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Hyperhidrosis is a debilitating pathophysiological condition characterized
by excessive sweating. It is classified as primary focal or secondary. Primary
focal hyperhidrosis affects symmetrical areas of the body, and
tends to involve palms, soles of the feet, axillae and craniofacial regions,
although other areas may be affected.
Clinical evaluation of the patient with hyperhidrosis requires a careful
history, including assessment of impact of the condition on the patient’s
quality of life, occupation and social interactions. Physical examination
and investigations should exclude underlying disease processes causing
secondary hyperhidrosis.
Treatment is directed towards the individual patient’s needs. Noninvasive
treatments, used with varying degrees of success, include topical
treatments; oral medications; and iontophoresis. For axillary hyperhidrosis,
intradermal administration of botulinum toxin A has proven efficacy
although treatments may need to be repeated. In severe palmar/plantar
hyperhidrosis, endoscopic thoracic sympathectomy is an established
and effective procedure, but surgery should be reserved for patients in
whom less invasive treatments have proved ineffective. Clinicians should
be aware of the specific deleterious side effects and potential complications
of surgery, including compensatory hyperhidrosis, which in some patients
can outweigh the potential benefits of intervention.
Original languageEnglish
Pages (from-to)251-5
Number of pages5
Issue number5
Publication statusPublished - May 2013


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