Severe hyperhidrosis can cause extreme embarrassment that may lead to social and professional isolation. Therapeutic strategies to hyperhidrosis should employ the least invasive treatment that provides effective symptom control. The treatment options available for control of hyperhidrosis, non-surgical or surgical, differ in their invasiveness and efficacy. Mechanisms of action of antiperspirants, iontophoresis, cholinergic inhibitor drugs, botulinum toxin, and surgical sympathectomy are reviewed.
There is little published evidence in the form of comparative randomised trials to support the use of one treatment over another. However, authors have tended to recommend those therapies that are available to their speciality. Specific therapies should be tailored to the patient's symptoms to gain maximum symptomatic improvement with minimum invasiveness and side-effects. To achieve this, the full range of treatment options should be available to, or accessible by the consulting doctor in order for the patient to have a meaningful choice.
