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Primary Focal Hyperhidrosis
Axillary
Palmar
Plantar
Facial and Gustatory
Plantar
An important first step in the care of the plantar hyperhidrosis patient is to provide
education regarding good foot hygiene (to keep the feet as dry as possible). Useful
plantar hygienic products include: absorbent foot powder, absorbent insoles for shoes,
and moisture-wicking socks. Patients should also be encouraged to wear nonocclusive
footwear and to change their shoes and socks frequently.[145,148]
Topical aluminum chloride antiperspirants are often considered the first line of
treatment for plantar 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 plantar sweating. [7,145] One of the benefits of iontophoresis
for plantar symptoms is that the patient avoids the irritation often associated with
aluminum chloride use. Additionally, iontophoresis is often effective for the feet
(whereas it is not as effective for the underarms) and, with training, patients can
learn to perform the procedure at home.[7,95] When treating plantar hyperhidrosis
with BTX-A both physicians and patients should understand that due to the large surface
area that usually requires treatment (up to 36 injections may be necessary) and the
sensitivity of the feet, the procedure may be "more tedious and uncomfortable" than
it would be for palmar or axillary hyperhidrosis. [29]
If the patient does not respond to BTX-A, the last therapeutic option to consider
is the use of a systemic medication. Additionally, if symptoms are exacerbated in
known anxiety-provoking situations, short-term expectant use of a benzodiazepine or
anticholinergic may be considered. [9,19]
Download printable algorithm
here.
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