Peer Reviewed
Feature Article Dermatology

Assessing, investigating and managing hyperhidrosis

Hugh Roberts, Con Dolianitis, Rodney Sinclair
Abstract
Effective treatment of hyperhidrosis greatly improves quality of life in patients with the condition. Treatment regimens should be tailored to suit each patient.
Key Points
  • Hyperhidrosis is a common condition that may result in a significant impairment in social, occupational and recreational activities.
  • Symmetrical involvement of the palms, axillae or soles is suggestive of primary or idiopathic hyperhidrosis. Investigations are usually not required unless there are features suggestive of a secondary aetiology, such as fever, weight loss and palpitations.
  • Management should be tailored to suit the individual, weighing up the advantages and disadvantages of each treatment. Start with the least invasive treatment, and progress to the more invasive options with higher risks of side effects and complications.
  • Topical aluminium chloride is an appropriate first step in treatment but is rarely effective for moderate to severe hyperhidrosis.
  • Iontophoresis with glycopyrrolate is very effective for palmoplantar hyperhidrosis but requires regular visits to specialist clinics.
  • Intradermal botulinum toxin is an effective treatment, particularly for axillary hyperhidrosis, and usually lasts six months.
  • Surgical therapy, although effective and often permanent, should be reserved for patients who have failed less invasive treatments. This is partly because of the risk of postoperative complications and compensatory hyperhidrosis.
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