Continuing medical educationThe etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Therapeutic options
Section snippets
Trigger avoidance and clothing
Patients should avoid hyperhidrosis (HH) triggers, including crowded areas, emotional provocations, spicy foods, and alcohol.1 The avoidance of tight clothing, man-made synthetic fabrics, and occlusive footwear may also help. Other strategies include masking sweat using underarm liners or dress shields,2, 3, 4 frequent sock and shoe changes, leather shoes, absorbent shoe insoles, foot powder, and cotton or wool socks.5
Topical antiperspirants
Key points Aluminum chloride hexahydrate is the most commonly used topical medication for mild to moderate hyperhidrosis Antiperspirants should be applied to dry skin before bedtime Antiperspirants need to stay on the skin for 6 to 8 hours before being washed off Aluminum chloride hexahydrate blocks the lumen of the distal eccrine sweat gland ducts No evidence exists that links the use of aluminum-containing antiperspirants to Alzheimer disease No clear link exists between the use of aluminum-containing
Oral agents
Key points Oral systemic medications are reserved for treatment-resistant cases or generalized hyperhidrosis Anticholinergics are the most commonly used oral medications for hyperhidrosis treatment Adverse effects of anticholinergic agents force one-third of patients to discontinue treatment
Although not approved by the US Food and Drug Administration (FDA), oral anticholinergics are commonly used for generalized or multifocal primary HH.49, 50 Anticholinergics operate by competitively inhibiting the effect
Iontophoresis
Key points Iontophoresis is effective and is considered the primary treatment for palmar and plantar hyperhidrosis At-home iontophoresis treatment devices may yield improved compliance Alterations to the liquid medium used in iontophoresis devices may amplify the anhidrotic effect
Iontophoresis is a cost-effective, safe therapy approved by the US FDA that is most appropriate for palmar and plantar HH.15, 70 Three devices are registered by the FDA: RA Fischer (RA Fischer Co, Northridge, CA), Hidrex USA
Injectable therapies: BTX
Key points Botulinum toxin is a common, safe, and effective injectable medication for focal hyperhidrosis Botulinum toxin injections are administered at the dermal–subcutaneous junction The most common complaint related to botulinum toxin treatment is pain Most patients with axillary hyperhidrosis experience excellent results from botulinum toxin treatment Most patients with hyperhidrosis require 1 to 2 botulinum toxin treatments annually
BTX-A and, to a lesser degree, BTX-B are the serotypes frequently used
Surgical treatment of hyperhidrosis
Key points Surgery is considered when conservative treatments have failed Local surgical techniques include excision, curettage, liposuction, or a combination of these techniques Sympathectomy is the treatment of last resort in the management of hyperhidrosis The most common long-term complication after sympathectomy is compensatory sweating
Surgery is used when conservative treatments have failed.179 Local surgical techniques for axillary HH include excision, curettage, liposuction, and a combination of
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[Translated article] Topical Anticholinergics in the Management of Focal Hyperhidrosis in Adults and Children. A Narrative Review
2024, Actas Dermo-SifiliograficasDevelopment and Validation of a Nomogram to Predict Recurrence of Primary Hyperhidrosis after CT-guided Percutaneous Radiofrequency Sympathectomy
2023, Journal of Vascular and Interventional RadiologyPrimary palmar hyperhidrosis
2023, PielTopical Anticholinergics in the Management of Focal Hyperhidrosis in Adults and Children. A Narrative Review
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Date of release: September 2019
Expiration date: September 2022
Funding sources: None.
Conflicts of interest: None disclosed.