Hyperhidrosis

Hyperhidrosis is a condition characterized by excessive sweating beyond what is required for thermoregulation. It most commonly affects the palms, soles, axillae, and face, and can be focal or generalized. Primary focal hyperhidrosis is usually idiopathic and begins in adolescence or early adulthood; secondary hyperhidrosis results from another medical condition or medication.

Most cases are thought to involve overactivity of the sympathetic nervous system and eccrine sweat glands, with a genetic predisposition in many patients. Triggers can include heat, anxiety, or exercise, but sweating may occur spontaneously. Diagnosis is clinical, supported by patient history and physical examination. Tests such as the starch-iodine test or thermoregulatory sweat test can map sweating patterns when needed. It is important to exclude secondary causes such as hyperthyroidism, infections, menopause, diabetes, certain medications, or caffeine excess.

Treatment aims to reduce sweating and improve quality of life. Topical aluminum chloride is often first-line for axillary hyperhidrosis. For palms or soles, or when topical therapy is insufficient, iontophoresis can help. Oral anticholinergics (for example glycopyrrolate or oxybutynin) can reduce sweating but may cause dry mouth, constipation, or urinary effects. Botulinum toxin injections are effective for focal areas such as axillae, palms, or soles but require repeat treatment every several months. For axillary hyperhidrosis, microwave or ultrasound-based devices offer a noninvasive option. Endoscopic thoracic sympathectomy is a last resort for severe, refractory cases and carries a risk of compensatory sweating elsewhere on the body. Liposuction-assisted and suction-blister techniques are less commonly used surgical approaches.

Prognosis varies; hyperhidrosis is typically a chronic condition that can significantly affect daily activities and psychosocial well-being, though many patients achieve meaningful relief with treatment.