Primary focal hyperhidrosis: current treatment options and a step‐by‐step approach

Abstract

Primary focal hyperhidrosis is a common disorder for which treatment is often a therapeutic challenge. A systematic review of current literature on the various treatment modalities for primary focal hyperhidrosis was performed and a step-by-step approach for the different types of primary focal hyperhidrosis (axillary, palmar, plantar and craniofacial) was established. Non-surgical treatments (aluminium salts, local and systemic anticholinergics, botulinum toxin A (BTX-A) injections and iontophoresis) are adequately supported by the current literature. More invasive surgical procedures (suction curettage and sympathetic denervation) have also been extensively investigated, and can offer a more definitive solution for cases of hyperhidrosis that are unresponsive to non-surgical treatments. There is no consensus on specific techniques for sympathetic denervation, and this issue should be further examined by meta-analysis. There are numerous treatment options available to improve the quality of life (QOL) of the hyperhidrosis patient. In practice, however, the challenge for the dermatologist remains to evaluate the severity of hyperhidrosis to achieve the best therapeutic outcome, this can be done most effectively using the Hyperhidrosis Disease Severity Scale (HDSS).

Prevalence and Disease Burden of Hyperhidrosis in the Adult Population

“…It has been shown in several studies that many patients affected with hyperhidrosis suffer from social problems and impairments in daily activities, as well as emotional and physical strains [5,6]. For this, a dermatological workup is indicated in all patients seeking help, including clinical and laboratory investigations as well as psychosocial assessment [7]. A variety of treatment options is available and can be applied according to the trigger factors and causes of hyperhidrosis [8,9].…”

Craniofacial hyperhidrosis can usually be managed pharmacologically, but surgery may sometimes be needed

“…Although aluminium chloride hexahydrate is often associated with skin irritation, burning and pain, these symptoms may be alleviated by the coadministration of topical hydrocortisone [13].…”

“…Topical aluminium chloride hexahydrate acts by blocking the epidermal duct of eccrine sweat glands [13], resulting in atrophy and vacuolization at the level of the glandular secretory cells, as well as necrosis of the epidermal cells of the duct delineation. Although aluminium chloride hexahydrate is often associated with skin irritation, burning and pain, these symptoms may be alleviated by the coadministration of topical hydrocortisone [13].…”

Axillary hyperhidrosis: A review of the extent of the problem and treatment modalities

“…The initial dose is a10-20% solution which can be increased to a 35% solution dissolved in ethyl alcohol or a 2e4% salicylic acid gel. 19 The most common adverse effects of aluminium chloride treatment are itching and stinging immediately after application and ongoing skin irritation. 20 In one series of 691 patients, pruritus was slight and short in duration in 70%, moderate in 21%, and severe in 9%, while skin irritation was moderate in 36% and severe in 14%.…”