hyperhidrosis
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Introduction
Excessive exocrine sweating (perspiration).
Classification
- localized hyperhidrosis
- isolated patches on glabrous skin
- generalized hyperhidrosis
Etiology
- localized sweating of palms & or soles or axillae
- idiopathic
- anxiety
- neurologic
- generalized hyperhidrosis
- pharmacologic agents
- allergic drug reactions
* beta-blockers do NOT block perspiration response to hypoglycemia
Epidemiology
- prevalence ~2.8% in U.S.
- threshold of what prompts patient to complain of hyperhidrosis varies with individual
Pathology
- eccrine glands most often associated with hyperhidrosis
Clinical manifestations
- thin, odorless sweat*[8]
- axillary hyperhidrosis is independent of axillary odor
- social & emotional embarrassment
- staining of clothing
- reduction of self esteem
- occupational disability
- inability to handle intruments, tools or paper (palmar hyperhidrosis)
* contrast with viscous odiferous sweat of axillae & groin
Laboratory
- no objective clinical testing is indicated, unless systemic cause is suspected
Complications
- high risk of secondary skin infection
Management
- localized sweating of palms & or soles or axillae
- aluminum-containing antiperspirants
- anticholinergic-containing towelettes[6]
- glycopyrronium (Qbrexza) FDA-approved June 2018
- systemic anticholinergic agent
- propantheline: start 15 mg PO TID
- oxybutynin[5]
- doses sufficient to suppress hyperhidrosis often associated with unacceptable side effects
- iontophoresis
- surgery
- excision of axillary skin
- adnexectomy
- indications: - age >= 21 years - at least one episode per week - bilateral & relatively symmetric locations - cessation of focal sweating during sleep - impairment of activities of daily living - positive family history
- thoracic sympathectomy is a last resort
- botulinum toxin injection for axillary hyperhidrosis
More general terms
More specific terms
Additional terms
References
- ↑ Stedman's Medical Dictionary 26th ed, Williams & Wilkins, Baltimore, 1995
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 928-929
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 16 American College of Physicians, Philadelphia 2012
- ↑ Walling HW. Primary hyperhidrosis increases the risk of cutaneous infection: a case-control study of 387 patients. J Am Acad Dermatol. 2009 Aug;61(2):242-6 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19395123
- ↑ 5.0 5.1 Schollhammer M, Brenaut E, Menard-Andivot N et al. Oxybutynin as a treatment for generalized hyperhidrosis: A randomized, placebo-controlled trial. Br J Dermatol 2015 Nov; 173:1163. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26114588 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/bjd.13973/abstract
- ↑ 6.0 6.1 Bankhead C Topical Therapy Improves Hyperhidrosis in Kids. Sweat production falls, QOL rises with anticholineregic wipes. MedPage Today. February 20, 2018 https://www.medpagetoday.com/meetingcoverage/aad/71266
Hebert AA, et al Glypyrronium tosylate for the treatment of primary axillary hyperhidrosis: Pediatric subgroups analyses from the ATMOS-1 and ATMOS-2 phase III randomized controlled trials. American Academy of Dermatology (AAD) 2018; Late-Breaking Research Abstract 6659. - ↑ Brooks M FDA OKs New Topical Treatment for Excessive Underarm Sweating. Medscape - Jun 29, 2018 https://www.medscape.com/viewarticle/898719
- ↑ 8.0 8.1 8.2 8.3 8.4 James W Fast Five Quiz: Hyperhidrosis Medscape. July 5, 2023 https://reference.medscape.com/viewarticle/992459
Obed D, Salim M, Bingoel AS, Hofmann TR, Vogt PM, Krezdorn N. Botulinum Toxin Versus Placebo: A Meta-Analysis of Treatment and Quality-of-life Outcomes for Hyperhidrosis. Aesthetic Plast Surg. 2021 Aug;45(4):1783-1791. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33619611 PMCID: PMC8316174 Free PMC article.