Hyperhidrosis

Excerpt

Hyperhidrosis is a disorder of excessive sweating due to the overstimulation of cholinergic receptors on eccrine glands. This disorder is characterized by sweating beyond what the body uses for homeostatic temperature regulation. Eccrine glands are concentrated in areas such as the axillae, palms, soles, and face, most commonly associated with hyperhidrosis. The acetylcholine negative feedback loop is likely impaired in these patients, which may help explain how a physiologic response can become pathologic. Studies have shown that the prevalence of this disorder is approximately 3% in the United States. Hyperhidrosis can result in emotional, psychological, social, and occupational impairment.

Hyperhidrosis is classified as primary and secondary, and the management and treatment can significantly differ. The primary disease typically presents earlier in life with more localized symptoms. The secondary disease typically presents due to adverse effects of medications or systemic disorders, particularly neurologic. The diagnosis is often made clinically, and grading scales and tests are available to determine the severity and localization. Laboratory workup may be indicated if a secondary cause is suspected to rule out infection, hyperthyroidism, diabetes mellitus, neurologic disorder, or a medication side-effect. Several treatment options for hyperhidrosis include topical aluminum chloride and oral anticholinergic medications, which are sufficient in patients with mild to moderate disease. Botulinum toxin A injections, sympathectomy, and local excision are also effective but reserved for patients resistant to conservative therapy.