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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.

Sex: equal.

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.


  • Palmoplantar: excessive sweat and sweat droplets producing a moist appearance and clammy feel

  • Axillary: staining of shirts in the underarm area


Clinical appearance does not suggest other disorders.


Starch-iodine or ninhydrin test are useful in defining areas of sweating (Fig. 16.1).

Figure 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.


  • Medication history

  • Past treatments and response

  • Assess for systemic abnormality

  • Recent surgery


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.

Figure 16.2

Hyperhidrosis treatment diagram

Compensatory hyperhidrosis secondary to sympathectomy limits its use at present except as a final therapeutic modality.


  • Aluminum chloride hexahydrate.

    • – Application of 10% to 30% aluminum chloride hexahydrate solution in ethanol with or without occlusion to unshaven skin for 6 to 8 hours nightly for 3 to 4 days can be beneficial but is complicated by local irritation. Retreatment once or twice weekly for maintenance is recommended. Treated skin should be washed the following morning.

    • – In ...

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