Are there any effective treatments for hyperhidrosis?
— Gerardo M. Maradiaga, MD, Roanoke Rapids, N.C.

Hyperhidrosis is estimated to affect 1%-2% of the U.S. population and can create problems for patients socially, occupationally, and psychologically. Primary focal hyperhidosis is defined as more than six months of excessive, bilateral, symmetric sweating that has no apparent cause, starts before the age of 25, and may occur in the axillae, palms, feet, or craniofacial areas. The diagnosis is made after ruling out secondary causes, especially if the hyperhidrosis is asymmetric or unilateral. The preferred treatments depend on the location involved. A multispecialty consensus panel which examined the available literature (J Am Acad Dermatol. 2004;51:274-286) recommended that initial treatment, regardless of location, be topical aluminum chloride. This agent is available in different concentrations; higher concentrations are more effective but cause more skin irritation. Second-line treatment is generally intradermal botulinum toxin type A (Botox) injection, which is safe and effective. This therapy is well tolerated for axillary and craniofacial hyperhidrosis but slightly less preferred for palmar hyperhidrosis, as it is painful and may result in mild transient weakness of the intrinsic hand muscles.

Another option for palmar or plantar hyperhidrosis, which can be tried before botulinum toxin type A, is tap water iontophoresis. Patients with refractory axillary or palmar hyperhidrosis can consider endoscopic transthoracic sympathectomy, which has side effects, including compensatory hyperhidrosis in other parts of the body.
—Susan Kashaf, MD, MPH

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