Hyperhidrosis is a common complaint, but it rarely signifies underlying pathology.

• Abnormal wetness
• Sweaty palms
• Stained clothing
• Offensive odor
• The amount that people sweat in response to the physiologic stimuli of heat, emotion, or eating varies greatly

Causes

• The cause of primary Hyperhidrosis is unknown, may be caused by sympathetic overactivity
• Anxiety can exacerbate the situation for many sufferers
• They get nervous because they sweat, then sweat more because they are nervous
• Other factors can play a role; certain foods & drinks, nicotine, caffeine, and smells can trigger a response
•  Its the normal physiologic response to everyday stress
•  Menopause is the leading cause of generalized sweats
•  Fever is the most common
•  Central neurologic injury from stroke or tumor may produce Hyperhidrosis. Various drugs, such as antipyretics, insulin, Meperidine, emetics, alcohol, and Pilocarpine, may induce sweating.

Medical therapy

Topical therapy

The most effective topical agent for use on the hands and the axilla is a 20% alcoholic solution of aluminum chloride Hexahydrate (Drysol).

A preparation of 6.25% aluminum tetrachloride (Xerac) is a less potent alternative. Other topical therapies include 10% formalin compresses, which work well but can induce allergic sensitization.

Systemic therapy

Scopolamine and other cholinergic agents decrease sweating but can cause central nervous system side effects and precipitate glaucoma or      urinary obstruction in patients with underlying prostatic hypertrophy.

Surgery

• Axillary Hyperhidrosis may be cured with surgical removal of the glands in the axillae.
• Palmar sweating may respond to sympathectomy, which can be performed endoscopically.
• Botulinum A neurotoxin (Botox) has been used successfully for both axillary and Palmar Hyperhidrosis.

Other recommendations

Reassure the patient that excess sweating is not the consequence of a pathologic condition once medical causes have been ruled out.

For axillary sweating, recommend frequent washing and changes of clothing. For excess sweating of the palms or the axillae, recommend a 20% alcoholic solution of aluminum chloride Hexahydrate (Drysol).

An effective alternative is 6.25% aluminum tetrachloride (Xerac). It should be applied at bedtime and covered with a plastic food wrap; polyethylene or vinyl gloves can be worn if the palms are affected. In the morning, the treated areas should be washed with soap and water.