supplements: Certain herbs, such as sage or witch hazel, may have a mild antiperspirant effect. Cost: Varies depending on the specific supplement.
• Iontophoresis: A non-invasive treatment that uses a low-level electrical current to reduce sweating. Cost: $200 to $300 per session.

Lifestyle Interventions

• Wear breathable clothing: Choose loose-fitting, natural fabrics that allow air to circulate.
• Use absorbent materials: Use absorbent pads or clothing liners to help manage excessive sweating.
• Avoid triggers: Identify and avoid triggers that may worsen sweating, such as spicy foods or caffeine.
• Practice stress management: Engage in relaxation techniques, such as deep breathing or meditation, to help reduce stress and sweating.
• Maintain good hygiene: Shower regularly and use antiperspirants or deodorants to help manage sweating.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – A09 Sweating problem (ICD-10:R61)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Sweating problem effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI^[10].

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Sweating problem. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Doolittle, J., Walker, P., Mills, T., & Thurston, J. (2016). Hyperhidrosis: an update on prevalence and severity in the United States. Archives of dermatological research, 308(10), 743-749.
2. Nawrocki, S., & Cha, J. (2019). The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Therapeutic options. Journal of the American Academy of Dermatology, 81(3), 669-680.
3. Grabell, D. A., & Hebert, A. A. (2017). Current and emerging medical therapies for primary hyperhidrosis. Dermatology and therapy, 7(1), 25-36.
4. Haider, A., & Solish, N. (2005). Focal hyperhidrosis: diagnosis and management. Cmaj, 172(1), 69-75.
5. Kamudoni, P., Mueller, B., Halford, J., Schouveller, A., Stacey, B., & Salek, M. S. (2017). The impact of hyperhidrosis on patients’ daily life and quality of life: a qualitative investigation. Health and quality of life outcomes, 15(1), 121.
6. Brackenrich, J., & Fagg, C. (2020). Hyperhidrosis. In StatPearls [Internet]. StatPearls Publishing.
7. Cheshire, W. P., & Fealey, R. D. (2008). Drug-induced hyperhidrosis and hypohidrosis. Drug Safety, 31(2), 109-126.
8. Walling, H. W., & Swick, B. L. (2011). Treatment options for hyperhidrosis. American journal of clinical dermatology, 12(5), 285-295.
9. Hornberger, J., Grimes, K., Naumann, M., Glaser, D. A., Lowe, N. J., Naver, H., … & Multi-Specialty Working Group on the Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis. (2004). Recognition, diagnosis, and treatment of primary focal hyperhidrosis. Journal of the American Academy of Dermatology, 51(2), 274-286.
10. Kreyden, Oliver P (2004). Iontophoresis for palmoplantar hyperhidrosis. DOI: 10.1111/j.1473-2130.2004.00126.x