Hyperhidrosis

Etiology: Excessive sweating, either generalized or focal (e.g., palmar, palmoplantar, axillae), and affecting 2%—3% of general population; most common in adolescence and young adults. Generalized hyperhidrosis can be associated with underlying systemic disorder, e.g., infectious (e.g., TB), endocrine, or neurologic; focal hyperhidrosis often idiopathic.

History & Physical:

Diagnostic criteria for primary focal idiopathic hyperhidrosis.

■ Focal, visible, excessive sweating of at least 6 mo duration without apparent cause with at least 2 of the following characteristics:

■ Bilateral and relatively symmetrical sweating.

■ Frequency of at least 1 episode per wk.

■ Impairment of daily activities.

■ Positive family history.

■ Cessation of sweating during sleep.

Investigations: Starch iodine test can be used to outline the area of excessive sweating. DDx:Thyrotoxicosis, medication-induced hyperhydrosis, pheochromocytoma.

Management

Important to rule out systemic causes — infections, malignancy (ask about night sweats).

Topical: Aluminum chloride hexahydrate solution in ethanol (e.g.,

Drysol®), glycopyrrolate iontophoresis. Systemic: Anticholinergics (e.g., Robinul® 1 mg bid—tid), diltiazem, clonidine, Botulinum toxin (Botox®) injections— very effective; can last 6—12 mo. Surgery: Endoscopic thoracic sympathectomy, subcutaneous liposuction.

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