Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Hyperhidrosis Treatment & Management

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
 
Updated: Jun 06, 2016
 

Medical Care

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

Topical agents for hyperhidrosis therapy include topical anticholinergics, boric acid, 2-5% tannic acid solutions, resorcinol, potassium permanganate, formaldehyde (which may cause sensitization[21] ), glutaraldehyde, and methenamine. All of these agents are limited by staining, contact sensitization, irritancy, or limited effectiveness. 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% is sold as Cidex. It is not as effective but less staining. The 20-50% solution can be diluted to 10% (more effective, especially for feet, but still staining occurs).

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.[22]

Axillary hyperhidrosis may be treated with aluminium chloride gel, although the gel may cause mild cutaneous irritation.[23] Its antiperspirant action for treatment of palmar hyperhidrosis and its low risk of systemic adverse effects from absorption and accumulation of aluminium in visceral organs are noteworthy.[24]

Systemic agents used to treat hyperhidrosis include anticholinergic medications. Anticholinergics such as propantheline bromide, glycopyrrolate, oxybutynin,[25] and benztropine are effective because the preglandular neurotransmitter for sweat secretion is acetylcholine (although the sympathetic nervous system innervates the eccrine sweat glands).[26, 27] 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.[28, 29, 30] 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.[31] 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.[31] 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.[32] However, the latter is safe and effective when used on Monday, Wednesday, and Friday for 4 weeks, with continued treatment maintaining the effect.[33] Noncompliance is common with tap water iontophoresis, as it can be time-consuming.[34] This technique merits consideration prior to systemicoraggressive surgical intervention.

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.[35, 36, 37, 38, 39]

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.[40] 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.[41] A substantial increase in the duration of efficacy may be produced by repetitive injections in those with primary palmar hyperhidrosis.[42]

In a similar study, the effects of sodium chloride solution injections in one palm were compared with botulinum toxin injections in the other palm.[43] 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.[44] 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.[45]

Woolery-Lloyd et al reported on successful treatment of inguinal hyperhidrosis with botulinum toxin A. The condition was initially misdiagnosis as urinary incontinence.[46]

Bromhidrosis may be treated with a glycine-soja sterocomplex topical agent, which has shown encouraging results on both the intensity and quality of odor in patients with bromhidrosis.[47]

Next

Surgical Care

In addition to pharmacologic therapy, other treatments include surgical sympathectomy, radiofrequency ablation,[48] surgical excision of the affected areas, and subcutaneous liposuction. Each modality has been used effectively. Use of microneedle radiofrequency therapy for axillary hyperhidrosis has been recommended.[49]

Palmar hyperhidrosis is a benign functional disorder that is a psychological and social handicap.[50] 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.[51] Sympathectomy involves the surgical destruction of the ganglia responsible for hyperhidrosis.[52, 53, 54]  Sympathectomy for hyperhidrosis treatment requires an inpatient stay.

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.[8] 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.[55]

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.[8] In a similar study[56] 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.[57] .

T4 ganglion interruption for palmar hyperhidrosis is an effective approach that can simultaneously minimize the rate of compensatory hyperhidrosis.[58] 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.[59]

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.[60]

Video-assisted thoracic sympathectomy may be preferable to no treatment for children with palmar hyperhidrosis and a poor quality of life.[61]

Topical glycopyrrolate application may be effective and safe for the treatment of excessive facial sweating in primary craniofacial and secondary gustatory hyperhidrosis following sympathectomy.[62]

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.[63]  Radiofrequency thermotherapy has also been recommended.[64]

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.[65]

Previous
Next

Consultations

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

Previous
Next

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). It may also be linked with depressive symptoms.[66]

Palmoplantar sweating may result in irritation of the affected skin, ultimately leading to chafing.

Axillary hyperhidrosis may be malodorous, causing social embarrassment.

Previous
Next

Long-Term Monitoring

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

Previous
 
 
Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, 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, 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, Medical Society of New Jersey

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

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, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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, Royal Society of Medicine, Women's Dermatologic Society, American Medical Association, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

References
  1. Altman RS, Schwartz RA. Emotionally induced hyperhidrosis. Cutis. 2002 May. 69(5):336-8. [Medline].

  2. Ruchinskas R. Hyperhidrosis and anxiety: chicken or egg?. Dermatology. 2007. 214(3):195-6. [Medline].

  3. Esen AM, Barutcu I, Karaca S, et al. Peripheral vascular endothelial function in essential hyperhidrosis. Circ J. 2005 Jun. 69(6):707-10. [Medline].

  4. Yamashita N, Tamada Y, Kawada M, Mizutani K, Watanabe D, Matsumoto Y. Analysis of family history of palmoplantar hyperhidrosis in Japan. J Dermatol. 2009 Dec. 36(12):628-31. [Medline].

  5. Adar R, Kurchin A, Zweig A, Mozes M. Palmar hyperhidrosis and its surgical treatment: a report of 100 cases. Ann Surg. 1977 Jul. 186(1):34-41. [Medline].

  6. Cloward RB. Hyperhydrosis. J Neurosurg. 1969 May. 30(5):545-51. [Medline].

  7. Cloward RB. Treatment of hyperhidrosis palmaris (sweaty hands); a familial disease in Japanese. Hawaii Med J. 1957 Mar-Apr. 16(4):381-7. [Medline].

  8. Drott C, Gothberg G, Claes G. Endoscopic transthoracic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis. J Am Acad Dermatol. 1995 Jul. 33(1):78-81. [Medline].

  9. Saglam M, Esen AM, Barutcu I, et al. Impaired left ventricular filling in patients with essential hyperhidrosis: an echo-Doppler study. Tohoku J Exp Med. 2006 Apr. 208(4):283-90. [Medline].

  10. Tugnoli V, Eleopra R, De Grandis D. Hyperhidrosis and sympathetic skin response in chronic alcoholic patients. Clin Auton Res. 1999 Feb. 9(1):17-22. [Medline].

  11. Moon SY, Shin DI, Park SH, Kim JS. Harlequin syndrome with crossed sympathetic deficit of the face and arm. J Korean Med Sci. 2005 Apr. 20(2):329-30. [Medline]. [Full Text].

  12. Karaca S, Emul M, Kulac M, et al. Temperament and character profile in patients with essential hyperhidrosis. Dermatology. 2007. 214(3):240-5. [Medline].

  13. Walling HW. Clinical differentiation of primary from secondary hyperhidrosis. J Am Acad Dermatol. 2011 Feb 17. [Medline].

  14. Rodrigues Masruha M, Lin J, Arita JH, DE Castro Neto EF, Scerni DA, Cavalheiro EA, et al. Spontaneous periodic hypothermia and hyperhidrosis: a possibly novel cerebral neurotransmitter disorder. Dev Med Child Neurol. 2010 Dec 17. [Medline].

  15. Mehta S, Ralot T, Masatkar V, Agarwal N, Rana A. A curious case of hourly attacks of disabling episodic spontaneous hypothermia with hyperhidrosis. Indian J Dermatol Venereol Leprol. 2015 Mar-Apr. 81(2):185-6. [Medline].

  16. Martín AF, Figueroa SC, Merino Mde L, Hurlee AD. Hyperhidrosis in association with efavirenz. AIDS Patient Care STDS. 2009 Mar. 23(3):143-5. [Medline].

  17. Kocyigit P, Akay BN, Saral S, Akbostanci C, Bostanci S. Unilateral hyperhidrosis with accompanying contralateral anhidrosis. Clin Exp Dermatol. 2009 Dec. 34(8):e544-6. [Medline].

  18. Lera M, España A, Idoate MÁ. Focal hyperhidrosis secondary to eccrine naevus successfully treated with botulinum toxin type A. Clin Exp Dermatol. 2015 Mar 28. [Medline].

  19. López V, Pinazo I, Santonja N, Jordá E. Eccrine angiomatous hamartoma in a child. Pediatr Dermatol. 2010 Sep-Oct. 27(5):548-9. [Medline].

  20. Sanusi T, Li Y, Sun L, Wang C, Zhou Y, Huang C. Eccrine Angiomatous Hamartoma: A Clinicopathological Study of 26 Cases. Dermatology. 2015 Apr 14. [Medline].

  21. Shelley WB, Laskas JJ, Satanove A. Effect of topical agents on planter sweating. AMA Arch Derm Syphilol. 1954 Jun. 69(6):713-6. [Medline].

  22. Sato K, Kang WH, Saga K, Sato KT. Biology of sweat glands and their disorders. II. Disorders of sweat gland function. J Am Acad Dermatol. 1989 May. 20(5 Pt 1):713-26. [Medline].

  23. Streker M, Reuther T, Verst S, Kerscher M. [Axillary hyperhidrosis--efficacy and tolerability of an aluminium chloride antiperspirant. Prospective evaluation on 20 patients with idiopathic axillary hyperhidrosis]. Hautarzt. 2010 Feb. 61(2):139-44. [Medline].

  24. Yanagishita T, Tamada Y, Ohshima Y, Ito K, Akita Y, Watanabe D. Histological localization of aluminum in topical aluminum chloride treatment for palmar hyperhidrosis. J Dermatol Sci. 2012 Mar 3. [Medline].

  25. Del Boz J, Millán-Cayetano JF, Blázquez-Sánchez N, de Troya M. Individualized Dosing of Oral Oxybutynin for the Treatment of Primary Focal Hyperhidrosis in Children and Teenagers. Pediatr Dermatol. 2016 May. 33 (3):327-31. [Medline].

  26. Klaber M, Catterall M. Treating hyperhidrosis. Anticholinergic drugs were not mentioned. BMJ. 2000 Sep 16. 321(7262):703. [Medline].

  27. Wozniacki L, Zubilewicz T. Primary hyperhidrosis controlled with oxybutynin after unsuccessful surgical treatment. Clin Exp Dermatol. 2009 Dec. 34(8):e990-1. [Medline].

  28. Bouman HD, Lentzer EM. The treatment of hyperhidrosis of hands and feet with constant current. Am J Phys Med. 1952 Jun. 31(3):158-69. [Medline].

  29. Karakoç Y, Aydemir EH, Kalkan MT, Unal G. Safe control of palmoplantar hyperhidrosis with direct electrical current. Int J Dermatol. 2002 Sep. 41(9):602-5. [Medline].

  30. Murphy R, Harrington CI. Treating hyperhidrosis. Iontophoresis should be tried before other treatments. BMJ. 2000 Sep 16. 321(7262):702-3. [Medline].

  31. Sato K, Ohtsuyama M, Samman G. Eccrine sweat gland disorders. J Am Acad Dermatol. 1991 Jun. 24(6 Pt 1):1010-4. [Medline].

  32. Abell E, Morgan K. The treatment of idiopathic hyperhidrosis by glycopyrronium bromide and tap water iontophoresis. Br J Dermatol. 1974 Jul. 91(1):87-91. [Medline].

  33. Siah TW, Hampton PJ. The effectiveness of tap water iontophoresis for palmoplantar hyperhidrosis using a Monday, Wednesday, and Friday treatment regime. Dermatol Online J. 2013 Mar 15. 19(3):14. [Medline].

  34. Ozcan D, Güleç AT. Compliance with tap water iontophoresis in patients with palmoplantar hyperhidrosis. J Cutan Med Surg. 2014 Mar 1. 18(2):109-13. [Medline].

  35. Fujita M, Mann T, Mann O, Berg D. Surgical pearl: use of nerve blocks for botulinum toxin treatment of palmar-plantar hyperhidrosis. J Am Acad Dermatol. 2001 Oct. 45(4):587-9. [Medline].

  36. Moraru E, Voller B, Auff E, Schnider P. Dose thresholds and local anhidrotic effect of botulinum A toxin injections (Dysport). Br J Dermatol. 2001 Aug. 145(2):368. [Medline].

  37. Naumann M. Evidence-based medicine: botulinum toxin in focal hyperhidrosis. J Neurol. 2001 Apr. 248 Suppl 1:31-3. [Medline].

  38. Naumann M, Lowe NJ. Botulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: randomised, parallel group, double blind, placebo controlled trial. BMJ. 2001 Sep 15. 323(7313):596-9. [Medline]. [Full Text].

  39. Kang A, Burns E, Glaser DA. Botulinum toxin A for palmar hyperhidrosis: associated pain, duration, and reasons for discontinuation of therapy. Dermatol Surg. 2015 Feb. 41(2):297-8. [Medline].

  40. Shelley WB, Talanin NY, Shelley ED. Botulinum toxin therapy for palmar hyperhidrosis. J Am Acad Dermatol. 1998 Feb. 38(2 Pt 1):227-9. [Medline].

  41. Swartling C, Farnstrand C, Abt G, Stalberg E, Naver H. Side-effects of intradermal injections of botulinum A toxin in the treatment of palmar hyperhidrosis: a neurophysiological study. Eur J Neurol. 2001 Sep. 8(5):451-6. [Medline].

  42. Lecouflet M, Leux C, Fenot M, Célerier P, Maillard H. Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis: A study of 28 patients. J Am Acad Dermatol. 2014 Mar 12. [Medline].

  43. Schnider P, Binder M, Auff E, Kittler H, Berger T, Wolff K. Double-blind trial of botulinum A toxin for the treatment of focal hyperhidrosis of the palms. Br J Dermatol. 1997 Apr. 136(4):548-52. [Medline].

  44. Vadoud-Seyedi J, Simonart T. Treatment of axillary hyperhidrosis with botulinum toxin type A reconstituted in lidocaine or in normal saline: a randomized, side-by-side, double-blind study. Br J Dermatol. 2007 May. 156(5):986-9. [Medline].

  45. Flanagan KH, King R, Glaser DA. Botulinum toxin type a versus topical 20% aluminum chloride for the treatment of moderate to severe primary focal axillary hyperhidrosis. J Drugs Dermatol. 2008 Mar. 7(3):221-7. [Medline].

  46. Woolery-Lloyd H, Elsaie ML, Avashia N. Inguinal hyperhidrosis misdiagnosed as urinary incontinence: treatment with botulinum toxin A. J Drugs Dermatol. 2008 Mar. 7(3):293-5. [Medline].

  47. Gregoriou S, Rigopoulos D, Chiolou Z, Papafragkaki D, Makris M, Kontochristopoulos G. Treatment of bromhidrosis with a glycine-soja sterocomplex topical product. J Cosmet Dermatol. 2011 Mar. 10(1):74-7. [Medline].

  48. Purtuloglu T, Atim A, Deniz S, Kavakli K, Sapmaz E, Gurkok S, et al. Effect of radiofrequency ablation and comparison with surgical sympathectomy in palmar hyperhidrosis. Eur J Cardiothorac Surg. 2013 Feb 21. [Medline].

  49. Naeini FF, Saffaei A, Pourazizi M, Abtahi-Naeini B. Histopathological evidence of efficacy of microneedle radiofrequency for treatment of axillary hyperhidrosis. Indian J Dermatol Venereol Leprol. 2015 Apr 8. [Medline].

  50. Kumagai K, Kawase H, Kawanishi M. Health-related quality of life after thoracoscopic sympathectomy for palmar hyperhidrosis. Ann Thorac Surg. 2005 Aug. 80(2):461-6. [Medline].

  51. Kotzareff A. Resection partielle de trone sympathetique cervical droit pour hyperhidrose unilaterale. Rev Med Suisse Romande. 1920. 40:111-3.

  52. Chen HJ, Lu K, Liang CL. Transthoracic endoscopic T-2, 3 sympathectomy for facial hyperhidrosis. Auton Neurosci. 2001 Oct 8. 93(1-2):91-4. [Medline].

  53. Hsu CP, Shia SE, Hsia JY, Chuang CY, Chen CY. Experiences in thoracoscopic sympathectomy for axillary hyperhidrosis and osmidrosis: focusing on the extent of sympathectomy. Arch Surg. 2001 Oct. 136(10):1115-7. [Medline].

  54. Kim BY, Oh BS, Park YK, Jang WC, Suh HJ, Im YH. Microinvasive video-assisted thoracoscopic sympathicotomy for primary palmar hyperhidrosis. Am J Surg. 2001 Jun. 181(6):540-2. [Medline].

  55. Panhofer P, Zacherl J, Jakesz R, Bischof G, Neumayer C. Improved quality of life after sympathetic block for upper limb hyperhidrosis. Br J Surg. 2006 May. 93(5):582-6. [Medline].

  56. Lai YT, Yang LH, Chio CC, Chen HH. Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. Neurosurgery. 1997 Jul. 41(1):110-3; discussion 113-5. [Medline].

  57. Chwajol M, Barrenechea IJ, Chakraborty S, Lesser JB, Connery CP, Perin NI. Impact of compensatory hyperhidrosis on patient satisfaction after endoscopic thoracic sympathectomy. Neurosurgery. 2009 Mar. 64(3):511-8; discussion 518. [Medline].

  58. Chou SH, Kao EL, Li HP, Lin CC, Huang MF. T4 sympathectomy for palmar hyperhidrosis: an effective approach that simultaneously minimzes compensatory hyperhidrosis. Kaohsiung J Med Sci. 2005 Jul. 21(7):310-3. [Medline].

  59. Heckmann M. Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. Neurosurgery. 1998 Jun. 42(6):1403-4. [Medline].

  60. Li X, Tu YR, Lin M, Lai FC, Chen JF, Miao HW. Minimizing endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: guided by palmar skin temperature and laser Doppler blood flow. Ann Thorac Surg. 2009 Feb. 87(2):427-31. [Medline].

  61. Neves S, Uchoa PC, Wolosker N, Munia MA, Kauffman P, de Campos JR, et al. Long-Term Comparison of Video-Assisted Thoracic Sympathectomy and Clinical Observation for the Treatment of Palmar Hyperhidrosis in Children Younger Than 14. Pediatr Dermatol. 2012 Apr 4. [Medline].

  62. Kim WO, Kil HK, Yoon KB, Yoon DM. Topical glycopyrrolate for patients with facial hyperhidrosis. Br J Dermatol. 2008 May. 158(5):1094-7. [Medline].

  63. Goldman A, Wollina U. Subdermal Nd-YAG laser for axillary hyperhidrosis. Dermatol Surg. 2008 Jun. 34(6):756-62. [Medline].

  64. Schick CH, Grallath T, Schick KS, Hashmonai M. Radiofrequency Thermotherapy for Treating Axillary Hyperhidrosis. Dermatol Surg. 2016 May. 42 (5):624-30. [Medline].

  65. Lillis PJ, Coleman WP 3rd. Liposuction for treatment of axillary hyperhidrosis. Dermatol Clin. 1990 Jul. 8(3):479-82. [Medline].

  66. Gross KM, Schote AB, Schneider KK, Schulz A, Meyer J. Elevated social stress levels and depressive symptoms in primary hyperhidrosis. PLoS One. 2014. 9(3):e92412. [Medline]. [Full Text].

  67. Na GY, Park BC, Lee WJ, Park DJ, Kim do W, Kim MN. Control of palmar hyperhidrosis with a new "dry-type" iontophoretic device. Dermatol Surg. 2007 Jan. 33(1):57-61. [Medline].

  68. Choi YH, Lee SJ, Kim do W, Lee WJ, Na GY. Open clinical trial for evaluation of efficacy and safety of a portable "dry-type" iontophoretic device in treatment of palmar hyperhidrosis. Dermatol Surg. 2013 Apr. 39(4):578-83. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.