Hyperhidrosis

Definition

• Hyperhidrosis is excessive sweating, usually in localised areas (palms, soles, axillae, face) but can also be generalised.

• It affects approximately 2–3% of the population and can be exacerbated by stress.

• It often occurs independently of ambient temperature or exertion.

Aetiology & Causes

• Primary Hyperhidrosis: Often idiopathic, with no underlying pathology.

• Rule out secondary causes:

  • Thyroid dysfunction (check TSH)

  • Diabetes mellitus (poor glycaemic control)

  • Phaeochromocytoma (adrenal tumour → episodic sweating)

  • Lymphoma (night sweats)

  • Post-Surgical changes, spinal cord injury

  • Certain medications (e.g. SSRIs)

Management

First-Line

• Topical Aluminium Chloride 20% Solution:

  • Apply daily (morning or night) to dry skin in affected area.

  • Gradual reduction in sweating over days to weeks.

  • Possible skin irritation → consider lower concentrations or less frequent application.

Specialist Treatments (Severe Cases)

1. Palmar/Plantar Hyperhidrosis:

   • Iontophoresis: Immersion of hands/feet in tap water with a mild electric current (repeated sessions).

   • Anticholinergic Drugs (e.g. glycopyrrolate, oxybutynin) if severe or resistant; watch for side effects (dry mouth, blurred vision).

2. Axillary Hyperhidrosis:

   • Botulinum Toxin A Injections: Effective for ~6 months, repeated as needed.

   • Consider surgical options (e.g. local excision of sweat glands, endoscopic thoracic sympathectomy) only in refractory cases.

3. Generalised Hyperhidrosis:

   • Systemic Anticholinergics (e.g. oxybutynin 2.5–5 mg PO) if multiple areas affected.

   • Botulinum toxin or iontophoresis can help localised severe sweating.

   • Address underlying triggers or conditions where possible.

Notes

• Emphasise lifestyle measures: Loose clothing, breathable fabrics, daily hygiene, use of absorbent foot/shoe products.

• Psychosocial impact can be significant → Offer support or referral to mental health counselling if needed.

• If suspicion of secondary hyperhidrosis (e.g. night sweats, weight loss, palpitations, etc.), conduct appropriate investigations (TSH, FBC, glucose, consider imaging if indicated).