Sunday, January 20, 2008

El exceso de sudor: Un problema frecuente

El exceso de sudoración o hiperhidrosis es bastante frecuente:
  • En el 60% de los casos, afecta palmas y plantas
  • En el 30-40% el problema se localiza en las axilas

A veces la hiperhidrosis es palmoplantaraxilar (aproximadamente 15%) y algunas personas nos consultan por un molesto sudor en la cara (sobre todo la frente) y el cuero cabelludo.

La causa exacta es desconocida, aunque en muchas ocasiones los factores emocionales (estrés, ansiedad...) son desencadenantes y también puede existir historia familiar. ¿Cómo se puede manejar este problema? El primer paso (antes de tratamientos más agresivos) es el uso correcto de antiperspirantes tópicos, que se definen como sustancias que reducen la sudoración en al menos un 20% (cuando la temperatura ambiente está elevada).

En general, la mayoría de la población en España emplea desodorantes. ¿Son lo mismo que los antiperspirantes? No, mientras que los antiperspirantes (como su nombre indica) frenan la sudoración; los desodorantes contienen jabones y perfumes, para evitar malos olores (aunque pueden tener en su composición agentes antiperspirantes).

En condiciones higiénicas habituales, no sería necesario usar desodorante puesto que la limpieza o ducha diaria elimina las bacterias que, de persistir en el tiempo, serían descompuestas y provocarían mal olor. Pero, como a pesar de esta observación, muchos no nos sentiríamos cómodos sin utilizarlo, se deben elegir productos hipoalergénicos y, por supuesto, sin alcohol. Con cierta frecuencia vemos dermatitis en axilas causadas por los desodorantes.

Para las personas que nos consultan por un problema de exceso de sudor, debemos siempre recomendar un antiperspirante. Desde que en 1916 Stillian descubrió que el cloruro de aluminio hexahidratado disminuía la sudoración, la referencia y base de los antiperspirantes son las sales de aluminio, en diferentes formulaciones. Son altamente eficaces, y no es necesario utilizarlos todos los días: dos o tres veces por semana suelen ser suficientes para controlar el exceso de sudoración. La desventaja es la posible irritación de la piel, por lo que debéis tener cuidado y aplicarlo siempre sobre la piel completamente seca (incluso secarla previamente con un secador de pelo).

Existen preparados comerciales en toallitas, spray, roll-on; y también algunas fórmulas adaptadas para niños con el fin de aumentar la tolerancia.

En ciertas localizaciones específicas, como los pies, vuestro dermatólogo os puede recomendar tratamientos alternativos (la mayoría como fórmulas magistrales, es decir, preparados específicos que elaborarán en la oficina de farmacia).

En la mayoría de los casos, el problema se controla con antiperspirantes tópicos; aunque como el factor emocional está habitualmente presente serían recomendables técnicas de relajación (yoga, biofeedback...), e incluso, a veces, medicación específica (siempre bajo estricto control médico).

Si la hiperhidrosis no se controla, el segundo escalón de tratamiento es la iontoforesis de uso domiciliario. Es un aparato de venta en farmacias (existe un dispositivo para axilas y otro para manos-pies). ¿En qué consiste la iontoforesis? Disminuye el sudor mediante el paso de ciertos iones a través de la piel, para lo que se emplea una corriente continua de baja intensidad. Se utiliza con agua del grifo y podéis conseguir buenos resultados con 2-3 sesiones semanales. El sistema Drionic fue aprobado por la Food and Drug Administration (agencia federal americana que autoriza medicamentos) en el año 1984. Es muy seguro, pero está contraindicado en portadores de maracapasos o con arritmias cardiacas, y en mujeres embarazadas.

Para casos de hiperhidrosis muy severos o recalcitrantes, se reservaría la toxina botulínica o la cirugía, de los que hablaremos más adelante...

Artículo publicado en Yo Dona, de www.elmundo.es

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