Hiperhidroza

Hyperhidrosis
Highlights
Summary Overview
Basics
Definition Epidemiology Aetiology Pathophysiology Classification
Prevention
Secondary
Diagnosis
History & examination Tests Step-by-step Criteria Guidelines Case history
Treatment
Details Step-by-step Emerging Guidelines Evidence
Follow Up
Recommendations Complications Prognosis
Resources
References Images Online resources Patient leaflets Credits Email Print Feedback Share Add to Portfolio Bookmark Add notes
History & exam

Key factors
presence of risk factors excessive palmar sweating excessive plantar sweating onset in early childhood or puberty
exacerbation of palmar sweating with use of hand lotion severe facial sweating severe axillary sweating generalised sweating History & exam details
Diagnostic tests
Tests to consider
starch-iodine test gravimetry thyroid function test metabolic panel 24-hour urine collection for catecholamines, metanephrines, normetanephrines serum free metanephrines, normetanephrines urine 5-hydroxyindoleacetic acid urine drug screen chest x-ray CT scans Diagnostic tests details
Treatment details
Acute
primary: axillary hyperhidrosis topical aluminium chloride short-term anticholinergics botulinum toxin type A short-term anticholinergics local sweat gland excision short-term anticholinergics endoscopic thoracoscopic sympathectomy (ETS) short-term anticholinergics primary: palmar hyperhidrosis topical aluminium chloride short-term anticholinergics iontophoresis short-term anticholinergics
endoscopic thoracoscopic sympathectomy (ETS) short-term anticholinergics primary: plantar hyperhidrosis
supportive care short-term anticholinergics topical aluminium chloride with supportive care short-term anticholinergics iontophoresis with supportive care short-term anticholinergics primary: craniofacial hyperhidrosis
topical aluminium chloride short-term anticholinergics endoscopic thoracoscopic sympathectomy (ETS) short-term anticholinergics secondary hyperhidrosis
treatment of underlying condition short-term anticholinergics Treatment details
Summary
An excess sweating condition beyond physiological need. Classified as primary and of unknown cause (idiopathic), or secondary due to an underlying condition (usually an infectious, endocrine, or neurological disorder). Primary hyperhidrosis may also be described as palmar, plantar, axillary, and craniofacial, each of which has its own clinical characteristics. Patients may have a combination of anatomical areas affected. Primary hyperhidrosis occurs in both adults and children, commonly starting in early childhood or at puberty. Treatment options for primary hyperhidrosis include medical and surgical treatments. Medical treatments include topical aluminium chloride, oral anticholinergic agents, iontophoresis, and botulinum type A injections. Surgical treatments include direct axillary sweat gland removal and thoracoscopic sympathectomy.
Definition
A condition of excess sweating, beyond physiological need, which is frequently disabling for the patient, professionally and socially. It can be classified as primary and of unknown cause (idiopathic), or secondary due to
an underlying condition (usually an infectious, endocrine, or neurological disorder). Primary hyperhidrosis may also be described as palmar, plantar, axillary, or craniofacial, each of which has its own clinical characteristics. Patients may have a combination of anatomical areas affected.
Epidemiology
Hyperhidrosis has a prevalence range of approximately 2% to 4% worldwide, without an obvious gender predisposition. [1] [2] Global differences are apparent. One study estimated the prevalence of hyperhidrosis in the US at 2.9%, with approximately half (1.4%) of these people having the axillary variety. [2] In the Asian population there is a disproportionately high incidence of the palmar variety, with up to a 5% prevalence in certain areas of China. [3]Approximately 50% of patients with palmar hyperhidrosis have a family history of the disorder. Primary hyperhidrosis has a bimodal onset commonly starting in early childhood or at puberty.[1] [4] [5] Of patients with severe hyperhidrosis presenting for surgery, most have palmoplantar hyperhidrosis, 15% to 20% have combined palmar-axillary hyperhidrosis, 5% to 10% have isolated axillary hyperhidrosis, and less than 5% have craniofacial hyperhidrosis. [6]
Aetiology
Thermoregulation and sweating are controlled by complex neurological pathways involving the cerebral cortex, hypothalamus, and sympathetic nervous system. [4] The precise aetiology of primary hyperhidrosis is not entirely clear, but it is likely to be a result of overreactivity or hyperexcitability of the neurological circuits causing sweating. Although the simplest explanation is hyperactivity of the sympathetic nervous system, it is likely to be more complex, involving interactions between the sympathetic system, the parasympathetic system, and higher centres.
Schematic drawing showing the relationship of the central nervous system to the sympathetic ganglia and peripheral and visceral targetsFrom the personal collection of Fritz Baumgartner, MD
The strong familial pattern of palmar hyperhidrosis suggests a hereditary predisposition. [7]The disorder appears to be an autosomal dominant trait with variable penetrance, and estimates are that a child born to a parent with the classic pattern has a 1 in 4 chance of having the disorder as well, but with a wide range of expression. Genetic analysis has mapped the palmar variety to chromosome 14. [8] However, the genetic locus for the axillary or facial subsets of hyperhidrosis is not clear. [7] [8] Secondary hyperhidrosis is due to an organic aetiology, such as an endocrine, a neoplastic, or an infectious cause.
Pathophysiology
Humans have approximately 3 million sweat glands distributed over the body surface, with a higher concentration on the palms, forehead, soles, and axillae. [4] [9] Of the 3 types of sweat glands, the eccrine type is the most prevalent and clinically most significantly relevant to hyperhidrosis syndromes. Apocrine and apoeccrine sweats are less significant but may also be involved in axillary sweating. Patients with hyperhidrosis do not have any abnormalities in the number or histology of the eccrine sweat glands, nor is there any apparent histological abnormality of the sympathetic nervous fibres or ganglia in affected patients. The pathophysiology involves a more elusive and complex hyperexcitability of the neurological pathways, which is likely to involve cortical, hypothalamic, and autonomic nervous system interactions. The pathophysiology of secondary hyperhidrosis involves the systemic and
neurological effects of organic disorders and ultimately their effect on thermoregulatory centres in the hypothalamus.
Classification
Primary hyperhidrosis Palmoplantar hyperhidrosis
Excessive hand sweating (palmar hyperhidrosis) to the point of dripping or near dripping. The soles of the feet may be equally affected (plantar hyperhidrosis).
Axillary hyperhidrosis
Excessive underarm sweating that is not synonymous with underarm malodour. It is much more varied in severity, aetiology, and patient impact than palmar or plantar hyperhidrosis.
Craniofacial hyperhidrosis
Excessive head sweating, primarily of the face. It can be disabling for patients in its severe form.
Secondary hyperhidrosis Excess sweating due to specific pathologies, including endocrine, infectious, neoplastic, cardiovascular, drug, or toxicological causes. It can also result from a neurological injury. Because these disorders are readily suspected following a thorough history and physical exam, it is usually a simple matter to distinguish secondary from primary hyperhidrosis.
Secondary prevention
Preventative measures to help patients with hyperhidrosis (e.g., relaxation techniques or psychotherapy) are usually ineffective because the disorder has an organic, physiological, rather than psychological cause.
History & examination

Key diagnostic factorshide all
presence of risk factors (common)
Key risk factors for primary hyperhidrosis include family history, high emotional states, hot or humid climates.
Key risk factors for secondary hyperhidrosis include drugs and substance abuse, endocrine disorders, cardiovascular diseases, hypoglycaemia, menopause, infectious diseases, sepsis, neoplastic diseases, carcinoid tumours, and neurological injuries.
excessive palmar sweating (common)
Mild disease is a moist palmar surface without visible droplets of perspiration. If palmar sweating extends towards the fingertips, the condition can be considered moderate. If sweat drips off the palm and reaches all the fingertips it is severe. View image
excessive plantar sweating (common)
Moist socks and shoes as well as increased foot odour.
In some patients, soles of feet sweat to a level approximating excessive palmar sweating. onset in early childhood or puberty (common)
Typically, palmoplantar hyperhidrosis has a bimodal onset starting in early childhood or at puberty. [1] [4] [5]
exacerbation of palmar sweating with use of hand lotion (common)
Usually, patients with a history for palmoplantar (or palmar) hyperhidrosis present with completely dry hands. However, on application of ordinary hand lotion, their palms sweat profusely within minutes. View image
severe facial sweating (common) Occurs in patients with primary facial hyperhidrosis. severe axillary sweating (common) Occurs in patients with primary axillary hyperhidrosis. generalised sweating (common)
Risk
Secondary hyperhidrosis tends to occur as a more generalised all-over body sweating. factorshide all
Strong family history At least 50% of patients with palmar hyperhidrosis report a positive family history. [7] [8] high emotional states
Intense emotional reactions such as fear, anger, or stress may provoke the symptoms of primary hyperhidrosis, either focal or generalised.
hot or humid climates Can provoke the symptoms of primary hyperhidrosis, either focal or generalised. medications
Several types of medications can cause secondary hyperhidrosis as a side effect. These include insulin, meperidine, emetics, cholinesterase inhibitors, selective serotonin reuptake inhibitors, opioids, propranolol, pilocarpine, and physostigmine.
substance abuse Substance or alcohol abuse, or withdrawal from these, is associated with secondary hyperhidrosis. endocrine disorders
Generalised secondary hyperhidrosis may be caused by disorders of the thyroid, pituitary, pancreas, or adrenal glands (e.g., thyrotoxicosis, pituitary tumours, diabetes, or phaeochromocytoma).
cardiovascular diseases
Cardiovascular disorders, including congestive heart failure, acute coronary syndrome, and rhythm disorders, may cause generalised secondary hyperhidrosis.
hypoglycaemia May cause generalised secondary hyperhidrosis. menopause May cause secondary hyperhidrosis or 'hot flushes'. infectious diseases sepsis Septic states can cause secondary hyperhidrosis. neoplastic diseases
Infectious agents such as tuberculosis and malaria may cause generalised secondary hyperhidrosis.
May cause generalised secondary hyperhidrosis. For example, a patient with a neoplasia such as a lymphoma may have extensive night sweats of the entire body, lymphadenopathy, and shaking chills.
carcinoid tumours May cause generalised secondary hyperhidrosis. neurological injuries
May cause focal secondary hyperhidrosis. Injuries such as acute spinal cord injury, cerebral or medullary infarcts, or other nerve injuries (e.g., post-traumatic vasomotor dystrophy) may cause focal sweating. In addition, Frey's syndrome (sweating on one side of the forehead, face, scalp, and neck occurring soon after ingesting food as a result of damage to the nerve that innervates the parotid gland) may cause facial gustatory sweating.
Weak spicy foods May provoke the symptoms of primary hyperhidrosis, particularly the focal craniofacial variety. obesity
Although obesity is not a direct cause of hyperhidrosis, it may lead to a condition of generalised secondary hyperhidrosis.
Diagnostic tests
Tests to considerhide all
Test
starch-iodine test Reaction with sweat produces a purple sediment.
This is a qualitative test that indicates the extent of sweat activity. May be useful to map areas for local procedure axillary sweat gland excision or botulinum type A toxin injection.
During the test, a 1% to 5% solution of iodine in alcohol is applied to the area in question and allowed to dry. Cor then applied to the area. gravimetry A quantitative test that involves the measurement of sweat accumulation by filter paper. [4] [12] production in milligrams per minute.
Filter paper is weighed before and after contact with a sweaty body region and so provides a measure of the rate
thyroid function test Performed if thyrotoxicosis is suspected as the cause of secondary hyperhidrosis. metabolic panel
Performed if endocrine disorders, diabetes, or glucagonoma are suspected as the cause of secondary hyperhidr
24-hour urine collection for catecholamines, metanephrines, normetanephrines Performed if phaeochromocytoma is suspected as the cause of secondary hyperhidrosis. serum free metanephrines, normetanephrines Performed if phaeochromocytoma is suspected as the cause of secondary hyperhidrosis. urine 5-hydroxyindoleacetic acid hyperhidrosis. urine drug screen To rule out recreational drug use as the cause of secondary hyperhidrosis. chest x-ray
To exclude or confirm carcinoid tumours that secrete serotonin if these are suspected as the cause of secondary
May be used to rule out tuberculosis or a neoplastic cause if these are suspected as the cause of secondary hyp CT scans hyperhidrosis.
Performed if neoplastic disorders, pituitary tumours, or neurological injury is suspected as the cause of secondar
Step-by-step diagnostic approach

For primary hyperhidrosis, history confirmed by physical examination is usually all that is required for correct diagnosis. The skillful use of strategic questions will usually predict the physical findings. For secondary hyperhidrosis, the diagnosis is more complex because a thorough physical examination and detailed laboratory evaluations are required to identify the organic pathology that is the cause of the hyperhidrosis. [4]
History
The patient's symptoms and medical history should be ascertained. In primary hyperhidrosis the condition may be localised and patients may report excessive hand (palmar), foot (plantar), underarm (axillary), or head/facial (craniofacial) sweating. In secondary hyperhidrosis, patients may report more generalised all-over body sweating. Patients may also report changes in the amount or pattern of sweating, changes in the odour associated with sweating, and/or stained clothing. Some patients may report a family history of the condition. At least 50% of patients with palmoplantar hyperhidrosis report a positive family history. [7] [8]
Physical exam
Palmar hyperhidrosis
Mild disease occurs as a moist palmar surface without visible droplets of perspiration. If palmar sweating extends towards the fingertips, the condition can be considered moderate. If sweat drips off the palm and reaches all the fingertips, it is severe.
Plantar hyperhidrosis
Usually occurs in conjunction with palmar sweating. Patients with this variety have excessive sweating of the feet that leads to moist socks and shoes as well as increased foot odour.
Palmoplantar hyperhidrosis
o o o This is severe palmar and plantar sweating, which usually has four hallmark characteristics:[5] [10] [11] Severe palmar (hands) sweating to the point of dripping or near dripping Severe plantar (feet) sweating similar to the palms Bimodal onset, either in early childhood or at puberty (or worsened at puberty)
Exacerbation with application of hand lotion. View image
History and physical examination usually point to a debilitating level of craniofacial sweating often exacerbated by emotional stress or spicy foods. The point at which normal stress-induced facial sweating becomes pathological depends on the objective quantity of sweating (e.g., dripping) and the subjective impact level of the disorder on the patient's daily activities. It is important to consider whether normal, physiological sweating has been misinterpreted as pathological and abnormal by the patient. Therefore, the overall psychological stability of the patient should also be considered.
The point at which normal stress-induced axillary sweating becomes pathological depends on the objective quantity of sweating (e.g., dripping down the torso) and the subjective impact level of the disorder on the patient's daily activities. As with craniofacial sweating, it is important to consider whether normal, physiological sweating has been misinterpreted as pathological and abnormal by the patient. Therefore, the overall psychological stability of the patient should also be considered.
Secondary hyperhidrosis
Diagnosis depends on recognising the underlying organic pathology that is causing the excess sweating. [1] [4] For example, focal sweating may result from acute spinal cord injury, cerebral or medullary infarcts, or other nerve injuries (e.g., post-traumatic vasomotor dystrophy), and facial gustatory sweating may be caused by Frey's syndrome (sweating on one side of the forehead, face, scalp, and neck occurring soon after ingesting food as a result of damage to the nerve that innervates the parotid gland). More generalised sweating may be due to endocrine, neoplastic, infectious, drug, and toxicological-related problems and, depending on the history and physical examination, may require additional testing. These disorders may include thyroid, pituitary, diabetic, infectious, and neoplastic diseases, as well as phaeochromocytoma and carcinoid tumours. Acute coronary syndromes, heart failure, and rhythm disturbances may also cause sweating, as can substance abuse.
Objective diagnostic testing

In most cases of primary hyperhidrosis, history confirmed by physical examination is diagnostic; therefore, objective testing is usually not required. However, it may be used for difficult or questionable cases. [4] There are two main tests: starch iodine test and gravimetry. Starch-iodine test
This is a qualitative test that indicates the extent of sweat activity, and may be useful to map areas for local procedures, such as axillary sweat gland excision or botulinum type A toxin injection. During the test, a 1% to 5% solution of iodine in alcohol is applied to the area in question and allowed to dry. Cornstarch is then applied and the reaction with sweat produces a purple sediment.
Gravimetry
This is a quantitative test that involves the measurement of sweat accumulation by filter paper. [4] [12] Filter paper is weighed before and after contact with a sweaty body region and so provides a measure of the rate of sweat production in milligrams per minute. Axillary hyperhidrosis is diagnosed if sweat production is >100 mg/5 minutes in men and >50 mg/5 minutes in women. Palmar hyperhidrosis is diagnosed if sweat production is >30-40 mg/minute.
Laboratory tests
Unnecessary for the diagnosis of primary hyperhidrosis, they are useful when secondary hyperhidrosis is suspected. Thyroid function tests, metabolic and electrolyte panel, urine evaluation for metanephrines, catecholamines, and 5hydroxyindoleacetic acid, plain x-ray, and CT scanning can help distinguish between thyroid, pituitary, diabetic, infectious, and neoplastic disorders, as well as phaeochromocytoma and carcinoid tumours. An ECG and echocardiogram may be helpful to rule out acute coronary syndromes, heart failure, and rhythm disturbances. In addition, where suspected, urine analysis for substance abuse may be required.
Click to view diagnostic guideline references.
Diagnostic criteria
Hyperhidrosis Disease Severity Scale by the International Hyperhidrosis Society [4]
The severity of the hyperhidrosis, as judged by the level of impairment of the activities of daily living, can be assessed with the 4-point Hyperhidrosis Disease Severity Scale:
Level 1 is non-significant sweating that does not interfere with the activities of daily living Level 2 is tolerable sweating that sometimes interferes with the activities of daily living Level 3 is barely tolerable and frequently interferes with the activities of daily living Level 4 is intolerable and always interferes with the activities of daily living.
Case history #1
A 15-year-old boy presents with profound palmar sweating, with sweat dripping down from his hands. He says that he has had it for as long as he can remember. His feet sweat nearly as much as his hands, but this bothers him less. His sweating can occur randomly or be provoked by meeting new people, any stressful situation, or by application of hand lotion. One of his two brothers has the same problem. He avoids parties and social contact.
Case history #2
A 25-year-old actress presents with severe axillary sweating that is quite problematic for her career. Despite her use of over-the-counter clinical strength topical antiperspirants, underarm sweat is still quite obvious through her blouse.
Treatment Options
Treatment Patient group primary: axillary hyperhidrosis line 1st Treatmenthide all
topical aluminium chloride

Topical aluminium chloride for up to 1 week is the first-line treatment for axillary hyperhidrosis. [4] [9] [13] Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly
adjunct [?]
short-term anticholinergics
For those patients with symptoms exacerbated in known anxiety-provoking situations, a short-term oral

Topical aluminium chloride for up to 1 week is the first-line treatment for axillary hyperhidrosis. [4] [9] [13] Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly anticholinergic taken as required can be considered together with any of the other therapies, although its side effects may limit its usefulness. Primary Options glycopyrronium bromide : 1-2 mg orally twice or three times daily when required OR propantheline : 15 mg orally twice or three times daily when required
2nd
botulinum toxin type A

If symptoms do not resolve with aluminium chloride, botulinum toxin type A injections may be considered. Approved in many countries for axillary use and can be effective for months at a time. [9] [14] [B Evidence] The injection process may be painful. However, local topical anaesthetic may help. [9] Primary Options botulinum A toxin : 50 units intradermally given in 0.1 to 0.2

mL aliquots to multiple sites (10-15) 1-2cm apart in each axilla adjunct [?] short-term anticholinergics
For those patients with symptoms exacerbated in known anxiety-provoking situations, a short-term oral anticholinergic taken as required can be considered together with any of the other therapies, although its side effects may limit its usefulness. Primary Options glycopyrronium bromide : 1-2 mg orally twice or three times daily when required OR propantheline : 15 mg orally twice or three times daily when required
3rd
local sweat gland excision
If the patient does not respond to botulinum toxin type A or does not want repeated painful injections with temporary results, local sweat gland excision by curettage or

Topical aluminium chloride for up to 1 week is the first-line treatment for axillary hyperhidrosis. [4] [9] [13] Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly liposuction should be considered next.
Local axillary gland surgeries (including subcutaneous gland resection with or without resection of the overlying skin, curettage-liposuction, or electrosurgical or laser glandular destruction) have been shown to be effective. [15] [16] [17][18] [19] Local procedures seem to be more effective, with better patient satisfaction than thoracoscopic sympathetic surgeries, and have less compensatory and gustatory sweating. [20]
The procedure may be complicated by poor wound healing or scarring. Unlike surgical sympathectomy, local surgical procedures generally have no systemic manifestations (e.g., compensatory hyperhidrosis).
adjunct [?]
For those patients with symptoms exacerbated in known anxiety-provoking situations, a short-term oral anticholinergic taken as required can be considered together with any of the other therapies, although its side effects may limit its usefulness. Primary Options

Topical aluminium chloride for up to 1 week is the first-line treatment for axillary hyperhidrosis. [4] [9] [13] Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly glycopyrronium bromide : 1-2 mg orally twice or three times daily when required OR propantheline : 15 mg orally twice or three times daily when required
4th
endoscopic thoracoscopic sympathectomy (ETS)
If symptoms persist, ETS may be considered. The procedure is generally done on both sides at one sitting, under general anaesthesia, and is a short-stay procedure in the majority of instances.
The specific hyperhidrosis disorder determines the level of the sympathetic procedure. For example, surgery at the third (T3), fourth (T4), or fifth (T5) thoracic ganglia is for axillary hyperhidrosis. View image
Some controversy exists whether compensatory sweating is more problematic at higher sympathectomy levels, but patient selection is likely to be far more important. [21]
Sympathetic surgery at T3 or T4 can be expected to benefit 80% to 90% of patients with axillary hyperhidrosis.

Topical aluminium chloride for up to 1 week is the first-line treatment for axillary hyperhidrosis. [4] [9] [13] Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly However, several studies have shown that sympathetic surgery in patients with axillary hyperhidrosis is less successful and that the level of patient satisfaction is lower than it is for patients with palmar hyperhidrosis. [10] [22] [23] [24] [25] [26] [27]
adjunct [?]

primary: palmar hyperhidrosis
1st
Topical aluminium chloride is often the first-choice treatment for palmar hyperhidrosis but tends not to be as effective as it is for treating axillary hyperhidrosis. [4] [9] [13] [28]
Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly
adjunct [?]
For those patients with symptoms exacerbated in known anxiety-provoking situations, a short-term oral anticholinergic taken as required can be considered

Topical aluminium chloride for up to 1 week is the first-line treatment for axillary hyperhidrosis. [4] [9] [13] Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly together with any of the other therapies, although its side effects may limit its usefulness. Primary Options glycopyrronium bromide : 1-2 mg orally twice or three times daily when required OR propantheline : 15 mg orally twice or three times daily when required
2nd
iontophoresis
For patients who do not respond or cannot tolerate topical aluminium chloride on their hands, iontophoresis with tap water may be used.
Using an iontophoresis device, ions are introduced into cutaneous tissues via an electrical current. The mechanism most probably involves the ionic current temporarily blocking the sweat duct at the level of the stratum corneum.
The addition of anticholinergics or botulinum toxin A to the iontophoresis tap water may improve its efficacy. [9] [29]

Skin irritation from galvanic currents may occur. Iontophoresis is contraindicated in patients with pacemakers or metal implants, or who are pregnant. [9]
adjunct [?]
3rd

ETS is appropriate for severe, debilitating palmar sweating when other treatments have failed. In these cases, the expected benefits generally outweigh

Topical aluminium chloride for up to 1 week is the first-line treatment for axillary hyperhidrosis. [4] [9] [13] Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly the known side effects, which may include compensatory sweating. [5] [10]
The specific hyperhidrosis disorder determines the level of the sympathetic procedure. For example, surgery at the second (T2) or third (T3) thoracic ganglia is recommended for palmar hyperhidrosis. View imageView image
ETS is also appropriate for patients with severe palmar and severe plantar hyperhidrosis (palmoplantar hyperhidrosis) when other treatments have failed. It is emphasised that the ETS procedure is meant to cure the palmar hyperhidrosis, and any benefit for the feet is never the primary intent of the surgery.
Surgery can be performed at the T2 or T3 level. The best level to select is unclear and controversial. Surgery at the T2 level may be more consistently curative with less dramatic failures than at T3, [37] [36] but is associated with an increased incidence of compensatory hyperhidrosis postoperatively. [37][38] [35] [36]
Successful outcomes for palmar sweating are achieved in >95% of cases. Plantar sweating is improved in the short term in approximately 80% of cases, although not as

Topical aluminium chloride for up to 1 week is the first-line treatment for axillary hyperhidrosis. [4] [9] [13] Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly dramatically as the palmar sweating.
Because of the higher incidence of moderate or severe compensatory hyperhidrosis, some recommend avoiding T2 procedures altogether. Some even recommend levels of sympathetic intervention for palmoplantar hyperhidrosis at levels lower than T3 (i.e., over the 4th or 5th rib levels), although it is acknowledged by the authors that this may result in moister hands. [35] Some surgeons perform ramicotomy rather than sympathetic nerve/ganglion intervention to limit the severity of compensatory sweating. However, the incidence of recurrent sweating does seem to be higher with ramicotomy. [39] Thoracoscopic sympathetic intervention can be safe and effective in younger patients, even in early teenage years, and has been shown to result in markedly improved long-term quality of life compared to non-operative cohorts. [40]
adjunct [?]
For those patients with symptoms exacerbated in known anxiety-provoking situations, a short-term oral anticholinergic taken as required can be considered

Topical aluminium chloride for up to 1 week is the first-line treatment for axillary hyperhidrosis. [4] [9] [13] Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly together with any of the other therapies, although its side effects may limit its usefulness. Primary Options glycopyrronium bromide : 1-2 mg orally twice or three times daily when required OR propantheline : 15 mg orally twice or three times daily when required
primary: plantar hyperhidrosis
1st
supportive care
Initial management should include keeping the feet as dry as possible by use of absorbent foot powders and shoe inserts, and frequent changing of socks and shoes.
adjunct [?]
For those patients with symptoms exacerbated in known anxiety-provoking situations, a short-term oral anticholinergic taken as required can be considered together with any of the other therapies, although its side

Topical aluminium chloride for up to 1 week is the first-line treatment for axillary hyperhidrosis. [4] [9] [13] Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly effects may limit its usefulness. Primary Options glycopyrronium bromide : 1-2 mg orally twice or three times daily when required OR propantheline : 15 mg orally twice or three times daily when required
2nd
topical aluminium chloride with supportive care

Management of localised plantar sweating is primarily medical. Topical aluminium chloride tends not to be as effective for plantar hyperhidrosis as it is for axillary hyperhidrosis. [28] Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9]
Patients should keep their feet as dry as possible using

Topical aluminium chloride for up to 1 week is the first-line treatment for axillary hyperhidrosis. [4] [9] [13] Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly absorbent foot powders and/or shoe inserts, with frequent changing of socks and shoes. Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly
adjunct [?]

3rd
iontophoresis with supportive care
For patients who do not respond or cannot tolerate topical aluminium chloride, iontophoresis with tap water may be used.
The mechanism most probably involves the ionic current temporarily blocking the sweat duct at the level of the stratum corneum.
Oral anticholinergics or botulinum toxin A added to the iontophoresis tap water may improve its efficacy. [9] [29] Skin irritation from galvanic currents may occur. Iontophoresis is contraindicated in patients with pacemakers or metal implants, or who are pregnant. [9] Patients should keep their feet as dry as possible using absorbent foot powders and/or shoe inserts, with frequent changing of socks and shoes.
adjunct [?]
For those patients with symptoms exacerbated in known anxiety-provoking situations, a short-term oral anticholinergic taken as required can be considered together with any of the other therapies, although its side

Topical aluminium chloride for up to 1 week is the first-line treatment for axillary hyperhidrosis. [4] [9] [13] Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly effects may limit its usefulness. Primary Options glycopyrronium bromide : 1-2 mg orally twice or three times daily when required OR propantheline : 15 mg orally twice or three times daily when required
primary: craniofacial hyperhidrosis
1st

Topical aluminium chloride can be used for facial sweating. Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options

aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly adjunct [?] short-term anticholinergics
For those patients with symptoms exacerbated in known anxiety-provoking situations, a short-term oral anticholinergic taken as required can be considered together with any of the other therapies, although its side effects may limit its usefulness. Topical glycopyrrolate (glycopyrronium bromide) has been successfully used for craniofacial hyperhidrosis but it is not approved in some countries. [41] Primary Options glycopyrronium bromide : 1-2 mg orally twice or three times daily when required OR propantheline : 15 mg orally twice or three times daily when required

2nd
ETS is used for craniofacial sweating, although there is a higher incidence of patient dissatisfaction and complaints of compensatory sweating compared with palmar hyperhidrosis. [10] [22] [23] [24] [26] [25] [27] Treatment of craniofacial hyperhidrosis surgically should be considered very carefully as the side effects can be severe.
However, most patients with craniofacial hyperhidrosis will have significant benefit from sympathetic surgery at the T2 level. View image
adjunct [?]
For those patients with symptoms exacerbated in known anxiety-provoking situations, a short-term oral anticholinergic taken as required can be considered together with any of the other therapies, although its side effects may limit its usefulness. Topical glycopyrrolate (glycopyrronium bromide) has been successfully used for craniofacial hyperhidrosis but it is not approved in some countries. [41] Primary Options

Topical aluminium chloride for up to 1 week is the first-line treatment for axillary hyperhidrosis. [4] [9] [13] Commonly used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] Primary Options aluminium chloride topical : apply to the affected area(s) once daily at bedtime until desired effect is achieved, then taper to once weekly glycopyrronium bromide : 1-2 mg orally twice or three times daily when required OR propantheline : 15 mg orally twice or three times daily when required
secondary hyperhidrosis
1st
treatment of underlying condition
This form of hyperhidrosis is a manifestation of an underlying pathology, and necessitates treating the primary cause of the disorder.
For example, focal sweating may result from acute spinal cord injury, cerebral or medullary infarcts, or other nerve injuries (e.g., post-traumatic vasomotor dystrophy), and facial gustatory sweating may be caused by Frey's syndrome. More generalised sweating may be due to endocrine, neoplastic, infectious, drug, and toxicologicalrelated problems and, depending on the history and physical examination, may require additional testing.
adjunct

[?]
If symptoms persist after treatment of the underlying condition, oral anticholinergic medication to reduce sweating may be appropriate, although the side effects may limit its usefulness. Primary Options glycopyrronium bromide : 1-2 mg orally twice or three times daily when required OR propantheline : 15 mg orally twice or three times daily when required
Acute
Treatment approach
The most important issue in directing therapy for hyperhidrosis is to differentiate between types (i.e., primary or secondary), and between subtypes of primary hyperhidrosis, (i.e., palmar, plantar, axillary, or craniofacial). A treatment strategy that works well for one form of hyperhidrosis may be unsuccessful for another form. There are several ways to treat hyperhidrosis, including topical and systemic medications, as well as
iontophoresis, botulinum toxin type A injections, and surgery. The general recommendation is to use medical therapy before resorting to invasive treatment.
Topical aluminium chloride is the first-line treatment for axillary hyperhidrosis and is usually effective. [4] [9] [13] Commonly-used preparations include 20% aluminium chloride in ethanol and 6.25% aluminium tetrachloride. Local stinging and burning may occur due to formation of hydrochloric acid when sweat combines with the aluminium chloride. Topical baking soda or hydrocortisone cream may help if this occurs. [9] If symptoms do not resolve with aluminium chloride, botulinum toxin type A (BTX-A) injections may be considered. BTX-A is approved in many countries for axillary use and can be effective for months at a time. [9] [14] [B Evidence] The agent inhibits the release of acetylcholine at the sympathetic cholinergic nerve terminals that innervate eccrine sweat glands. The injection process may be painful. However, local topical anaesthetic may help. [9] If the patient does not respond to BTX-A or does not want repeated painful injections with temporary results, local sweat gland excision by curettage or liposuction should be considered next. Local axillary gland surgeries (including subcutaneous gland resection with or without resection of the overlying skin, curettage-liposuction, or electrosurgical or laser glandular destruction) have been shown to be effective. [15] [16] [17] [18] [19] Local procedures seem to be more effective with better patient satisfaction than thoracoscopic sympathetic surgeries, and have less compensatory and gustatory sweating. [20] Axillary surgery may result in poor wound healing or scarring. Unlike surgical sympathectomy, local surgical procedures generally have no systemic manifestations (e.g., compensatory hyperhidrosis). If symptoms persist, endoscopic thoracoscopic sympathectomy (ETS) may be considered. This is a minimally invasive video-assisted procedure. [6] The specific hyperhidrosis disorder determines the level of the sympathetic procedure. For example, surgery at the third (T3) or fourth (T4) thoracic ganglia is recommended for axillary hyperhidrosis. View image Some controversy exists whether compensatory sweating is more problematic at higher sympathectomy levels, but patient selection is likely to be far more important. [21] Sympathetic surgery at T3 or T4 can be expected to benefit 80% to 90% of patients with axillary hyperhidrosis. However, several studies have shown that sympathetic surgery in patients with axillary hyperhidrosis is less successful and that the level of patient satisfaction is lower than it is for patients with palmar hyperhidrosis. [10] [22] [23] [24] [25] [26] [27]
For those patients with symptoms exacerbated in known anxiety-provoking situations, a short-term oral anticholinergic (e.g., glycopyrronium bromide, propantheline) taken as required can be considered together with any of the other therapies, although the side effects may limit its usefulness.
Palmar hyperhidrosis
Topical aluminium chloride is often the first-choice treatment for palmar hyperhidrosis but tends to be less effective than it is for treating axillary hyperhidrosis. [4] [9] [13] [28] For patients who do not respond or cannot tolerate topical aluminium chloride on their hands, iontophoresis with tap water may be used. Using an iontophoresis device, ions are introduced into cutaneous tissues via an electrical current. The mechanism most probably involves the ionic current temporarily blocking the sweat duct at the level of the stratum corneum. The addition of anticholinergics or botulinum toxin A to the iontophoresis tap water may improve its efficacy. [9] [29] Skin irritation from galvanic currents may occur. Iontophoresis is contraindicated in patients with pacemakers or metal implants, or who are pregnant. [9] Although BTX-A is approved only for axillary use in many countries, it is often used off-label for other varieties of hyperhidrosis. [9] Therefore, if symptoms do not resolve with aluminium chloride or iontophoresis, BTX-A injections may be considered. The injection process may be painful. However, local topical anaesthetic may help. [9] Temporary muscle paralysis of the intrinsic muscles of the palms may occur following the injection. Endoscopic thoracoscopic sympathectomy (ETS) is appropriate for severe, debilitating localised palmar sweating when other treatments have failed. The procedure is generally done on both sides at the same sitting, under general anaesthesia. ETS can usually be performed in a short-stay setting. In cases of disabling palmar hyperhidrosis, the expected benefits generally outweigh the known side effects, which may include compensatory sweating. [5] [10]Sympathetic surgery at the second (T2) or third (T3) thoracic ganglia yields curative results for palmar sweating in >95% of cases. View image For patients with severe palmar and severe plantar hyperhidrosis (palmoplantar hyperhidrosis), ETS is recommended. [5] [10] [11] [28] [30] [31] [32] [33] [24] [34] [35] [36] Surgery can be performed at the T2 or T3 level. The best level to select is unclear and controversial. Surgery at the T2 level may be more consistently curative with less dramatic failures than at T3, [37][36] but is associated with an increased incidence of compensatory hyperhidrosis
postoperatively. [37] [38] [35] [36] Successful outcomes for palmar sweating are achieved in >95% of cases. Plantar sweating is improved in the short term in approximately 80% of cases, although not as dramatically as the palmar sweating. Because of the higher incidence of moderate or severe compensatory hyperhidrosis, some recommend avoiding T2 procedures altogether. Some even recommend levels of sympathetic intervention for palmoplantar hyperhidrosis at levels lower than T3 (i.e., over the 4th or 5th rib levels), although it is acknowledged by the authors that this may result in 'moister hands'. [35] Some surgeons perform ramicotomy rather than sympathetic nerve/ganglion intervention to limit the severity of compensatory sweating. However, the incidence of recurrent sweating does seem to be higher with ramicotomy. [39] Thoracoscopic sympathetic intervention can be safe and effective in younger patients, even in early teenage years, and has been shown to result in markedly improved long-term quality of life compared to non-operative cohorts. [40] For those patients with symptoms exacerbated in known anxiety-provoking situations, a short-term oral anticholinergic (e.g., glycopyrronium bromide, propantheline) taken as required can be considered together with any of the other therapies, although the side effects may limit its usefulness.
Plantar hyperhidrosis
Management of localised plantar sweating is primarily medical. Initial management includes keeping the feet as dry as possible by use of absorbent foot powders and shoe inserts, with frequent changing of socks and shoes. If these measures are ineffective, then topical aluminium chloride, or, as a next choice, iontophoresis may be used. Topical aluminium chloride tends not to be as effective as in localised axillary hyperhidrosis. [28] Although BTX-A is approved only for axillary use in many countries, it is often used off-label for other varieties of hyperhidrosis. [9] However, the injections are less well tolerated due to the sensitivity of the soles of the feet compared with other areas of the body. Lumbar sympathectomy procedures are not encouraged or routine due to autonomic side effects.
Medical treatments include topical aluminium chloride and botulinum toxin type A, although applications may be difficult and the results suboptimal due to facial structures. In addition, the injection process may be painful. Although BTX-A is approved only for axillary use in many countries, it is often used offlabel for other varieties of hyperhidrosis. [9] ETS is useful for localised craniofacial hyperhidrosis, although there is a higher incidence of patient dissatisfaction and complaints of compensatory sweating compared with palmar hyperhidrosis. [10] [22] [23] [24] [26] [25] [27] Most patients with disabling craniofacial hyperhidrosis will have significant benefit from sympathetic surgery at the T2 level. Nonetheless, treatment of craniofacial hyperhidrosis should be considered very carefully because side effects can be severe. For those patients with symptoms exacerbated in known anxiety-provoking situations, a short-term oral anticholinergic (e.g., glycopyrrolate, propantheline) taken as required can be considered together with any of the other therapies, although the side effects may limit its usefulness. Topical glycopyrrolate (glycopyrronium bromide) has also been successfully used for craniofacial hyperhidrosis but is not approved in some countries. [41]
Secondary hyperhidrosis
This form of hyperhidrosis is a manifestation of an underlying pathology, and necessitates treating the primary cause of the disorder. For example, focal sweating may result from acute spinal cord injury, cerebral or medullary infarcts, or other nerve injuries (e.g., post-traumatic vasomotor dystrophy), and facial gustatory sweating may be caused by Frey's syndrome. More generalised sweating may be due to endocrine, neoplastic, infectious, drug, and toxicological-related problems and, depending on the history and physical examination, may require additional testing. If symptoms persist after treatment of the underlying condition, oral anticholinergic medication to reduce sweating may be appropriate, although the side effects may limit its usefulness.
Emerging treatments
CT scan-guided sympatholysis CT scan-guided injection of phenol or alcohol into the sympathetic chain may permit non-surgical sympathetic ablation. [42] [43] One possible use may be in surgical failures from poor visibility due to lung adhesions or recurrence after initially successful surgery.
Endoscopic retroperitoneal lumbar sympathectomy A minimally invasive technique for refractory plantar hyperhidrosis that involves lumbar sympathectomy. [44] [45] [46] It may be considered for patients with severe palmoplantar hyperhidrosis who have had thoracoscopic sympathectomy but continue to have troublesome plantar sweating. However, the procedure is associated with the possibility of increased compensatory sweating.
Monitoring
During medical management of hyperhidrosis, routine follow-up is recommended to assess patient progress and to note any adverse treatment effects. After surgery (either thoracoscopic sympathectomy or local axillary gland resection), routine surgical follow-up is performed post-operatively.
Patient Instructions
Patients should report any adverse effects of medical management, and stop treatment if necessary. Endoscopic thoracoscopic sympathectomy (ETS) is an outpatient procedure. A routine post-operative chest x-ray is performed in recovery. Patients are advised to shower after 2 days and remove protective plastic adhesive after 5 days. [Center for the Cure of Hyperhidrosis: what is hyperhidrosis?] (external link) Patients may generally resume full activity and exercise 1 week post-operatively. [49] For local axillary surgery, patients should report skin discoloration or purulent drainage. [The Society of Thoracic Surgeons: hyperhidrosis (patient information)] (external link) [Center for the Cure of Hyperhidrosis: what is hyperhidrosis?] (external link)
Complications
Complicationhide all
poor quality of life The hallmark of clinically significant hyperhidrosis is the debilitation that it causes patients. It can impair daily activities and severely impact professional and social interactions. It may affect all aspects of patients' lives, including relationships, and may even cause them to change careers. [4] compensatory sweating The most common side effect of sympathectomy surgery. It occurs in the majority of patients. It involves sweating from truncal areas including back, chest, front, and thighs. On rare occasions, it is even worse than the initial condition. It appears to be least bothersome for the palmoplantar cases and more bothersome for axillary and craniofacial cases. Less frequently, craniofacial gustatory sweating may occur.
It is crucial to have a frank discussion of this side effect with patients preoperatively to allow them to weigh the benefit of surgery against the risk. [10] [22] [23] [48] hyperaluminaemia A rare complication resulting from massive (supraclinical) amounts of topical aluminium chloride used long term. Transcutaneous aluminium toxicity may be more clinically relevant in high-risk patients such as older patients with renal failure. [9] skin necrosis of axilla Aggressive subcutaneous gland excision of the axilla may devitalise the epidermis, leading to local skin complications. [10] Horner's syndrome This rare complication can follow sympathectomy surgery and occurs when the surgery is too close to the stellate ganglion or from electrocautery transmission up the sympathetic chain. It results in ptosis and miosis. It may be temporary or permanent. [10] bleeding Can occur following sympathectomy surgery; however, it is infrequent. pneumothorax see our comprehensive coverage of Pneumothorax Can occur following sympathectomy surgery; however, it is infrequent. paraesthesia see our comprehensive coverage of Assessment of paraesthesia Can occur following sympathectomy surgery. Local chest wall paraesthesia may occur rarely from subcutaneous nerve or intercostal nerve impingement. Arm paraesthesia may temporarily occur if somatic nerves lateral to the high sympathetic chain are irritated. [48]
Last updated
Prognosis
Palmar and palmoplantar hyperhidrosis
Untreated, these disorders generally worsen at puberty and rarely improve over the patient's life. Thoracoscopic sympathectomy has a high success rate in achieving relief from hyperhidrosis of the palms alone or in combined disease with the soles of the feet. Treated by thoracoscopic sympathectomy, the palmar component of palmoplantar disorder is permanently cured in the majority of cases. The plantar component is initially improved in about 80% of cases, but not as significantly as the palmar component. In addition, this
number decreases with time so that ultimately only a minority of plantar cases benefit from the treatment. [47]
The natural history of this condition is unclear, but it may improve with increasing age. Medical treatment may provide significant, albeit temporary, relief. Local surgical intervention with axillary gland resection may provide long-lasting relief. Thoracoscopic sympathectomy may be useful, but generally these patients have less satisfaction with the procedure than those with palmar hyperhidrosis. This is because of less efficacy and more complaints of compensatory sweating.
The natural history of this condition is unclear, but it may improve with increasing age. Medical treatment may provide temporary relief. Thoracoscopic sympathectomy for this condition appears more useful compared with its effect in the axillary variety. However, patient satisfaction is lower compared with the palmar variety

Hiperhidroza

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Hiperhidroza

Uploaded by

Copyright:

Available Formats

Hyperhidrosis

History & exam

endoscopic thoracoscopic sympathectomy (ETS) short-term anticholinergics primary: plantar hyperhidrosis

treatment of underlying condition short-term anticholinergics Treatment details

History & examination

excessive palmar sweating (common)

excessive plantar sweating (common)

Moist socks and shoes as well as increased foot odour.

exacerbation of palmar sweating with use of hand lotion (common)

carcinoid tumours May cause generalised secondary hyperhidrosis. neurological injuries

starch-iodine test Reaction with sweat produces a purple sediment.

Step-by-step diagnostic approach

Exacerbation with application of hand lotion. View image

Objective diagnostic testing

topical aluminium chloride

topical aluminium chloride

botulinum toxin type A

topical aluminium chloride

local sweat gland excision

topical aluminium chloride

topical aluminium chloride

endoscopic thoracoscopic sympathectomy (ETS)

topical aluminium chloride

topical aluminium chloride

primary: palmar hyperhidrosis

topical aluminium chloride

topical aluminium chloride

topical aluminium chloride

endoscopic thoracoscopic sympathectomy (ETS)

topical aluminium chloride

topical aluminium chloride

topical aluminium chloride

primary: plantar hyperhidrosis

topical aluminium chloride

topical aluminium chloride with supportive care

Patients should keep their feet as dry as possible using

topical aluminium chloride

topical aluminium chloride

iontophoresis with supportive care

topical aluminium chloride

primary: craniofacial hyperhidrosis

topical aluminium chloride

topical aluminium chloride

topical aluminium chloride

endoscopic thoracoscopic sympathectomy (ETS)

topical aluminium chloride

treatment of underlying condition

topical aluminium chloride

You might also like