II. Pathophysiology

  1. Cerebral cortex releases stimuli secondary to emotion
  2. Hypothalamus is hypersensitive to these stimuli
  3. Results in Eccrine Gland hypersecretion
    1. Eccrine Glands are normal

III. Symptoms

  1. Excessive sweating palms and soles
  2. Exacerbated by stress or anxiety
  3. Only occurs while awake

V. Management

  1. Bedtime technique: First-line, preferred option
    1. Apply topical (Drysol) 2-3 times per week at bedtime
    2. Apply Occlusive Dressing over night
    3. Remove in the morning and wash off
    4. Apply baking soda to skin to reduce irritation
  2. Topical Preparations
    1. Aluminum Chloride hexahydrate 20% (Drysol, Xerac)
      1. Obstruct Eccrine Gland pores
      2. Results in atrophy of Sweat Gland secretory cells
    2. Other agents with lower efficacy
      1. Zeasorb Powder (Miconazole)
      2. Boric acid
      3. Topical Anticholinergic Agents
      4. Tannic acid
      5. Numerous others (Formaldehyde, Glutaraldehyde)
  3. Systemic Preparations
    1. Anticholinergics (Not recommended for longterm use)
      1. Glycopyrrolate (Robinul)
      2. Phenoxybenzamine (Dibenzyline)
    2. Medications to reduce anxiety (low efficacy)
      1. Serzone
      2. Imipramine
      3. Propranolol
      4. Benzodiazepines
        1. Not recommended due to dependency risk
  4. Tap water Iontophoresis
    1. Safe, effective and well tolerated since the 1950s
    2. Galvanic current 15-20 mA applied to intact skin
      1. Applied to each palm or sole
      2. Apply current for 30 minutes each for 10 days
      3. Uses tap water
    3. Adjuncts (increase efficacy)
      1. Aluminum Chloride hexahydrate (Drysol)
      2. Atropine (limit to 1 mg per 30 cc tap water)
  5. Surgical Interventions (Refractory, severe cases)
    1. Botulinum Toxin Type A (Botox) local injection
      1. Safe and effective
      2. Expensive ($1500 for both hands repeated q6 months)
      3. Regional Anesthesia (Median and Ulnar Nerve Block)
      4. Preferred option for axillary Hyperhidrosis
      5. Serial intracutaneous injections
        1. Each injection spaced 0.5 to 2 cm apart
        2. Anhidrosis at each site persists 4-13 months
    2. Endoscopic sympathectomy
      1. Surgical destruction of sympathetic ganglia
        1. Palmar: third thoracic ganglia (T3)
        2. Plantar: Not done due to Sexual Dysfunction
          1. Improves with 50% of T4 sympathectomy
          2. Consider iotophoresis as alternative
      2. Indications
        1. Method of last resort for severe Hyperhidrosis
        2. Case refractory to other measures
        3. Highly effective for palmar Hyperhidrosis
      3. Relative contraindications
        1. Axillary Hyperhidrosis (T4) due to poor efficacy
        2. Face, scalp Hyperhidrosis (T2)
          1. Due to very high risk of compensatory sweating
      4. Adverse effects and complications
        1. Compensatory sweating
          1. Trunk, groin, thighs and popliteal fossa
          2. Severe in 50% if T2 sympathectomy
          3. Severe in 19% if only T3 sympathectomy
          4. Clip removal may alleviate symptoms
        2. Gustatory sweating
          1. Sweating at back of neck when eating spicy food
          2. May follow T2 sympathectomy
          3. Also seen with Diabetic Autonomic Neuropathy
        3. Injury to adjacent structures during surgery
          1. Pneumothorax, Pneumonia, Pneumothorax
          2. Horner's Syndrome

VI. Resources

  1. International Hyperhidrosis Society
    1. http://www.sweathelp.org

VII. References

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Ontology: Hyperhidrosis disorder (C0020458)

Definition (NCI) Excessive perspiration.
Definition (NCI_CTCAE) A disorder characterized by excessive perspiration.
Definition (MSH) Excessive sweating. In the localized type, the most frequent sites are the palms, soles, axillae, inguinal folds, and the perineal area. Its chief cause is thought to be emotional. Generalized hyperhidrosis may be induced by a hot, humid environment, by fever, or by vigorous exercise.
Concepts Finding (T033)
MSH D006945
ICD10 R61 , R61.9
SnomedCT 206774006, 206779001, 312230002, 158176000, 158174002, 139115006, 52613005
English Hyperhidrosis, HYPERHIDROSIS, [D]Hyperhidrosis, [D]Hyperhidrosis NOS, Hyperhidrosis, unspecified, [D]Hyperhidrosis (context-dependent category), [D]Hyperhidrosis NOS (context-dependent category), Hyperhydrosis, hyperhidrosis (diagnosis), hyperhidrosis, hyperhidrosis (physical finding), hyperhidrosis of skin, Hyperhydrosis disorder, Hyperhidrosis disorder, Hyperhidrosis [Disease/Finding], hyperhydrosis, Hyperhydrosis disorder (disorder), Hyperhidrosis (disorder), [D]Hyperhidrosis NOS (situation), [D]Hyperhidrosis (situation), Hyperhidrosis symptom, excess; secretion, sweat, secretion; excess, sweat, Hyperhidrosis NOS
French HYPERHIDROSE, Hyperhidrose
Spanish HIPERHIDROSIS, [D]hiperhidrosis (categoría dependiente del contexto), [D]hiperhidrosis, SAI (categoría dependiente del contexto), [D]hiperhidrosis (situación), [D]hiperhidrosis, SAI, [D]hiperhidrosis, [D]hiperhidrosis, SAI (situación), hiperhidrosis (trastorno), hiperhidrosis, Hiperhidrosis
Japanese 多汗症, タカンショウ
Swedish Svettning, överdriven
Czech hyperhidróza, Hyperhidróza, anaforéza, diaforéza, polyhidróza
Finnish Hyperhidroosi
Portuguese HIPERHIDROSE, Hiperidrose
German HYPERHIDROSIS, Hyperhidrose, nicht naeher bezeichnet, Hyperhidrosis, Hyperhidrose
Korean 다한증, 상세불명의 다한증
Polish Pocenie się nadmierne
Hungarian Hyperhidrosis
Norwegian Hyperhidrose
Dutch overmaat; secretie, zweet, secretie; overmaat, zweet, Hyperhidrosis, niet gespecificeerd, hyperhidrose, Hyperhidrosis
Italian Iperidrosi