Diagnosis and treatment of primary hyperhidrosis.

Primary Hyperhidrosis (PHH) is a disease of genetic origin, characterized by excessive secretion of eccrine sweat, mainly within palms, armpits and feet (1, 2, 3). Having onset in early childhood or adolescence, according to correspondence research the disease concerns circa 0.6-1% of the Caucasian population (4, 5) and is associated with significant reduction of life quality resulting from impairment of daily activities, social interactions and professional activities (6, 7). The disease is more common in females than males, with a predominance of females 65: 35 (1, 8). A reliable evaluation of hyperhidrosis prevalence in the population is not easy. Correspondence research, which constitutes the majority of PHH epidemiological analyses, are burdened with interpretation error made by respondent. As demonstrated in papers of our team, the subjective evaluation of hyperhidrosis prevalence in population often significantly differs from actual data obtained with objective methods (9, 10, 11). On the basis of research conducted by our team on 253 students it has been demonstrated that primary palmar hyperhidrosis may occur even from 4.7% of people (subjective declaration) to 7.1% (gravimetric screening method), whereas axillary hyperhidrosis from 11% (subjective declaration) to 16.2% (gravimetric assessment) (10). The pathophysiology of primary hyperhidrosis is not fully understood. Front cortex of a part of cingulate gyrus is presumably responsible for excessive sweating which occurs in response to sensory or emotional stimuli (5). Research conducted by Sato et al. (2) has not revealed the presence of histopathological changes in the sweat glands or their increased number in patients with diagnosed primary hyperhydrosis. Cholinergic sympathetic nerve overactivity (12) or disorder of the sympathetic nervous system (13), which lead to the production of excessive amounts of sweat and reduce cutaneous blood flow, are considered to be the cause of the symptoms. The most common form of focal hyperhidrosis is excessive sweating localized mainly on the surface of palms or feet. In circa 50% of cases, excessive sweating in axillary area additionally coexists with that types of localization. The least frequently occurring type of primary hyperhidrosis is isolated craniofacial hyperhidrosis (5). Maceration is not a rare ailment occurring in people who excessively sweat in axillary area. Moreover, skin inflammation with general irritation or contact allergies may occur as a result of too frequent use of soap and antiperspirant (14). Sweat drops are often visible to the naked eye, especially often they appear on the sides or even on the backs of the fingers. Patients complain of high discomfort which they experience in everyday life such as constant staining of documents and other objects made of paper as well as that items made of metal touched by people affected by the disease are often subject to corrosion (14). Thus, the disease has a significant impact on the life quality of patients, leading to withdrawal from social functioning and avoidance of interpersonal relationships (7). Young people do not take the effort to achieve a higher level of edu-