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Primary Focal Hyperhidrosis
Axillary
Palmar
Plantar
Facial and Gustatory
Axillary
Topical aluminum chloride antiperspirants have long been, and continue to be, the first line of treatment for axillary hyperhidrosis.
[9,58]
The exception to this is if the patient’s excessive sweating symptoms occur during, or are exacerbated by, known anxiety-provoking
situations such as during presentations at work, dramatic performances, etc. In these cases, the patient may be treated prior to
such events with an anticholinergic or a short course benzodiazepine.
[9,19]
If a patient does not adequately respond to topical antiperspirant therapy or if the side effects of such therapy are intolerable,
botulinum toxin A (BTX-A) injections are the next line of treatment. The U.S. Food & Drug Administration (FDA) approved BTX-A for
the treatment of severe primary axillary hyperhidrosis in patients unable to obtain relief using antiperspirants on July19, 2004.
BTX-A injections offer a minimally invasive treatment option and should be repeated as necessary to control symptoms.
[99]
Should a patient not respond BTX-A or require such frequent re-injections as to be impractical surgical measures may be considered.
Local sweat gland excision by curettage or liposuction, done on an outpatient basis with tumescent local anesthesia, are less
invasive surgical options. [7,99]
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| Starch iodine
test, with the darkened area showing location of excessive
sweating before and after treatment with BTX-A. Photo
courtesy of Markus Naumann, MD |
Download printable algorithm
here.
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