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International Academy of Cosmetic Dermatology

HYPERHIDROSIS

Primary focal hyperhidrosis is defined as excess sweating in selected areas that is not associated with an underlying disease process. The most common locations are the axillae, palms, soles, and face.  This condition affects otherwise healthy individuals and significantly impairs their activities of daily living.

It is important to distinguish this type of excess sweating from secondary hyperhidrosis, which is related to an underlying medical condition and may present in localized areas or over the entire body.  Symptoms such as fever, night sweats, or weight loss require further investigation to rule out secondary causes.

A standard definition of hyperhidrosis has yet to be established, and most attempts to standardize an abnormal quantity of sweat have failed to consider the parameter of surface area, which means smaller persons (often women) may be under diagnosed.  For evaluation purposes, any sweating that considerably affects patients’ quality of living should be viewed as abnormal.

The prevalence of hyperhidrosis is approximately 2-3% or the population.  It has significant social implications and can have a strong negative impact on quality of life. The etiology of hyperhidrosis is unknown, but it is believed to stem from the over activity of sympathetic innervations to the eccrine sweat glands.

Treatments include:
  • Topicals
  • Iontophoresis
  • Injectable Botulinum toxin A
  • Surgery, rarely
When treatment is offered and is successful, it can have a tremendous impact on the patient’s quality of life.

Nowell Solish, MD, FRCP
Toronto, ONT, Canada