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War Surgery and Medicine

Hyperidrosis (Excessive Sweating)

Hyperidrosis (Excessive Sweating)

Causes: In most cases the patient was a ‘seborrhoeic’ subject. It will be helpful to explain exactly what is meant by this term, which is a bad one, since only a minority of these people have oily skins. The seborrhoeic diathesis is an inborn constitution in which the skin is deficient in several respects. Its resistance to infection is low, resulting in furunculosis, sycosis barbae, chronic blepharitis, styes, dandruff, seborrhoeic dermatitis, acne, and intertrigo. It tends to become hypersensitive, resulting in eczema, especially ‘seborrhoeic’ and ‘dysidrotic’ eczema. And its secretions are apt to be excessive, resulting in hyperidrosis, and in a few cases, seborrhoea.

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The mucous membranes are often similarly defective, particularly in the respiratory tract (causing chronic rhinitis, sinusitis, tonsillitis, and bronchitis) and the alimentary tract (causing chronic gastritis and other dyspepsias). These foci of sepsis aggravate the skin condition, and in some cases of hyperidrosis and eczema removal of them will give relief.

Seborrhoeic subjects are frequently of a psychoneurotic temperament, and since the sweat glands of the hands and feet are under direct nervous control, this makes matters worse. Hyperidrosis is also common in those with flat feet.

Clinical Features: The appearance of the hyperidrotic foot is characteristic. Constantly moist with sweat, the skin becomes macerated. It takes on a sodden, dead-white appearance, for which the maximum sites are the pressure areas—across the anterior arch, especially the ball of the big toe, and on the heels; and the parts of greatest sweat stagnation—between the toes. It is this whitish colour that leads to this condition being called ‘tinea’, and in the fifth toe cleft the appearances may be identical. Some cases show in addition a hyperkeratosis of the pressure areas, which may be very marked.

Treatment and Disposal: As a routine method the following was the most satisfactory:

Twice a day wash the feet in soap and water, and then soak for fifteen minutes in 1 in 4000 potassium permanganate solution (if possible warm). Allow this to dry thoroughly. Then dust liberally with powder—e.g., Acid. Salicyl. 3 per cent Talc (French chalk) or Acid. Boric. Put on clean socks containing some of this powder.

If there is no improvement try acid. Tannic 10 per cent in spirit, applied as a paint, instead of the permanganate soaks.

It is only where there is added hyperkeratosis that Whitfield's ointment should be used (or better, an ointment containing salicylic acid alone 3–6 per cent). This can be applied each night until the keratosis is reduced.

It was felt that men whose condition could not be controlled by the above methods should be forwarded to Base, where more constant attention was possible, for consideration of regrading.