Hyperhidrosis

Hyperhidrosis is excessive sweating of the underarms, palms, soles, or facial region in excess of the amount needed to regulate body temperature. Sweat glands in patients with hyperhidrosis are not different from those in normal patients. There is not an increase in the number or size of glands, hyperhidrosis is simply caused by an increased function of the sweat glands.

Presentation:
Hyperhidrosis typically presents in childhood or adolescence with symmetric sweating on both sides of the body. Frequent episodes (>1 per week) often impair daily activities. Localized sweating stops during sleep, and may worsen with increased stress or temperature. Often there may be other family members with the same symptoms.

Testing:
Visible signs of hyperhidrosis are often clearly evident. If direct visualization of the affected areas is desired, the iodine starch test may be used. After the skin is cleansed and dried, iodine is applied and then dusted with a fine starch powder. Perspiration combines with the iodine and glucose in the starch to produce a black color.

Associations with other conditions:
There are numerous diseases leading to secondary hyperhidrosis and these should be excluded before diagnosing a patient with primary hyperhidrosis. Some examples include fever, illness, diabetes, tumors, menopause, or medications.

Treatments:
Topical Treatment – Prescription strength aluminum chloride antiperspirants such as Drysol or Xerac appear to be the most effective topical therapy.

Oral Treatments – Anticholinergic medications such as propantheline bromide (Probanthine®) , glycopyrrolate (Robinul®), oxybutynin (Ditropan®), and benztropine (Cogentin®) are often used to block sweating, however, adverse effects such as blurry vision, dry mouth and eyes, urinary retention, and constipation limit the use of these medications.

Iontophoresis – The patient uses a battery-powered device to deliver a low direct current of electricity to the hands or feet while the patient’s body is immersed in water. This treatment is useful for palmar and plantar hyperhidrosis, but is difficult to administer to the axillary areas.

Botulinum toxin type A is approved by the U.S. Food and Drug Administration for the treatment of axillary hyperhidrosis. Efficacy can be observed within a week and can last from 4 to 13 months.

Surgical treatment – Both surgical removal of the sweat or surgical removal of the nerves that innervate the sweat glands have been used effectively to treat hyperhidrosis. Usually these treamtments are reserved as a final treatment option after other options have been tried.

References:
1. Altman, RS, Schwartz (2006) Hyperhidrosis. Emedicine.
2. Hornberger J, Grimes K, Naumann M, et al (2004) Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad of Dermatol 51:274-286.

External Links: www.sweathelp.org

Robyn Siperstein, M.D.

Department Dermatology
University of Medicine and Dentistry of New Jersey
New Jersey Medical School.