Hyperhydrosis

Question 2

What is hyperhidrosis and how can it be classified?

Answer 2

Sweating in excess of that required for regulation of body temperature. Sweating normally controlled sympathetically

Primary: no underlying cause, usually localised to hands, armpits, scalp or feet in symmetrical distribution

Secondary: associated with conditions or medication and can be generalised sweating or focal to areas

Question 3

What are some causes of secondary hyperhidrosis?

Answer 3

• Pregnancy or menopause
• Anxiety
• Infections (TB, malaria, HIV)
• Malignancy (lymphoma)
• Endocrine disorders (hyperthyroidism, phaeochromocyoma)
• Medication (anticholinesterases, antidepressants, propanolol)

Question 4

What are the clinical features of hyperhidrosis?

Answer 4

Primary: often bilateral and symmetrical focal sweating, occuring at least one a week, often <25 years when onset, needs to be present >6/12 for diagnosis

Secondary: often generalised sweating usually at night time

Question 5

What investigations are done for hyperhidrosis?

Answer 5

• Diagnosis through history and exam

- Blood tests: FBC, CRP, U+Es, TFTs, Glucose

- CXR

Question 6

How are patients with hyperhidrosis managed?

Answer 6

Conservative

• Lifestyle advice e.g avoid spicy foods, loose fitting clothes
• Antiperspirants with aluminium chloride
• Propantheline (anticholinergic)

Surgical (resistant symptoms or affecting QoL)

- Iontophoresis which is putting electrical current through the area with water soaked sponges, only short term

- Botulinum toxins to block nerve supply to sweat glands, lasts 2-6 months and only licenced underarm

- Endoscopic Thoracic Sympathectomy which damages thoracic sympathetic ganglion for palms and face. Risk of damage to lungs and other nerves so last resort

Question 7

What do you need to warn patients undergoing surgery for hyperhidrosis?

Answer 7

May develop compensatory sweating in other locations