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Monday , August 13 , 2012
 
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CIMA Gallary
Body odour? No sweat
Bathe twice a day using a loofah and a medicated soap
Remove hair in the underarm and groin areas
Use a deodorant spray after bathing
Wear cotton clothes and change them daily
Use sweat wicking garments while exercising
Wear cotton or sweat wicking socks
Wear leather or canvas shoes
Give your shoes and slippers time to dry by wearing a pair only once in 24 hours

Sweating is a very individual phenomenon. It is difficult to categorise the amount a person sweats as normal or excessive. Some people and families perceptibly sweat more (and smell). Also, increased sweating is normal in hot weather, with exercise or extreme emotions like fear or anger.

Sweat is a clear fluid secreted by two types of glands. The eccrine glands are situated all over the body. They open directly on to the skin. They secrete a clear and odourless sweat composed of water, electrolytes and a little urea. The apocrine sweat glands develop at puberty. They are situated in the hairy areas of the body, the scalp, armpits and groin. They open into the hair follicles. The sweat mixes with the fatty secretions in the hair follicles. This provides a good medium for the overgrowth of bacteria, which are normally present on the skin. The bacteria breakdown the “fatty” portion of the sweat, causing body odour. (Children do not smell even if they sweat because they lack apocrine glands).

Everyone has a distinctive body odour. It is influenced by diet (especially garlic and onions). It becomes distinctive in certain diseases. In diabetes, the body smells fruity, in liver disease, particularly cirrhosis, and in renal failure there is a musty odour. Lung abscesses smell like apple blossoms. Non healing ulcers smell like rotting compost. Schizophrenics have a distinct odour in their sweat owing to a chemical called trans-3-methylhexanoic acid.

Some people sweat excessively, in quantities far greater than needed to cool their bodies. This is a condition is known as “hyperhidrosis”. It usually affects the palms, soles and underarms. It becomes a social embarrassment as such people have wet and smelly clothes, cold clammy hands, are unable to write or hold a pen, and feet which slip out of foot wear or smell bad, especially if they wear socks. The constant dampness may cause the nails (both fingers and toes) to develop fungal infections, which are difficult to eradicate. Bacterial infection may occur on the hair follicles or the area between the toes. The armpits may be wet and foul smelling.

Focal hyperhidrosis affects only the palms and soles and is usually an exaggerated response to emotions. It may be inherited.

In generalised hyperhidrosis, sweating affects the whole body. It can be normal or occur unexpectedly at different times of the day or week during the peri-menopausal period when the female hormone levels fluctuate. It can occur during certain infections like malaria or tuberculosis. It can be precipitated by low blood sugars. It can be one of the symptoms of an overactive thyroid gland. The ingestion of medication like aspirin, paracetemol or even caffeine found in tea, coffee or aerated beverages can precipitate an attack. It may also be the first sign of a heart attack.

Hyperhidrosis can be tackled with antiperspirants containing aluminium chloride. This should be applied to the armpits, palms and soles at night after washing and drying the area. They should be washed off in the morning. They work well in mild cases. Antiperspirants are different from deodorants, which contain perfume to mask body odour. The label on the container should be read carefully.

A group of drugs called “anticholinergics” reduce sweating. They are effective but can react with other medications and cause side effects like dryness of the mouth, blurred vision, constipation, retention of urine, dizziness and loss of taste.

Dermatologists do a procedure called “iontophoresis”. The body is immersed in water and a low electric current is passed using a battery-operated device. Initially, daily therapy is required, but eventually maintenance treatment once in 10-15 days is all that is needed.

Injections of botulinium toxin (Botox) have become very popular. They act by blocking the nerves. They need to be given by a qualified cosmetic surgeon. Inexpert administration can cause side effects like weakness of the muscles. The action is not permanent but lasts around 4-6 months.

Sweat glands can be surgically removed from troublesome areas like the armpits. If the problem is more widespread, the nerves carrying the messages to the sweat glands can be cut with an endoscope. This is specialised surgery and should be reserved for severe cases.

Excessive sweating may only be part of the problem. People are usually more concerned about the unpleasant body odour it causes.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in