The usual areas affected are the axillae, palms and soles. Often the condition is worse in the summer and may be exacerbated by emotional triggers.
- aluminium chloride preparations
- are the first line treatment
- applied at night just before sleep
- used daily initially together with standard antiprespirant and once the symptoms improve, could be used as required
- topical glycopyrrolate - anticholinergic drugs
Patients who fail to respond to lifestyle advice and topical aluminium chloride (trialled for at least six weeks) should be referred to a dermatologist. Treatment options available in secondary care include:
- iontophoresis
- although mode of action is unknown, many guidelines recommend its use.
- each palm or sole is placed in a small tray filled with tap water, through which a current of 15-20 mA is run.
- once the level sweating is controlled with treatment maintenance treatment should be undertaken once a week or less.
- oral anticholinergic drugs
- e.g. - oxybutynin, glycopyrrolate
- not currently licensed for UK use in primary hyperhidrosis,
- botolinum toxin may be considered in selected cases depending on the site affected
- botulin A toxin (BTX-A) is the most commonly used and it inhibits acetylcholine release temporarily but more effectively than topical agents.
- used in axillary hyperhidrosis unresponsive to topical agents
- effect of treatment last for six to nine months and , lifelong treatment is necessary
- surgery
- endoscopic thoracosympathectomy
- most commonly used method which provides permanent relief
- usually performed as a day case procedure under general anaesthesia
- reserved for patients who are unresponsive to other less invasive interventions
- patients should be infoemd about the irreversible nature of the surgery and possible side effects (compensatory hyperhidrosis elsewhere on the body.)
- other emerging surgical tecniques
- suction curettage - an arthroscopic shaver or similar device is used to debride the subcutaneous tissue and clear the glands through a small (1-2 cm) incision, usefull in the management of axillary hyperhidrosis
- laser treatment - used in a similar way to suction curettage (1).
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