University Dermatological Clinic, D-69115, Heidelberg, Germany.
Overproduction of sweat by the exocrine sweat glands is called hyperhidrosis. It is differentiated into two forms - a localised (e.g. axillary, palmar and plantar hyperhidrosis) and a generalised form that affects the entire skin. Patients with increased sweat production often suffer from enormous psychosocial stress because they are restricted in both their private and professional lives. If the hyperhidrosis is not caused by a primary disease (e.g. hyperthyroidism or phaeochromocytoma) that can be treated, with elimination of the sweating problem, then only symptomatic treatment is possible.
For axillary hyperhidrosis, local application of aluminium chloride seems to be the method of choice; an alternative is botulinum toxin whose efficacy for 3 to 9 months is an advantage. Surgical options should not be considered until conservative methods have failed. Curettage with a scraper and liposuction are reliable and safe treatments for axillary hyperhidrosis.
The method of choice in treating palmoplantar hyperhidrosis is tap water iontophoresis. Adding anticholinergic substances to the water produces a more rapid therapeutic success that also lasts longer. Botulinum toxin can be an effective and promising alternative. Surgical treatment, i.e. sympathectomy, does bring about a long-term resolution of the problem, but should only be considered in well-justified cases because of the highly invasive character of the procedure.
The use of systemic anticholinergic medication for patients with localised or generalised tendency to sweat can be tried, but is often limited because of the profile of adverse effects.
It can be stated that in spite of the interesting and promising new alternatives, especially using botulinum toxin, the tried-and-true procedures such as tap water iontophoresis and aluminium chloride salts still have a firm place in the treatment of hyperhidrosis.