| Treatment options for hyperhidrosis. | |
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MedLine Citation:
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PMID: 21714579 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Hyperhidrosis is a disorder of excessive sweating beyond what is expected for thermoregulatory needs and environmental conditions. Primary hyperhidrosis has an estimated prevalence of nearly 3% and is associated with significant medical and psychosocial consequences. Most cases of hyperhidrosis involve areas of high eccrine density, particularly the axillae, palms, and soles, and less often the craniofacial area. Multiple therapies are available for the treatment of hyperhidrosis. Options include topical medications (most commonly aluminum chloride), iontophoresis, botulinum toxin injections, systemic medications (including glycopyrrolate and clonidine), and surgery (most commonly endoscopic thoracic sympathectomy [ETS]). The purpose of this article is to comprehensively review the literature on the subject, with a focus on new and emerging treatment options. Updated therapeutic algorithms are proposed for each commonly affected anatomic site, with practical procedural guidelines. For axillary and palmoplantar hyperhidrosis, topical treatment is recommended as first-line treatment. For axillary hyperhidrosis, botulinum toxin injections are recommended as second-line treatment, oral medications as third-line treatment, local surgery as fourth-line treatment, and ETS as fifth-line treatment. For palmar and plantar hyperhidrosis, we consider a trial of oral medications (glycopyrrolate 1-2 mg once or twice daily preferred to clonidine 0.1 mg twice daily) as second-line therapy due to the low cost, convenience, and emerging literature supporting their excellent safety and reasonable efficacy. Iontophoresis is considered third-line therapy for palmoplantar hyperhidrosis; efficacy is high although so are the initial levels of cost and inconvenience. Botulinum toxin injections are considered fourth-line treatment for palmoplantar hyperhidrosis; efficacy is high though the treatment remains expensive, must be repeated every 3-6 months, and is associated with pain and/or anesthesia-related complications. ETS is a fifth-line option for palmar hyperhidrosis but is not recommended for plantar hyperhidrosis due to anatomic risks. For craniofacial hyperhidrosis, oral medications (either glycopyrrolate or clonidine) are considered first-line therapy. Topical medications or botulinum toxin injections may be useful in some cases and ETS is an option for severe craniofacial hyperhidrosis. |
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Authors:
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Hobart W Walling; Brian L Swick |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: American journal of clinical dermatology Volume: 12 ISSN: 1175-0561 ISO Abbreviation: Am J Clin Dermatol Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-08-12 Completed Date: 2011-11-30 Revised Date: 2012-03-06 |
Medline Journal Info:
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Nlm Unique ID: 100895290 Medline TA: Am J Clin Dermatol Country: New Zealand |
Other Details:
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Languages: eng Pagination: 285-95 Citation Subset: IM |
Affiliation:
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hobartwalling@yahoo.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Algorithms Botulinum Toxins / administration & dosage Humans Hyperhidrosis / physiopathology, therapy* Iontophoresis Practice Guidelines as Topic* Sympathectomy / methods* |
| Chemical | |
Reg. No./Substance:
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EC 3.4.24.69/Botulinum Toxins |
| Comments/Corrections | |
Comment In:
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Am J Clin Dermatol. 2012 Apr 1;13(2):139
[PMID:
22248186
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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