Abstract: Hyperhidrosis (HH) is a disorder of the eccrine sweat glands causing excessive sweating. It is caused by hyperactivity of the sympathetic nervous system resulting in excessive release of acetylcholine and activation of the sweat glands. Primary essential HH is thought to have a large genetic component, while secondary HH is the result of an underlying condition or medications. HH will often cause excessive sweating in areas with a high density of eccrine sweat glands that include the palms, soles, face, head, or axillae. Diagnosis is largely based on history and physical which can help differentiate between primary and secondary HH. Hyperhidrosis can have a significant impact on quality of life. Management includes identifying and avoiding triggers, the use of topical antiperspirants, and advanced therapies in recalcitrant cases (such as tap water iontophoresis, botulinum toxin injection and surgical options).
Hyperhidrosis is common and affects about 5% of the population
A simple measure of the severity of hyperhidrosis can be done with the 4-question hyperhidrosis disease severity score
Secondary hyperhidrosis should be ruled out with a good history and physical exam
Patients who fail treatment with topical antiperspirants can be treated with tap-water iontophoresis, botulinum toxin injections, oral anticholinergics and surgical options.
Hyperhidrosis is excessive sweating that can be most commonly primary but can have secondary causes
Patients with hyperhidrosis can experience significant impairment on quality of life and this should be explored
First-line treatment consists of topical antiperspirants
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