Skip to main content
Top

Tip

Swipe om te navigeren naar een ander artikel

Gepubliceerd in: Huisarts en wetenschap 9/2015

01-09-2015 | Nascholing

‘Dokter, ik zweet te veel’: hyperhidrose in de praktijk

Auteur: Roel Genders

Gepubliceerd in: Huisarts en wetenschap | Uitgave 9/2015

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Samenvatting

Genders R. ‘Dokter, ik zweet te veel’: hyperhidrose in de praktijk Huisarts Wet 2015;58(9):492-5.
Er zijn twee soorten zweetklieren: eccriene zweetklieren zorgen voor de thermoregulatie en bevinden zich overal op het lichaam, apocriene zweetklieren produceren vooral geurstoffen en bevinden zich in de oksels, rond de tepels en bij de geslachtsorganen. Overmatig zweten kan leiden tot schaamte, verminderd zelfvertrouwen en psychische klachten. Ongeveer 1-3% van de algemene bevolking heeft last van hyperhidrose, bij ongeveer eenderde van hen zijn de klachten zodanig dat ze bij de huisarts komen.
Een belangrijk onderscheid is dat tussen primaire en secundaire hyperhidrose. Primaire hyperhidrose is meestal lokaal (handen, voeten, oksels, liezen of gelaat), secundaire hyperhidrose is doorgaans gegeneraliseerd. Bekende oorzaken van secundaire hyperhidrose zijn overgewicht, metabole, endocriene en neurologische aandoeningen, druggebruik en medicatie.
Er is een scala van behandelingen voor primaire hyperhidrose, variërend van topicale of orale medicatie, iontoforese, botulinetoxine-injecties en microgolfbehandeling tot chirurgische ingrepen zoals excisie, curettage of sympathectomie. De niet-invasieve microgolftechniek ter behandeling van axillaire hyperhidrose is nieuw en veelbelovend.
De huisarts speelt een belangrijke rol in de diagnostiek en verwijzing. Welke behandeling hij kiest bij primaire hyperhidrose is sterk afhankelijk van de wensen en verwachtingen van de patiënt, en van de ernst en lokalisatie van de aandoening. Bij secundaire hyperhidrose zal hij uiteraard eerst de onderliggende aandoening aanpakken.
Literatuur
1.
go back to reference Strutton DR, Kowalski JW, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol 2004;51:241–8. CrossRefPubMed Strutton DR, Kowalski JW, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol 2004;51:241–8. CrossRefPubMed
2.
go back to reference Miller JL, Hurley HJ. Diseases of the eccrine and apocrine sweat glands. In: Bolognia JL, Jorizzo JL, Schaffer JV, editors. Dermatology. 3rd ed. Philadelphia: Elsevier Saunders, 2012. Miller JL, Hurley HJ. Diseases of the eccrine and apocrine sweat glands. In: Bolognia JL, Jorizzo JL, Schaffer JV, editors. Dermatology. 3rd ed. Philadelphia: Elsevier Saunders, 2012.
3.
go back to reference Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe NJ, Naver H, et al. Multi-Specialty Working Group on the Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 2004;51:274–86. CrossRefPubMed Hornberger J, Grimes K, Naumann M, Glaser DA, Lowe NJ, Naver H, et al. Multi-Specialty Working Group on the Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 2004;51:274–86. CrossRefPubMed
4.
go back to reference Walling HW. Clinical differentiation of primary from secondary hyperhidrosis. J Am Acad Dermatol 2011;64:690–5. CrossRefPubMed Walling HW. Clinical differentiation of primary from secondary hyperhidrosis. J Am Acad Dermatol 2011;64:690–5. CrossRefPubMed
5.
go back to reference Torch EM. Remission of facial and scalp hyperhidrosis with clonidine hydrochloride and topical aluminum chloride. South Med J 2000;93:68–9. CrossRefPubMed Torch EM. Remission of facial and scalp hyperhidrosis with clonidine hydrochloride and topical aluminum chloride. South Med J 2000;93:68–9. CrossRefPubMed
6.
go back to reference Streker M, Reuther T, Verst S, Kerscher M. Hyperhidrosis axillaris - Effektivität und Verträglichkeit eines aluminiumchloridhaltigen Antiperspirants. Hautarzt 2010;61:139–44. CrossRefPubMed Streker M, Reuther T, Verst S, Kerscher M. Hyperhidrosis axillaris - Effektivität und Verträglichkeit eines aluminiumchloridhaltigen Antiperspirants. Hautarzt 2010;61:139–44. CrossRefPubMed
7.
go back to reference Rajagopal R, Mallya NB. Comparative evaluation of botulinum toxin versus iontophoresis with topical aluminium chloride hexahydrate in treatment of palmar hyperhidrosis. Med J Armed Forces India 2014;70:247–52. CrossRefPubMedPubMedCentral Rajagopal R, Mallya NB. Comparative evaluation of botulinum toxin versus iontophoresis with topical aluminium chloride hexahydrate in treatment of palmar hyperhidrosis. Med J Armed Forces India 2014;70:247–52. CrossRefPubMedPubMedCentral
8.
go back to reference Klaber M, Catterall M. Treating hyperhidrosis: Anticholinergic drugs were not mentioned. BMJ 2000;321:70–3. CrossRef Klaber M, Catterall M. Treating hyperhidrosis: Anticholinergic drugs were not mentioned. BMJ 2000;321:70–3. CrossRef
9.
go back to reference Wozniacki L, Zubilewicz T. Primary hyperhidrosis controlled with oxybutynin after unsuccessful surgical treatment. Clin Exp Dermatol 2009;34:e990–1. CrossRefPubMed Wozniacki L, Zubilewicz T. Primary hyperhidrosis controlled with oxybutynin after unsuccessful surgical treatment. Clin Exp Dermatol 2009;34:e990–1. CrossRefPubMed
11.
go back to reference Odia S, Vocks E, Rakoski J, Ring J. Successful treatment of dyshidrotic hand eczema using tap water iontophoresis with pulsed direct current. Acta Derm Venereol 1996;76:472–4. PubMed Odia S, Vocks E, Rakoski J, Ring J. Successful treatment of dyshidrotic hand eczema using tap water iontophoresis with pulsed direct current. Acta Derm Venereol 1996;76:472–4. PubMed
12.
go back to reference Reinauer S, Neusser A, Schauf G, Holzle E. Die gepulste GleichstromIontophorese als neue Behandlungsmöglichkeit der Hyperhidrosis. Hautarzt 1995;46:543–7 CrossRefPubMed Reinauer S, Neusser A, Schauf G, Holzle E. Die gepulste GleichstromIontophorese als neue Behandlungsmöglichkeit der Hyperhidrosis. Hautarzt 1995;46:543–7 CrossRefPubMed
13.
go back to reference Siah TW, Hampton PJ. The effectiveness of tap water iontophoresis for palmoplantar hyperhidrosis using a monday, wednesday, and friday treatment regime. Dermatol Online J 2013;19:1–4. Siah TW, Hampton PJ. The effectiveness of tap water iontophoresis for palmoplantar hyperhidrosis using a monday, wednesday, and friday treatment regime. Dermatol Online J 2013;19:1–4.
14.
go back to reference Naumann M, Dressler D, Hallett M, Jankovic J, Schiavo G, Segal KR, et al. Evidence-based review and assessment of botulinum neurotoxin for the treatment of secretory disorders. Toxicon 2013;67:141–52. CrossRefPubMed Naumann M, Dressler D, Hallett M, Jankovic J, Schiavo G, Segal KR, et al. Evidence-based review and assessment of botulinum neurotoxin for the treatment of secretory disorders. Toxicon 2013;67:141–52. CrossRefPubMed
15.
go back to reference Naumann M, Lowe NJ. Botulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: randomised, parallel group, double blind, placebo controlled trial. BMJ 2001;323:596–9. CrossRefPubMedPubMedCentral Naumann M, Lowe NJ. Botulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: randomised, parallel group, double blind, placebo controlled trial. BMJ 2001;323:596–9. CrossRefPubMedPubMedCentral
16.
go back to reference Lowe NJ, Glaser DA, Eadie N, Daggett S, Kowalski JW, Lai PY; North American Botox in Primary Axillary Hyperhidrosis Clinical Study Group. Botulinum toxin type A in the treatment of primary axillary hyperhidrosis: a 52-week multicenter double-blind, randomized, placebo-controlled study of efficacy and safety. J Am Acad Dermatol 2007;56:604–11. CrossRefPubMed Lowe NJ, Glaser DA, Eadie N, Daggett S, Kowalski JW, Lai PY; North American Botox in Primary Axillary Hyperhidrosis Clinical Study Group. Botulinum toxin type A in the treatment of primary axillary hyperhidrosis: a 52-week multicenter double-blind, randomized, placebo-controlled study of efficacy and safety. J Am Acad Dermatol 2007;56:604–11. CrossRefPubMed
17.
go back to reference Lecouflet M, Leux C, Fenot M, Célerier P, Maillard H. Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis: A study of 28 patients. J Am Acad Dermatol 2014;70:1083–7. CrossRefPubMed Lecouflet M, Leux C, Fenot M, Célerier P, Maillard H. Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis: A study of 28 patients. J Am Acad Dermatol 2014;70:1083–7. CrossRefPubMed
18.
go back to reference Jacob C. Treatment of hyperhidrosis with microwave technology. Semin Cutan Med Surg. 2013;32:2–8. PubMed Jacob C. Treatment of hyperhidrosis with microwave technology. Semin Cutan Med Surg. 2013;32:2–8. PubMed
19.
go back to reference Glaser DA, Coleman WP 3rd, Fan LK, Kaminer MS, Kilmer SL, Nossa R, et al. A randomized, blinded clinical evaluation of a novel microwave device for treating axillary hyperhidrosis: the dermatologic reduction in underarm perspiration study. Dermatol Surg 2012;38:185–91. CrossRefPubMed Glaser DA, Coleman WP 3rd, Fan LK, Kaminer MS, Kilmer SL, Nossa R, et al. A randomized, blinded clinical evaluation of a novel microwave device for treating axillary hyperhidrosis: the dermatologic reduction in underarm perspiration study. Dermatol Surg 2012;38:185–91. CrossRefPubMed
20.
21.
go back to reference Drott C, Göthberg G, Claes G. Endoscopic transthoracic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis. J Am Acad Dermatol 1995;33:78–81. CrossRefPubMed Drott C, Göthberg G, Claes G. Endoscopic transthoracic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis. J Am Acad Dermatol 1995;33:78–81. CrossRefPubMed
22.
go back to reference Ibrahim O, Kakar R, Bolotin D, Nodzenski M, Disphanurat W, Pace N, et al. The comparative effectiveness of suctioncurettage and onabotulinumtoxin-A injections for the treatment of primary focal axillary hyperhidrosis: a randomized control trial. J Am Acad Dermatol 2013;69:88–95. CrossRefPubMed Ibrahim O, Kakar R, Bolotin D, Nodzenski M, Disphanurat W, Pace N, et al. The comparative effectiveness of suctioncurettage and onabotulinumtoxin-A injections for the treatment of primary focal axillary hyperhidrosis: a randomized control trial. J Am Acad Dermatol 2013;69:88–95. CrossRefPubMed
23.
go back to reference Bechara FG, Sand M, Tomi NS, Altmeyer P, Hoffmann K. Repeat liposuction-curettage treatment of axillary hyperhidrosis is safe and effective. Br J Dermatol 2007;157:739–43. CrossRefPubMed Bechara FG, Sand M, Tomi NS, Altmeyer P, Hoffmann K. Repeat liposuction-curettage treatment of axillary hyperhidrosis is safe and effective. Br J Dermatol 2007;157:739–43. CrossRefPubMed
24.
go back to reference Atkinson JL, Fode-Thomas NC, Fealey RD, Eisenach JH, Goerss SJ. Endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis: outcomes and complications during a 10-year period. Mayo Clin Proc 2011;86:721–9. CrossRefPubMedPubMedCentral Atkinson JL, Fode-Thomas NC, Fealey RD, Eisenach JH, Goerss SJ. Endoscopic transthoracic limited sympathotomy for palmar-plantar hyperhidrosis: outcomes and complications during a 10-year period. Mayo Clin Proc 2011;86:721–9. CrossRefPubMedPubMedCentral
25.
go back to reference Chwajol M, Barrenechea IJ, Chakraborty S, Lesser JB, Connery CP, Perin NI. Impact of compensatory hyperhidrosis on patient satisfaction after endoscopic thoracic sympathectomy. Neurosurgery 2009;64:511–8. CrossRefPubMed Chwajol M, Barrenechea IJ, Chakraborty S, Lesser JB, Connery CP, Perin NI. Impact of compensatory hyperhidrosis on patient satisfaction after endoscopic thoracic sympathectomy. Neurosurgery 2009;64:511–8. CrossRefPubMed
Metagegevens
Titel
‘Dokter, ik zweet te veel’: hyperhidrose in de praktijk
Auteur
Roel Genders
Publicatiedatum
01-09-2015
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Huisarts en wetenschap / Uitgave 9/2015
Print ISSN: 0018-7070
Elektronisch ISSN: 1876-5912
DOI
https://doi.org/10.1007/s12445-015-0258-3

Andere artikelen Uitgave 9/2015

Huisarts en wetenschap 9/2015 Naar de uitgave