A 14-year-old girl has diaphoretic palms, which cause her a great deal of embarrassment. This does not appear related to stress or hormonal cycles, and she has no other medical conditions. Is there anything that can be done for her? I have read that botulinum toxin A (Botox) has been used to treat other types of perfuse sweating.
—Karen Ganey, MS, RN, Waukesha, Wis.

The patient’s history is compatible with a diagnosis of primary focal hyperhidrosis. However, secondary causes of excessive sweating should be excluded. A treatment algorithm for palmar hyperhidrosis was published recently. Initial recommendations include either topical therapy with 10%-35% aluminum chloride hexahydrate or tap-water iontophoresis. Patients who fail to achieve a satisfactory response with aluminum chloride or iontophoresis may be offered intradermal injections of botulinum toxin into their palms. For selected patients with severe hyperhidrosis who are not able to tolerate other therapies, endoscopic thoracic sympathectomy is an option (J Am Acad Dermatol. 2004;51:274-286).
—Philip R. Cohen, MD (103-14)

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