Hyperhidrosis is the secretion of excessive amounts of sweat from the eccrine sweat glands at rest and at normal room temperature. It produces both physical and social discomfort. The most commonly affected areas are the axillae, palms, and plantar feet. It can present in a bilateral or symmetric fashion. The most common cause of hyperhidrosis is idiopathic.
Incidence: no good epidemiologic studies of prevalence.
Age: palmoplantar: birth; axillary: puberty.
Race: no racial predilection.
Precipitating factors: idiopathic, emotional, central nervous system injury/disease, drug, surgical injury are the most common causes. In most cases, there is a family history.
Eccrine glands are primarily innervated by sympathetic fibers that are cholinergic rather than adrenergic in neural response.
Clinical appearance does not suggest other disorders.
Starch-iodine or ninhydrin test are useful in defining areas of sweating (Fig. 16.1).
An example of the starch-iodine test in the left axilla. Note the prominent dark blue-black discoloration at sites of hyperhidrosis
No characteristic findings. Biopsy plays no role in management.
Does not remit spontaneously; may improve slightly with age.
KEY CONSULTATIVE QUESTIONS
The goal of the treatment is to substantially decrease sweat production to improve physical and social discomfort, not complete elimination. There are multiple treatments for hyperhidrosis (Fig. 16.2). Botulinum toxin A is a very effective treatment providing temporary reduction in sweating. Topical and oral medications are only modestly effective. Surgical therapy, including liposuction, is more effective than topical therapy.
Hyperhidrosis treatment diagram
Compensatory hyperhidrosis secondary to sympathectomy limits its use at present except as a final therapeutic modality.