|
|
|
|
|
|
|
|
|
|
|
Primary Focal Hyperhidrosis
Axillary
Palmar
Plantar
Facial and Gustatory
Palmar
Topical aluminum chloride antiperspirants are often considered the
first line of treatment for palmar hyperhidrosis, keeping in mind
that a higher concentration of active ingredients (up to 30%) than
is used to treat axillary hyperhidrosis is often required.[145]
Many experts, however, also consider tap water iontophoresis to
be a first line treatment for palmar sweating. [7,145] One of the
benefits of iontophoresis for palmar symptoms is that the patient
avoids the irritation often associated with aluminum chloride use.
Additionally, iontophoresis is often effective for the palms
(whereas it is not as effective for the underarms) and, with
training, patients can learn to perform the procedure at home. [7,58]
As with axillary hyperhidrosis, first line treatment may be different
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 symptoms do not resolve with topical antiperspirants, iontophoresis, or short
course oral medications (if appropriate), the remaining options to consider are:
botulinum toxin type A (BTX-A) injections, on-going use of systemic medications,
or endoscopic thoracic sympathectomy (ETS).[95] Since systemic medications are
often associated with side effects precluding long-term treatment and ETS is
invasive and associated with high rates of compensatory hyperhidrosis, BTX-A
is often recommended first and repeated as necessary to control symptoms.[95]
 |
 |
| 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.
Back to top
|
|
|
|
|
|
 |
|
|
 |
|
|
|
|
|
 |
|
|
List your practice or search for colleagues. |
|
|
 |
|
|
|
|
|
 |
|
|
|
|
|
 |
|
 |
|
|
|
|
| |
| |
|
|
