eMedicine Specialties > Dermatology > Diseases of the Adnexa

Hyperhidrosis

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Rachel Altman, MD, Staff Physician, Department of Dermatology, UMDNJ-New Jersey Medical School; George Kihiczak, MD, Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital

Updated: May 29, 2009

Introduction

Background

Hyperhidrosis, which is sweating in excess of that required for normal thermoregulation, is a condition that usually begins in either childhood or adolescence. Although any site on the body can be affected, the sites most commonly affected are the palms, soles, and axillae. This condition may be idiopathic or secondary to other diseases, metabolic disorders, febrile illnesses, or medication use. Hyperhidrosis exists in 3 forms: emotionally induced (in which it affects the palms, soles, and axillae^1,2), localized, or generalized. The condition often causes great emotional distress and occupational disability for the patient, regardless of the form.

Pathophysiology

Generalized hyperhidrosis may be the consequence of autonomic dysregulation, or it may develop secondary to a metabolic disorder, febrile illness, or malignancy. In its localized form, hyperhidrosis may result from a disruption followed by abnormal regeneration of sympathetic nerves or a localized abnormality in the number or distribution of the eccrine glands, or it may be associated with other (usually vascular) abnormalities.

Essential hyperhidrosis, a disorder of the eccrine sweat glands, is associated with sympathetic overactivity.³ It does not appear to be a generalized disorder involving vascular endothelium.

Frequency

United States

In adolescents and young adults, an incidence of 0.6-1.0% is reported.⁴

International

Palmoplantar hyperhidrosis occurs 20 times more frequently in the Japanese than in any other ethnic group.^5,6

Mortality/Morbidity

Hyperhidrosis is not associated with mortality. Severe cases of hyperhidrosis may adversely affect the patient's quality of life (see Complications).

Race

All races can be affected; however, Japanese are reportedly affected more than 20 times more frequently than other ethnic groups.^5,6

Sex

Both sexes can be affected by hyperhidrosis.

Age

Persons of all ages can be affected by hyperhidrosis. Localized hyperhidrosis, unlike generalized hyperhidrosis, usually begins in childhood or adolescence. In a study of 850 patients with palmar, axillary, or facial hyperhidrosis, 62% of patients reported that sweating began since before they could remember; 33%, since puberty; and 5%, during adulthood.⁷

Clinical

History

Essential hyperhidrosis is a dermatologic and neurologic disorder characterized by excessive sweating of the eccrine sweat glands.⁸

Patients note excessive sweating in affected areas, which ultimately prompts them to seek medical attention.
Palmoplantar hyperhidrosis (excessive sweating of the palms and soles) is observed in persons with chronic alcoholism.⁹
Localized hyperhidrosis, unlike generalized hyperhidrosis, usually begins in childhood or adolescence.
Hyperhidrosis beginning later in life should prompt a search for secondary causes such as systemic diseases, adverse effects of medication use, or metabolic disorders.
Harlequin syndrome is characterized by unilateral hyperhidrosis and flushing, predominantly induced by heat or exercise.¹⁰ The sympathetic deficits are usually limited to the face.
An echo-Doppler study found impaired left ventricular filling in patients with essential hyperhidrosis, which is associated with cardiac autonomic dysfunction because sympathetic fibers to eccrine glands of the palms of the hand arise from stellate and upper thoracic ganglia, which also innervate the heart.⁸ This study indicated that hyperactivity of the sympathetic nervous system in patients with hyperhidrosis may alter cardiac function in the long term.
The temperament and character profile for patients with essential hyperhidrosis has stimulated interest,¹¹ but data suggest that hyperhidrosis is not related to social phobia or personality disorder.

Physical

Visible signs of hyperhidrosis are clearly evident.
If direct visualization of the affected areas is desired, the iodine starch test may be used.
- This test requires spraying of the affected area with a mixture of 0.5-1 g of iodine crystals and 500 g of soluble starch.
- Areas that produce sweat will turn black.

Causes

Hyperhidrosis may be idiopathic or secondary to other diseases, metabolic disorders, febrile illnesses, or medication use.

Generalized hyperhidrosis may be secondary to numerous conditions including the following:
- Neurologic or neoplastic diseases
- Metabolic disorders or processes (eg, thyrotoxicosis, diabetes mellitus, hypoglycemia, gout, pheochromocytoma, menopause)
- Febrile illnesses
- Medications: Use of medications may affect one or more components of human thermoregulation and induce hyperhidrosis. Agents such as propranolol, physostigmine, pilocarpine, tricyclic antidepressants, and serotonin reuptake inhibitors have been implicated. Efavirenz was recently described to induce excessive nocturnal sweating that resolved after dose reduction.¹² The clinical trial Excessive Sweating Caused by Antidepressants: Measurement and Treatment With Terazosin (ADIES) is currently recruiting.
- Chronic alcoholism
- Hodgkin disease or tuberculosis (in nocturnal hyperhidrosis)
Localized unilateral or segmental hyperhidrosis is rare and of unknown origin. The condition usually presents on the forearm or forehead in otherwise healthy individuals, without evidence of the typical triggering factors found in essential hyperhidrosis. Unilateral hyperhidrosis with accompanying contralateral anhidrosis is also rare.¹³ Unilateral hyperhidrosis has been described on the right sides of the forehead, the nose, and the palmar surface of the right hand, with anhidrosis on the left hand.
Localized hyperhidrosis may also be associated with the following:
- Gustatory stimuli (associated with Frey syndrome, encephalitis, syringomyelia, diabetic neuropathies, herpes zoster parotitis, and parotid abscess)
- Eccrine nevus
- Eccrine angiomatous hamartoma
- Blue rubber-bleb nevus
- Glomus tumor
- Peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasma-proliferative disorder, and skin changes (POEMS) syndrome
- Burning feet syndrome
- Pachydermoperiostosis
- Pretibial myxedema

Differential Diagnoses

Blue Rubber Bleb Nevus Syndrome
Glomus Tumor
Pachydermoperiostosis
POEMS Syndrome
Pretibial Myxedema

Workup

Laboratory Studies

Search for primary causes if generalized hyperhidrosis is noted.
Important laboratory studies may include the following:
- Thyroid function tests may reveal underlying hyperthyroidism or thyrotoxicosis.
- Blood glucose levels may reveal diabetes mellitus or hypoglycemia.
- Urinary catecholamines may reveal a possible pheochromocytoma.
- Uric acid levels may reveal gout.
- A purified protein derivative (PPD) test can be performed to screen for tuberculosis.

Imaging Studies

Chest radiography may be used to rule out tuberculosis or a neoplastic cause.

Histologic Findings

Individuals with hyperhidrosis have morphologically and functionally normal eccrine glands. Localized hyperhidrosis may result from an abnormal number and/or distribution of otherwise normal eccrine glands. Examples of such conditions include eccrine nevus and eccrine angiomatous hamartoma.

Treatment

Medical Care

Therapy can be challenging for both the patient and the physician. Both topical and systemic medications have been used. Other treatment options include iontophoresis and botulinum toxin injections.

Topical agents include topical anticholinergics, boric acid, 2-5% tannic acid solutions, resorcinol, potassium permanganate, formaldehyde (which may cause sensitization¹⁴), glutaraldehyde, and methenamine. All of these agents are limited by staining, contact sensitization, irritancy, or limited effectiveness. Because of the limitations of other agents, Drysol (20% aluminum chloride hexahydrate in absolute anhydrous ethyl alcohol) is more commonly used as the first-line topical agent. Drysol should be applied nightly on dry skin with or without occlusion until a positive result is obtained, after which the intervals between applications may be lengthened. To minimize irritation, the remainder of the medication should be washed off when the patient awakes, and the area may be neutralized with the topical application of baking soda.¹⁵
Systemic agents used to treat hyperhidrosis include anticholinergic medications. Anticholinergics such as propantheline bromide, glycopyrrolate, oxybutynin, and benztropine are effective because the preglandular neurotransmitter for sweat secretion is acetylcholine (although the sympathetic nervous system innervates the eccrine sweat glands).¹⁶ The use of anticholinergics may be unappealing because their adverse effect profile includes mydriasis, blurry vision, dry mouth and eyes, difficulty with micturition, and constipation. In addition, other systemic medications, such as sedatives and tranquilizers, indomethacin, and calcium channel blockers, may be beneficial in the treatment of palmoplantar hyperhidrosis.
Iontophoresis was introduced in 1952 and consists of passing a direct current across the skin.^17,18,19 The mechanism of action remains under debate. In palmoplantar hyperhidrosis, the daily treatment of each palm or sole for 30 minutes at 15-20 mA with tap water iontophoresis is effective.²⁰ Intact skin can endure 0.2-mA/cm² galvanic current without negative consequences, and as much as 20-25 mA per palm may be tolerated.²⁰ Numerous agents have been used to induce hypohidrosis, including tap water and anticholinergics; however, treatment with anticholinergic iontophoresis is more effective than tap water iontophoresis.²¹
Botulinum toxin injections are effective because of their anticholinergic effects at the neuromuscular junction and in the postganglionic sympathetic cholinergic nerves in the sweat glands.^22,23,24,25 See Botulinum Toxin for more information.
- In palmar hyperhidrosis, 50 subepidermal injections of 2 mouse units per palm (total 100 mouse units per palm) results in anhydrosis lasting 4-12 months.²⁶ Each injection produces an area of anhydrosis approximately 1.2 cm in diameter. The only adverse effect is mild transient thumb weakness that resolves within 3 weeks. Adverse effects of intradermal injections of botulinum A toxin may result from diffusion into underlying muscles.²⁷
- In a similar study, the effects of sodium chloride solution injections in one palm were compared with botulinum toxin injections in the other palm.²⁸ Treatment with 120 mouse units of botulinum toxin (injected into 6 sites in the palm) resulted in a 26% reduction in sweat production after 3 and 8 weeks and a 31% reduction after 13 weeks. Noted adverse effects included minor muscle weakness at the toxin-treated sites, which resolved after 2-5 weeks. Injections of botulinum toxin must be repeated at varying intervals to maintain long-term results.
- Treatment of axillary hyperhidrosis with botulinum toxin type A reconstituted in lidocaine or in normal saline was described in a randomized, side-by-side, double-blind study.²⁹ The results were the same; however, injections of botulinum toxin A reconstituted in lidocaine are associated with significantly reduced pain, thus, lidocaine-reconstituted botulinum toxin A may be preferable for treating axillary hyperhidrosis.
- A 2008 study found botulinum toxin type A to be more effective than topical 20% aluminum chloride for the treatment of moderate-to-severe primary focal axillary hyperhidrosis.³⁰
- Woolery-Lloyd et al reported on successful treatment of inguinal hyperhidrosis with botulinum toxin A. The condition was initially misdiagnosis as urinary incontinence.³¹
- The American Academy of Neurology guidelines Assessment: botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology may be of interest.³²

Surgical Care

In addition to pharmacologic therapy, other treatments include surgical sympathectomy, surgical excision of the affected areas, and subcutaneous liposuction. Each modality has been used effectively.

Palmar hyperhidrosis is a benign functional disorder that is a psychological and social handicap.³³ A survey showed thoracoscopic sympathectomy to be minimally invasive and to improve the patient's quality of life, even if compensatory hyperhidrosis occurs.

Sympathectomy has been used as a permanent effective treatment since 1920. Usually, it is reserved for the final treatment option.³⁴ Sympathectomy involves the surgical destruction of the ganglia responsible for hyperhidrosis.^35,36,37
- The second (T2) and third (T3) thoracic ganglia are responsible for palmar hyperhidrosis, the fourth (T4) thoracic ganglia controls axillary hyperhidrosis, and the first (T1) thoracic ganglia controls facial hyperhidrosis.
- Two surgical approaches are available: an open approach and a newer endoscopic approach. The endoscopic approach has become favored because of its improvements in terms of complications, surgical scars, and surgical times. Endoscopic thoracic sympathectomy is an effective treatment for hyperhidrosis; in one study, immediate positive results occurred in 832 (98%) of 850 patients.⁷ After a 31-month average follow-up, symptoms recurred in 17 patients. Improved quality of life has been described for upper limb hyperhidrosis after treatment with limited endoscopic thoracic sympathetic block at T4.³⁸
- Numerous complications are associated with this endoscopic treatment option; these include compensatory sweating (induction of sweating in previously unaffected areas of the body), gustatory sweating, pneumothorax, intercostal neuralgia, Horner syndrome, recurrence of hyperhidrosis, and the sequelae of general anesthetic use.
  - Of 850 patients who underwent endoscopic transthoracic sympathectomy, 55% had compensatory sweating (mostly on the trunk), and 36% had gustatory sweating.⁷ In a similar study³⁹ of 72 patients who underwent transthoracic endoscopic sympathectomy (T2 or T2 and T3) for palmar hyperhidrosis, the success rate was 93%; compensatory sweating occurred in an overwhelming 99% of patients within 1 month after surgery, and gustatory sweating occurred in 17%. The overall occurrence of severe compensatory hyperhidrosis was reduced after T3 ganglionectomy as opposed to ganglionectomies performed at all other levels.⁴⁰
  - T4 ganglion interruption for palmar hyperhidrosis is an effective approach that can simultaneously minimize the rate of compensatory hyperhidrosis.⁴¹ Thus, T4 sympathectomy may be an effective cure. Its rate of compensatory hyperhidrosis appears to be remarkably low compared with T2 sympathetic ganglionic interruption. An effective treatment for such compensatory sweating is the intradermal injection of botulinum toxin.⁴²
  - Li et al reported on minimizing endoscopic thoracic sympathectomy for hyperhidrosis of the palms using the skin temperature of the palms and Doppler-guided blood flow analysis as aids.⁴³
  - Topical glycopyrrolate application may be effective and safe for the treatment of excessive facial sweating in primary craniofacial and secondary gustatory hyperhidrosis following sympathectomy.⁴⁴
Surgical excision of the affected area (identified with iodine starch testing) removes the appropriate sweat glands, thereby eliminating sweating. This technique is particularly useful in axillary hyperhidrosis.
The treatment of axillary hyperhidrosis using the 1064-nm Nd-YAG laser was found to be effective and safe in a pilot trial.⁴⁵
Subcutaneous liposuction is another means of removing the eccrine sweat glands responsible for axillary hyperhidrosis. Compared with classic surgical excision, this modality results in less disruption to the overlying skin, resulting in smaller surgical scars and a diminished area of hair loss.⁴⁶

Consultations

Consult a neurosurgeon if sympathectomy is necessary in severe cases of hyperhidrosis that are refractory to all other treatments.

Medication

The goals of pharmacotherapy are to reduce morbidity and prevent complications. Control of palmar hyperhidrosis with a new dry-type iontophoretic device has been described.⁴⁷ Dry-type iontophoresis may reduce palmar sweating more conveniently than other conventional methods.

Aldehydes

These agents reduce perspiration by denaturing keratin and thereby occluding the pores of the sweat glands. They have a short-lasting effect. Contact sensitization is increased, especially with formalin. Aldehydes are used to treat the palms and soles; they are not as effective in the axillae.

Glutaraldehyde solution

2% as Cidex. Not as effective but less staining. 20-50% solution can be diluted to 10% (more effective, especially for feet, but still staining occurs).

Dosing

Adult

Apply to affected areas 3 times per wk for 2 wk, then every wk or prn

Pediatric

Administer as in adults

Interactions

None reported

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Avoid contact with eyes or mucous membranes; produces a temporary brown discoloration; may cause local irritation; thermal decomposition may release harmful fumes according to MSDS

Aluminum compounds

These agents are antiperspirants that are used in the management of hyperhidrosis.

Aluminum chloride (20% Drysol)

Certin-Dri and Xerac are over-the-counter products at low concentrations. Work best if applied to a dry area and covered with plastic overnight. Should be washed off in the morning. Effect should be noted within 1 mo.

Dosing

Adult

Apply to affected area qhs for 2-7 consecutive days prn; to prevent irritation, completely dry area prior to application

Pediatric

Administer as in adults

Interactions

None reported

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Not for application on irritated, broken, or recently shaved skin

Anticholinergic agents

The use of these agents is usually avoided because they are poorly tolerated at the required doses when given systemically. Acetylcholine is the preglandular neurotransmitter for sweat secretion. These drugs inhibit the binding of acetylcholine to the cholinergic receptor. Clinical effects usually occur within days.

Propantheline (Pro-Banthine)

Blocks action of acetylcholine at postganglionic parasympathetic receptor sites.

Dosing

Adult

15 mg PO bid/tid 30 min ac initially; gradually titrate to effect

Pediatric

Not established

Interactions

Concurrent antacids decrease effects; concurrent disopyramide, TCAs, phenothiazides, corticosteroids, atenolol, digoxin, bretylium, or other drugs with anticholinergic activity increase toxicity; may decrease effectiveness of phenothiazides

Contraindications

Documented hypersensitivity to product or related products; ulcerative colitis; narrow-angle glaucoma; obstructive disease of GI tract or urinary tract; intestinal atony of elderly or debilitated patients; myasthenia gravis; toxic megacolon; unstable cardiovascular adjustment in acute hemorrhage

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in renal, CNS, or hepatic disease; caution in geriatric patients and patients with Down syndrome; may cause urinary retention, arrhythmia, CNS dysfunction, visual changes, xerostomia, constipation, or heat intolerance
Confusion may occur in geriatric patients; diarrhea may be early symptom of incomplete intestinal obstruction (in this instance, treatment with propantheline would be inappropriate and possibly harmful); autonomic neuropathy may occur; caution on concomitant administration of belladonna alkaloids, synthetic/semisynthetic anticholinergic agents, narcotic analgesics, type 1 antiarrhythmics, antihistamines, phenothiazines, TCAs, or other psychoactive drugs; additional adverse effects include congestive heart failure, coronary heart disease, hepatic or renal disease, hiatal hernia associated with reflux esophagitis, hypertension, and hyperthyroidism

Glycopyrrolate (Robinul)

Acts in smooth muscle, CNS, and secretory glands to blocks action of acetylcholine at parasympathetic sites.

Dosing

Adult

1-2 mg PO bid/tid initially, then titrate to effective dose; not to exceed 8 mg/d
Topical formulation of extemporaneously formulated 0.5-1% cream or roll-on lotion; 0.1% solution applied using iontophoresis

Pediatric

<16 years: Not established
>16 years: Administer as in adults

Interactions

Levodopa decreases effects; concurrent antacids decrease effects; concurrent disopyramide, TCAs, phenothiazides, corticosteroids, atenolol, digoxin, bretylium, or other drugs with anticholinergic activity increase activity; may decrease effectiveness of phenothiazides; Slow-K enteric toxicity

Contraindications

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Benztropine (Cogentin)

Blocks striatal cholinergic receptors; may help balance cholinergic and dopaminergic activity in striatum.

Dosing

Adult

1-2 mg/d PO; not to exceed 6 mg/d

Pediatric

Not recommended

Interactions

Decreases effects of levodopa; concurrent antacids decrease effects; concurrent disopyramide, TCAs, phenothiazides, corticosteroids, atenolol, digoxin, bretylium, or other drugs with anticholinergic activity increase toxicity; may decrease effectiveness of phenothiazides

Contraindications

Documented hypersensitivity to product or related products; children <3 y; ulcerative colitis; narrow-angle glaucoma; obstructive disease of GI tract or urinary tract; intestinal atony of elderly or debilitated patients; myasthenia gravis; toxic megacolon; unstable cardiovascular adjustment in acute hemorrhage

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Oxybutynin (Ditropan)

Inhibits action of acetylcholine on smooth muscle and has direct antispasmodic effect on smooth muscles.

Dosing

Adult

Immediate release: 5 mg PO bid/tid; not to exceed 5 mg qid
Extended release: 5 mg or 10 mg PO qd at same time each day; dose may be increased in 5-mg increments qwk, not to exceed 30 mg/d

Pediatric

<5 years: Not established
>5 years: 5 mg (immediate release) PO bid; not to exceed 5 mg tid
>6 years: 5 mg (extended release) PO qd at same time each day; dose may be increased in 5-mg increments, not to exceed 20 mg/d

Interactions

Effects decrease with concurrent antacids; concurrent disopyramide, TCAs, phenothiazides, corticosteroids, atenolol, digoxin, bretylium, or other drugs with anticholinergic activity increase toxicity; may decrease effectiveness of phenothiazides

Contraindications

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Neuromuscular blocking agents

These agents inhibit the transmission of nerve impulses at the neuromuscular junction of skeletal muscle and/or autonomic ganglia.

Botulinum toxin A (BOTOX®)

Prevents calcium-dependent release of acetylcholine and produces a state of denervation at the neuromuscular junction and postganglionic sympathetic cholinergic nerves in the sweat glands.
Each injection produces an area of anhydrosis approximately 1.2 cm in diameter. Reportedly results in anhydrosis lasting 4-12 mo.
Injections of botulinum toxin must be repeated at varying intervals to maintain long-term results.

Dosing

Adult

Palmar hyperhidrosis: 50 subepidermal injections of 2 U per palm (total 100 U per palm)
Axillary hyperhidrosis: 50 U/axilla injected intradermally each axilla in 0.1-0.2 mL aliquots to multiple (10 to 15) sites in each axilla

Pediatric

Not established

Interactions

Aminoglycosides or drugs that interfere with neuromuscular transmission may potentiate effects

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Do not exceed recommended dosages and frequencies of administration; presence of antibodies to botulinum toxin type A may reduce effects of therapy; mild transient thumb weakness and muscle weakness at toxin-treated sites may occur but resolve within 2-5 wk
Units of biological activity of botulinum toxin type A cannot be compared to nor converted into units of any other botulinum toxin; relative potencies of botulinum A toxin preparations available in United Kingdom and North American differ significantly; reduced blinking as a result of administration of Botox ® Cosmetic may lead to corneal exposure, persistent epithelial defect and corneal ulceration; epinephrine should be available or other precautions taken as necessary should an anaphylactic reaction occur

Follow-up

Further Inpatient Care

Sympathectomy requires an inpatient stay.

Further Outpatient Care

Many of the treatment options require repeat visits to the dermatologist for continuing care (eg, repeated botulinum injections, refill prescriptions) and for evaluating therapeutic progress.

Complications

Severe cases of hyperhidrosis may adversely affect the patient's quality of life by causing great emotional distress, social embarrassment, and work-related disability (due to palmoplantar hyperhidrosis).
Palmoplantar sweating may result in irritation of the affected skin, ultimately leading to chafing.
Axillary hyperhidrosis may be malodorous, causing social embarrassment.

Prognosis

Hyperhidrosis is difficult to treat effectively.
With the newer treatment modalities now available, the patient has numerous options and is offered a better prognosis.

Patient Education

Patients should be educated regarding all of the treatment options, including their corresponding complications and costs.
For excellent patient education resources, visit eMedicine's Procedures Center. Also, see eMedicine's patient education article BOTOX® Injections.

Miscellaneous

Medicolegal Pitfalls

The failure to search for systemic causes for hyperhidrosis with an onset later in life is a pitfall.
The failure to search for systemic causes of generalized hyperhidrosis is a pitfall.
The failure to recognize underlying conditions is a pitfall that may result in unnecessary patient discomfort and ineffective treatment. Correction of underlying conditions may resolve hyperhidrosis.

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Keywords

hyperhidrosis, excessive sweating, palmoplantar hyperhidrosis, emotionally induced hyperhidrosis, generalized hyperhidrosis, localized hyperhidrosis, palmoplantar sweating, axillary hyperhidrosis, nocturnal hyperhidrosis

Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Rachel Altman, MD, Staff Physician, Department of Dermatology, UMDNJ-New Jersey Medical School
Rachel Altman, MD is a member of the following medical societies: Alpha Omega Alpha and Sigma Xi
Disclosure: Nothing to disclose.

George Kihiczak, MD, Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital
George Kihiczak, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Medical Society of New Jersey
Disclosure: Nothing to disclose.

Medical Editor

Catharine Lisa Kauffman, MD, FACP, Georgetown Dermatology and Georgetown Dermpath
Catharine Lisa Kauffman, MD, FACP is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Royal Society of Medicine, Society for Investigative Dermatology, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Further Reading

eMedicine Specialties > Dermatology > Diseases of the Adnexa

Hyperhidrosis

Introduction

Background

Pathophysiology

Frequency

United States

International

Mortality/Morbidity

Race

Sex

Age

Clinical

History

Physical

Causes

Differential Diagnoses

Other Problems to Be Considered

Workup

Laboratory Studies

Imaging Studies

Histologic Findings

Treatment

Medical Care

Surgical Care

Consultations

Medication

Aldehydes

Glutaraldehyde solution

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy

Precautions

Aluminum compounds

Aluminum chloride (20% Drysol)

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy

Precautions

Anticholinergic agents

Propantheline (Pro-Banthine)

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy

Precautions

Glycopyrrolate (Robinul)

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy

Precautions

Benztropine (Cogentin)

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy

Precautions

Oxybutynin (Ditropan)

Dosing

Adult

Pediatric

Interactions