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. What causes hyperhydrosis? 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 patients, hyperhydrosis may be due to anxiety, stress, hyperthyroidism, hypoadrenalism or excessive fluid intake. For others, it's just their natural metabolic set point.

The opposite of hyperhydrosis is called anhydrosis, or lack of perspiration. Anhydrosis is common in patients with advanced diabetic peripheral neuropathy. Diabetic peripheral neuropathy is common is cases of poorly controlled diabetes.  As diabetic peripheral neuropathy progresses, 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 perspiration, salivation and bowel motility. Anhydrosis results in dry, brittle skin that heals poorly.

Treatment of hyperhydrosis

When treating hyperhydrosis, it's important to realize that this condition cannot be cured with oral or topical medications. Treating hyperhydrosis requires ongoing, daily care. Some of the methods used to treat hyperhydrosis are really quite simple and focus on creating an environment in the shoe that is cool, dry and accessible to UV light. As an example, try these four simple tricks to keep the foot dry:

1. Rotate your shoes, wearing each pair every other day to allow them to dry thoroughly.
2. Avoid synthetic materials like rubber or vinyl and 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.

Topical drying agents, such as Onox, are useful to help control hyperhydrosis. 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 to control perspiration. Antihistamine and anticholinergic medications are used in severe cases. These medications include Benadryl, Banthine or Pro-Banthine.

Shoe odor, called bromhydrosis, can be reduced with the use of a drying agent like Onox. Bromhydrosis is due to bacterial overgrowth in the shoe that is promoted by hyperhydrosis. Control of bacterial growth in the shoe can be helped with the use of a shoe disinfectant. And remember that it's imperative to keep the shoe as dry as possible.

Severe cases of hyperhydrosis can also be treated with injections or surgery. Recently, injections of Botox, or attenuated botulism, have been used very successfully by dermatologists and podiatrists to control hyperhydrosis. 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.

And finally, it's interesting to note that those patients who have an interest in alternative healthcare may be reluctant to treat hyperhydrosis. 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.

Bromhydrosis is the term used to describe the odor associate with sweaty feet. 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. 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 diabetic peripheral neuropathy, 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).

Treatment of Sweaty Feet

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 a drying agent to decrease perspiration.
5. Treat your shoes with an antibacterial/antifungal spray on a weekly basis.
6. Use an antibacterial/antifungal soap on a daily basis.

Severe cases of hyperhydrosis can also be treated with injections or surgery. Injections of Botox, or attenuated botulism, has been used very successfully by dermatologists to control sweaty feet. 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.

The reason water is so important in cold weather injuries is that water carries a higher specific heat than air. A higher specific heat means that water can absorb much more heat, far more than air. As a result, damp/cold injuries are a much more common and problematic injury. Most damp/cold injuries occur at or just below the freezing point and really don't require a big drop in the mercury.

There's a number of ways that the body looses heat. Heat can be lost by conduction. Water is a great conductor of heat. Heat is also lost by windy conditions (convection) and contacting a cooler surface (radiation) such as standing on snow. There are a number of co-morbidities that can contribute to cold weather injuries.  These co-morbidities include alcohol, hunger, anemia and cardiovascular disease.  Each of these conditions make you more susceptible to heat loss and cold weather injury.

Our bodies are made of cells that are 75-85% water. With cold weather injuries, as the water in these cells begins to freeze, the result is interruption of normal cell function and rupture of the cell by expansion. Some authors refer to this process as dehydration of the cell. Ultimately, blood flow is arrested and even shunted away from the threatened area. The following is a comparison of dry and damp cold weather injuries;

Dry Cold Injuries (frostbite)

• Typically more superficial (2-3mm) tissue damage (skin, nails, superficial subcutaneous tissues)
• Tissue damage more severe and obvious
• Damaged cells will heal over time
• Local wound care is necessary following the injury
• Infection is common

Damp Cold Injuries (immersion foot)

• Tissue damage usually deep (nerves, arteries subcutaneous tissue)
• Damaged cells may not heal and cause chronic pain, edema and blotchy discoloration of the skin
• Superficial wounds (gangrene) and infections are uncommon
  

Preventive measures, although obvious, are often overlooked. Remember, 30% of heat loss is from the head. It's OK to wear a hat.

Treatment of cold exposure and thermal injuries consists of gradual warming. Be sure to warm the feet slowly with luke warm water at a temperature no higher than 104-106° F. Re-warming does not take long and can often be completed in less than 30 minutes. In severe cases, care of soft tissue gangrene and infection should be managed by your doctor. Wound care may include antibiotics, anticoagulants or other medications to reverse platelet aggregation and decrease blood viscosity. Hyperbaric oxygen and sympathetic nerve blocks are also employed to aid in wound healing. Pain management is also essential. Most surgeons will defer treatment of frostbite for several months to offer mother nature a chance to heal the majority of the injury.

There is no accepted treatment for the long term pain following damp/cold tissue injuries.  Patients do respond to treatment parameters similar to treating peripheral neuropathy.  Treatment includes the pharmaceutical agents Neurontin or Lyrica.  Nutritional products including Alpha Lipoic Acid and B complex vitamins are helpful.  Topical pain medication can also help to desensitize the foot and relieve persistent pain.

Treatment Tips

• Caution; feet that have sustained a thermal injury are unable to sense the temperature of the warm water and are therefore susceptible to burns.
• If you become caught outside with a cold weather injury to of the foot, wait to warm the foot until you can rest in one spot. Warming the foot and then walking distances will cause more pain and tissue damage.
• Delay surgical care until the wound has become well demarcated. This may mean several weeks to months following the injury.

Button up, it's cold out there. And don't forget your hat.

Trench foot is the term that is used to describe injuries of the foot due to water and cold exposure at sustained temperatures ranging from 32-65 degrees Fahrenheit. Trench foot differs from frostbite in that frostbite is the actual freezing of cells at or below 32 degrees Fahrenheit. Another difference between trench foot and frostbite is that frostbite can easily occur in the absence of moisture.

The symptoms of trench foot include burning and tingling of the feet. Loss of sensation is common. The effected portions of the foot and toes can appear cyanotic (gray) and blotchy. When warming the feet after cold exposure, burning can become severe. Maceration and fissures of the skin are common. Blisters, erythema (redness) and skin that peels are also common with repeated exposure to the cold.

The term immersion foot is used to describe both cold and warm weather injuries. Warm water immersion foot and tropical immersion foot describe two clinical types of tissue damage that occur with prolonged exposure to moisture. Warm water immersion foot can occur in folks with excessive perspiration who work in enclosed rubber boots. Warm water immersion foot and tropical immersion foot symptoms include painful thickening and maceration of the skin of the bottom of the foot. Warm water immersion foot and tropical immersion foot are found most commonly in adolescents and young adults.

Quite often we'll see that a person's occupation contributes to warm water immersion foot. Workers who wear boots, particularly rubber boots and insulated boots, are most susceptible to trench foot and warm water immersion foot. The jungles of Vietnam and combat boots were a 'shoe in' for tropical immersion foot.

Treatment of trench foot and immersion foot

Prevention becomes the key in treating trench foot and immersion foot. Limiting exposure to cold is essential in preventing and treating trench foot. Maintaining a dry environment within the shoe is a must. Controlling hyperhydrosis (excessive perspiration) can help. Remember, when treating hyperhydrosis this condition can not be cured, but rather needs to be managed over a patient's lifetime. 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. 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 podiatrists and dermatologists. Botox is used to paralyze the smooth muscle that regulates the sweat glands of the bottom of the foot. Endoscopic excision of the dorsal root ganglion is a method used by neurosurgeons to create surgical anhydrosis (absence of perspiration) by surgically removing that component of the nervous system responsible for autonomic functions such as perspiration.

Trench foot injuries are sustained in temperatures ranging from 32-65 degrees Fahrenheit. Trench foot differs from frostbite in that frostbite is the actual freezing of cells at or below 32 degrees Fahrenheit. Another difference between trench  foot and frostbite is that frostbite can easily occur in the absence of moisture.

The symptoms of trench foot and immersion foot include burning and tingling of the feet. Loss of sensation is common. The effected potions of the foot and toes can appear cyanotic (gray) and blotchy. When warming the feet after cold exposure, burning can become severe. Maceration and fissures of the skin are common. Blisters, erythema (redness) and skin that peels are also common with repeated exposure to the cold.

The term immersion foot is used to describe both cold and warm weather injuries. Warm water immersion foot and tropical immersion foot describe two clinical types of tissue damage that occur with prolonged exposure to moisture. Warm water immersion foot can occur in folks with excessive perspiration who work in enclosed rubber boots. Warm water immersion foot and tropical immersion foot symptoms include painful thickening and maceration of the skin of the bottom of the foot. Warm water immersion foot and tropical immersion foot is most common in adolescents and young adults.

Quite often we'll see that a person's occupation contributes to warm water immersion foot. Workers who wear boots, particularly rubber boots and insulated boots, are most susceptible to trench foot and warm water immersion foot. The jungles of Vietnam and combat boots were a 'shoe in' for tropical immersion foot.

Treatment of trench foot and immersion foot

Prevention becomes the key in treating trench foot and immersion foot. Limiting exposure to cold is essential in preventing and treating trench foot. In-shoe foot warmers or topical L-arginine cream can help decrease the risk of cold exposure.

Maintaining a dry environment within the shoe is a must. Controlling hyperhydrosis (excessive perspiration) can help. Remember, when treating hyperhydrosis this condition can not be cured with topical or oral medications, but rather needs to be managed over a patient's lifetime. 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. Shoe odor can be reduced by rotating the shoes to allow them to dry and by the used of a shoe disinfecting agent.

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.