eISSN: 2299-0046
ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
Current issue Archive Manuscripts accepted About the journal Editorial board Reviewers Abstracting and indexing Subscription Contact Instructions for authors Publication charge Ethical standards and procedures
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
2/2022
vol. 39
 
Share:
Share:
Review paper

Hyperhidrosis: disease aetiology, classification and management in the light of modern treatment modalities

Anna Kisielnicka
1
,
Aneta Szczerkowska-Dobosz
1
,
Dorota Purzycka-Bohdan
1
,
Roman J. Nowicki
1

1.
Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
Adv Dermatol Allergol 2022; XXXIX (2): 251-257
Online publish date: 2022/05/09
Article file
- Hyperhidrosis.pdf  [0.14 MB]
Get citation
 
 

Introduction

The aetiology of excessive perspiration can be either primary or secondary to the systemic diseases. Considering many differences in its clinical manifestations and management, it becomes necessary for clinicians to determine the origin of hyperhidrosis in order to incorporate individually tailored treatment options, and thus, achieve a therapeutic success [1].

Moreover, the symptoms of sweat overproduction contribute to the major deterioration of patients’ quality of life. They strongly affect manifold areas of life, such as psychological, social and even economic areas, leading to the disruption of daily life activities. They constitute a heavy burden for patients leading to self-isolation and loss of self-consciousness. Furthermore, they can be aggravated by stress and emotions which creates a vicious circle. Recently, researchers have observed an association between hyperhidrosis and the overall greater risk of psychiatric diseases, including depression [2, 3].

Hyperhidrosis has also a direct effect on skin condition by interfering with its natural protective mechanisms. This results in a greater prevalence of dermatoses among affected patients, especially of fungal, bacterial and less often viral origin [4]. Therefore, excessive perspiration constitutes a complex problem that requires a diligent professional care supported by the novel hyperhidrosis treatment modalities.

Hyperhidrosis epidemiology

Disproportionate perspiration is sometimes the cause of patients’ significant emotional distress and reluctance to inform physicians about their symptoms. For this reason, researchers emphasize the fact that the prevalence of hyperhidrosis is highly underreported. Nevertheless, the epidemiological studies conducted among large population in the United States of America and Canada estimated the global prevalence of primary hyperhidrosis equally at about 2.0–3.0% for men and women [5, 6]. Stefaniak et al. performed a research among Polish medical and dentistry students and discovered that the occurrence of hyperhidrosis reached up to 8.0% of the study group [7]. Such data discrepancies might result from the characteristic study group profile, because primary excessive sweat production is the most common in the population of patients aged 20–25 years. A typical onset of symptoms is usually observed in individuals aged 14–25 years and their intensity mostly reduces with time. Every hyperhidrosis manifestation in older patients, i.e. above 60 years old, should urge physicians to seek for secondary causes of the disease. Additionally, a correlation between the location of sweat overproduction and patients’ age was observed. Adolescents and young adults demonstrated the hyperhidrosis symptoms more often on palms, whereas adults around axillary areas [1, 8].

Regulatory mechanisms of the sweat production

Human organism consists of about 2–4 million sweat glands, which play a key role in dermal and thermoregulatory homeostasis of the body. Approximately 80% of them is represented by eccrine sweat glands, which are evenly distributed all over the body, except for local concentrations on palms and soles. They are the main source of water evaporation out of the body system and provide optimal body temperature due to the production of odourless, transparent secretion of watery consistency. The remaining part consists of the apocrine sweat glands, which are responsible for thick excretion of an unpleasant odour. They are distributed focally predominantly around axillae, groins and external genital organs. Additionally, some researchers distinguish the apocrine sweat glands in the axillae region, which combine both patterns of sweat secretion [9].

The innervation of the sweat glands comes from the sympathetic nervous system, which is controlled by the central nervous system. Perspiration results from the activation of the supraoptic nucleus, localized in the anterior region of the hypothalamus and is triggered by certain stimuli (mainly emotional and thermal ones and physical exercise). It is hypothesized that the overproduction of sweat might result from the dysfunction of the autonomic system nerve fibres. What is more, this concept is supported by the histopathological findings of the overactive sweat glands, which demonstrate abnormalities neither in their structure, nor in their amount around the affected body area [9, 10].

Hyperhidrosis – classification and clinical manifestations

Hyperhidrosis can be classified as either primary or secondary to the systemic causes. Clinical manifestations of both types vary in terms of patients’ age, family disease history, symptoms’ onset, localization and triggering factors [1].

Primary hyperhidrosis

The aetiology of primary hyperhidrosis is idiopathic, with the highest incidence among young patients without any comorbidities. Furthermore, in about 30–50% of cases, a positive family history of the disease can be observed, which suggests a potential genetic background of the hyperhidrosis. Excessive perspiration usually manifests as a solitary focus or multiple symmetrically localized foci. The most frequently affected areas of the body are axillae (about 50%), soles (about 30%), palms (about 25%), and face (about 20%) [1, 11]. The symptoms that patients commonly complain about are sweaty stains on clothing, shoes or touched objects (for example paper sheets), visible sweat drops on the forehead, wet handshakes or sensation of body odour. The primary type of sweat overproduction occurs episodically and can be triggered by emotions and stress. In addition, the symptoms emerge during daytime and disappear over sleep [5, 11].

Apart from that, clinicians distinguish also other rare variants of primary hyperhidrosis. Hexsel’s hyperhidrosis is characterized by excessive perspiration in the groin region, which can expand to anterior thigh surface, pubis, external genital organs and gluteal fissure. There are very few case reports describing localized unilateral hyperhidrosis, however, the genesis of the disease is still unknown [12, 13]. The Ross syndrome is a rare peripheral autonomic nerve fibre damage or degeneration of unknown mechanism, characterized by the triad of symptoms: uni- or bilateral segmental anhidrosis, Adie’s tonic pupils and the absence of deep tendon reflexes. The subsequent localised compensatory hyperhidrosis constitutes the patients’ major concern, although, other dysautonomia manifestations might appear (such as orthostatic hypotension, arrhythmia, dyspnoea, headache, gastroesophageal reflux and psychiatric disorders) [14, 15].

Secondary hyperhidrosis

On the other hand, secondary hyperhidrosis usually affects older patients and may result from fever, physiological processes like pregnancy or menopause as well as comorbid systemic diseases, drug adverse reactions or complications of medical procedures (for example after thoracic sympathectomy). In contrast to the primary type of the disease, secondary hyperhidrosis most often manifests itself as a generalized overproduction of sweat. The symptoms can also appear as asymmetrically localized foci. Moreover, the disease is not associated with any familial inheritance and may characteristically manifest itself during sleep as the night sweats [1].

Various systemic disorders can impair the thermoregulatory homeostasis of the body. Therefore, the exclusion of potential secondary causes of hyperhidrosis is an essential step in its diagnostic process. The most common triggering factors involve: proliferative diseases, endocrinopathies, cardiac, infectious, nervous system diseases, metabolic and psychiatric disorders [11, 16]. Excessive perspiration can also develop from adverse reactions after intake of a wide range of ubiquitous drugs like opioid analgesics and cyclooxygenase inhibitors, antibiotics and antivirals, cardiac and hypotensive medicaments, antidepressants and mood stabilizers, anticholinergic agents, antipyretics, hypoglycaemic agents or topically used formulas (for example glucocorticosteroids, isotretinoin) [17] (Table 1).

Table 1

The most common triggering factors of the secondary hyperhidrosis [11, 16, 17]

Physiological causes
Menopause
Pregnancy
Fever
Diseases
Proliferative diseasesMyelodysplastic disorder
Hodgkin’s lymphoma
EndocrinopathiesHyperthyroidism
Pheochromocytoma
Diabetes and hypoglycaemia
Carcinoid syndrome
Hypopituitarism and pituitary tumours
Acromegaly
Cardiac diseasesHeart failure
Endocarditis
Infectious diseasesInfluenza
HIV infection
Tuberculosis
Encephalitis
Nervous system diseasesPituitary stroke
Post-traumatic spinal cord injuries
Parkinson’s disease
Familial dysautonomia
Polyneuropathies
Metabolic disordersObesity
Psychiatric disordersAlcoholism
Generalized panic disorder
Social phobia
Drug adverse reactions
Opioid analgesicsMorphine, oxycodone, fentanyl, tramadol
Cyclooxygenase inhibitorsNaproxen, nabumetone
Antibiotics and antiviralsCeftriaxone, ciprofloxacin, acyclovir
Cardiac and hypotensive medicamentsAmlodipine, nifedipine, verapamil, carvedilol, metoprolol, enalapril, lisinopril, losartan, hydralazine, propafenone
Antidepressants and mood stabilizersTricyclic antidepressants, neuroleptics
Hypoglycaemic agentsInsulin, glipizide
Topically used formulasGlucocorticosteroids, isotretinoin

Secondary hyperhidrosis may also rarely manifest itself as a localized excessive perspiration, especially in the face area. It can be induced by intake of spicy meals, impairment of the sympathetic nervous system associated with pathology of the parotid gland (known as the Frey syndrome) or as a compensatory reaction after endoscopic thoracic sympathectomy [1]. Auriculotemporal syndrome (also recognized as the Frey syndrome) is a relatively common postoperative injury of the nerve fibres after the parotidectomy procedure, although, rare cases following neck dissection, face lifting or mechanical trauma were reported. Due to aberrant parasympathetic sweat gland reinnervation, mastication or salivary stimuli trigger facial gustatory excessive perspiration with concomitant local flushing, burning, itching of the skin and neuralgia [18].

Hyperhidrosis diagnosis

Medical history and clinical presentation of the disease constitute a fundamental element of the hyperhidrosis diagnosis. The severity of the disease can be evaluated using a 4-score questionnaire Hyperhidrosis Disease Severity Scale (HDSS) based on patients’ subjective perception of the daily routine disruption with the 4th level indicating the most exacerbated form of the sweat overproduction. Moreover, it is a valuable tool in clinicians’ daily practice which helps to assess the efficacy of the therapy by monitoring its score reduction, which results in symptom alleviation by about 50% (1-point), and by nearly 80% (2-points) [19].

In case of concerns about the relevance of the diagnosis, clinicians can use the gravimetric method as an objective quantitative measurement of perspiration. It is an easy and quick technique, which involves wiping the area of excessive sweat production with a gauze, and thereafter, determining the difference in its weight. Furthermore, it is possible to verify the location of the overactive sweat glands by performing a starch-iodine test (also known as the Minor’s test). Due to the chemical reaction between the iodine, starch and sweat, the excessive perspiration area colour turns purple, which enables its visualisation and implementation of targeted treatment methods. Other noteworthy methods for objective hyperhidrosis assessment involve dynamic sudorometry, thermoregulatory sweat test and skin conductance [17, 20, 21].

In order to distinguish between the primary and secondary type of hyperhidrosis the following factors should be taken into evaluation: symptom location and foci symmetry, frequency, duration, severity, occurrence at night, the onset of the disease, family history, the influence on daily life activities and other aspects pointing towards the presence of underlying systemic diseases. Furthermore, exclusion of the secondary causes of the excessive perspiration by performing laboratory tests is an obligatory step in every hyperhidrosis’ diagnostic process. The prerequisite for primary hyperhidrosis diagnosis is the focal overproduction of sweat without any perceptible cause lasting for at least 6 months and co-occurrence of at least 4 following additional criteria: bilateral symmetrical excessive perspiration, minimal frequency of symptoms occurence of at least once per week, their occurrence limited to daytime, disruption of daily life activities, age onset before 25 years or positive family history [8, 11, 22].

Hyperhidrosis current and emerging topical treatment methods

Due to the heavy social and economic burden of the disproportionate perspiration, current treatment methods still seem to be insufficient to meet patients’ expectations. Therefore, the researchers continue a robust pursuit of novel therapy modalities combining the most desirable features i.e. complete symptoms’ alleviation, elimination of the adverse reactions, convenient application and long-term effect duration. Topical treatment methods constitute the first-line therapy, followed by a wide range of alternative modalities such as oral agents, minimally invasive medical approach and surgical techniques (Table 2). Nevertheless, lifestyle changes are necessary and involve the avoidance of: factors provoking sweat overproduction, spicy meals or alcohol consumption and occlusive clothing or footwear [23].

Table 2

Modern treatment modalities of primary hyperhidrosis [2362]

PharmacologicalMedical proceduresSurgical
Aluminium chloride antiperspirants
Glycopyrrolate
Sofpironium bromide*
Oxybutynin
Oxybutynin and pilocarpine combination*
Botulinum toxin
Iontophoresis
Microwave thermolysis radiofrequency therapy
Ultrasound technology
Laser treatment
Local skin excision
Liposuction-curettage
Sympathectomy

* Emerging therapies.

Antiperspirants containing variable concentrations (from 5.0% to 25.0%) of the aluminium salts are a baseline treatment option of the mild and moderate sweat overproduction. Gels and powders which are rich in metal salts precipitate and temporarily obstruct the eccrine glands orifices until the stratum corneum exfoliates. The therapy involves a regular antiperspirant application on the cleaned and dried skin for the time period not shorter than 6 to 8 h, therefore nightly use is usually recommended. The amelioration of the disproportionate perspiration is usually observed after 1–2 weeks. Many trials and clinical experience endorsed the following method for the hyperhidrosis treatment in the axillary, palmar, plantar and craniofacial regions [23, 24]. Data from the research evaluating the overall aluminium salts efficacy in 691 patients indicated the effective disease control among about 80% of the study group. However, the therapy results may vary across the affected regions indicating the highest symptom reduction rate in the axillae and the lowest on palms [25, 26]. Skin irritation is the most common drug adverse reaction, which can be avoided by less frequent drug application or by the topical administration of the hydrocortisone ointments and emollients. Furthermore, recent concerns about the influence of the persistent aluminium exposure from the antiperspirants on the greater prevalence of the breast cancer and the Alzheimer’s disease have not been confirmed in the latest reports. Therefore, aluminium chloride antiperspirants remain a cost-effective and safe topical treatment method of the focal hyperhidrosis [23, 27].

Glycopyrrolate is an anticholinergic agent, currently available as a 0.5–4% concentrated topical formulation recommended for the craniofacial and gustatory sweating treatment. The substance transdermal mechanism of action enables skin penetration and competitive inhibition of the muscarinic acetylcholine receptors responsible for the sweat glands overactivity. Simultaneously, the abundance and diffusion of the active drug is insufficient for the induction of the systemic response, which significantly reduces the possible adverse reactions. Further safety analysis showed no phototoxic, genotoxic or carcinogenic effect of the topical glycopyrrolate, and therefore, proved its suitability for chronic usage [26, 28].

In 2018, the United States Food and Drug Administration (FDA) approved an innovative treatment option of the primary axillary hyperhidrosis in the form of a cloth pre-moistened with the 2.4% concentration of glycopyrronium bromide. The method is dedicated to patients above 9 years old and provides a convenient drug application. Two randomized, double-blind, vehicle-controlled phase III trials ATMOS-1 and ATMOS-2 demonstrated high efficacy and safety profile of the therapy, followed by an acceptable level of the adverse effects and the consequent sporadic treatment discontinuation. In the supplementary studies, the researchers observed the prevalence of mild to moderate cholinergic-derived side effects among 2–25% patients, of which the most commonly reported were xerostomia, blurred vision, mydriasis, urinary hesitation, nasal dryness and xerophthalmia [29, 30].

The promising results of the latest phase II randomized, controlled, double-blind clinical trial might result in an introduction of a new anticholinergic gel formula – sofpironium bromide, a derivate of the glycopyrrolate – for the primary axillary hyperhidrosis treatment. The researchers performed an evaluation of the 5%, 10% and 15% active drug concentrations, which provided a clinically valuable response and a statically significant reduction of the excessive perspiration. Moreover, due to the developed retrometabolic drug design, the adverse effects were limited to those of a mild and moderate severity. Hence, topical sofpironium bromide modalities might be an efficacious hyperhidrosis treatment option in the foreseeable future [28, 31].

Oxybutynin in the transdermal formula proved to be a successful therapy of the overactive bladder in adults due to its anticholinergic effect. Two small pilot studies investigated the use of 3% and 10% oxybutynin gel for the focal hyperhidrosis management. Both demonstrated meaningful symptom reduction and patients’ life quality enhancement. Although considerable systemic side effects were infrequent or absent, a consecutive investigation upon the safety, efficacy and drug dosage of the method is necessary [32, 33].

Finally, a pioneering pharmaceutical enrichment of the botulin toxin A skin absorption in a liposomal cream demonstrated satisfactory results of a possible clinical application for the non-invasive excessive axillary perspiration therapy [34].

Hyperhidrosis systemic treatment methods

According to the experts’ recommendations, oral therapies should be reserved for the patients non-responding to the topical treatment or multifocal hyperhidrosis. Systemic anticholinergic agents comprise the most common choice in the clinical practice regardless of the risk of their constitutional adverse reactions, which forces approximately 1/3 of the patients to cease the therapy. Additionally, there are some data available for the use of propranolol and clonidine in the anxiety-triggered sweat overproduction [23, 35].

Glycopyrrolate is a widely prescribed oral medicament with a fixed starting-point dosage of 1–2 mg daily. The inability of the glycopyrrolate to penetrate the hematoencephalic barrier is a favourable feature that limits the severity of the central nervous system-derived adverse reactions, and hence, allows for the possible dose augmentation to accomplish a satisfactory therapeutic effect [36, 37]. The alternative treatment involves 2.5 to 5 mg dose of oxybutynin that can be gradually increased up to 15 mg per day if the treatment is well tolerated. Reports of the oxybutynin efficacy found a 70% excessive perspiration reduction among subjects with palmar and axillary hyperhidrosis [38]. Nevertheless, the major side effects are the systemic adverse reactions which commonly involve xerostomia, xerophthalmia and blurred vision, constipation, hyperthermia, orthostatic hypotension, tachycardia, urinary retention, headache and dizziness [39]. Due to the anticholinergic mechanism of action, the following treatment is contraindicated in patients with myasthenia gravis, pyloric stenosis, paralytic ileus, closed-angle glaucoma or bladder outlet obstruction and other diseases requiring the use of the anti-Parkinson’s remedies, phenothiazines and tricyclic antidepressants [23].

Interestingly, the latest development of an innovative compound containing a set dose of oxybutynin and pilocarpine (7.5 mg/7.5 mg) might redefine the role of the systemic anticholinergic agents in the clinical practice. In comparison to oxybutynin, its equivalent therapeutic effect was associated with a lower prevalence of xerostomia among the patients with axillary and palmar hyperhidrosis [40].

The use of medical devices and minimally invasive methods in the hyperhidrosis therapy

Iontophoresis is a widespread first-line treatment of the plantar and palmar disproportionate sweating. The regionally limited application arises from the requirement of the intact skin submersion in liquid, which enables the transduction of a galvanic current. Multiple mechanisms of action are proposed to be accountable for the perspiration inhibition, mainly the formation of the hyperkeratotic plug, change in the sweat electrochemical gradient, disruption of the autonomic nerves’ transmission or the sweat pH value alterations [41, 42]. The therapy offers high anhidrotic efficacy and verified safety profile when applied for 3–4 weeks for 20–30 min at a current of 15–20 mA and the reported symptoms alleviation was perceivable after 6–15 treatment sessions. However, chronic use is required for the therapeutic effect maintenance which may trigger erythema and can be the source of patients’ frustration [43, 44]. Recent method development allows for the enhancement of the therapeutic effect by combining iontophoresis with the simultaneous application of aluminium chloride, anticholinergic agents and botulinum toxin [4547]. Nonetheless, the modality in contraindicated in pregnancy, epilepsy or in patients with implanted medical devices and pacemakers [23].

The expanding implementation of medical devices in the axillary hyperhidrosis treatment results in various modalities like microwave thermolysis, radiofrequency therapy, ultrasounds and laser treatment. Their fundamental therapeutic effect is based on the mechanical destruction of the eccrine sweat glands and confirmed by the follow-up histopathological analyses. Yet, the use of medical devices is not free from adverse effects, and importantly, entails significant expenses [44].

Furthermore, dermal-subcutaneous injections of the botulinum toxin (BTX) A and B formulations are a noteworthy treatment approach registered for the primary axillary hyperhidrosis. However, numerous clinical studies provided evidence for its therapeutic value in the off-label use for the focal disproportionate perspiration in the palms, soles, inguinal and craniofacial regions [48]. Although the fundamental Frey syndrome treatment approach is concentrated on the surgical prevention techniques, the BTX A intracutaneous injections in the facial area are reported to be an effective temporal method [49]. Furthermore, the BTX segmental administration, alongside with tap water iontophoresis, are two modalities for symptomatic treatment of the Ross syndrome [50, 51]. The BTX main mechanism of action involves chemical denervation of the sweat glands by acetylcholine release inhibition from the presynaptic neurons. Therefore, the method is contraindicated in case of myasthenia, Lambert-Eaton syndrome, pregnancy and cutaneous infections in the administration area [23]. The advantage of BTX over other hyperhidrosis treatment modalities is due to its high safety profile, significant perspiration reduction rate (around 80% for axillae and the lowest for soles – about 50%) and long-lasting anhidrotic effect (about 6–8 months) [52, 53]. Although the permanent hyperhidrosis control requires regular BTX injections, its repeated supply might prolong the therapeutic effect to 7–9.5 months [54]. Moreover, BTX B may exhibit moderately stronger autonomic effect and less impaired motor function in contrast to BTX A [55]. The principal limitations involve transitional muscle weakness, overall high therapy cost and, most importantly, painful delivery. Therefore, considering the latest, clinicians seek for new resolutions of pain alleviation which include: cold ice packs, vibration, topical lidocaine with prilocaine analgesia, dilution of BTX in lidocaine solution with transdermal administration by jet nebulization or multiple punctures injections [5659].

Hyperhidrosis surgical treatment methods

Surgical invasive treatment is considered as a therapeutic option in the most severe hyperhidrosis cases that are unresponsive to the conservative modalities. Retrodermal curettage involves mechanical removal of the sweat glands restricted to the axillary areas, and thus, permanent primary axillary hyperhidrosis symptoms alleviation. On the other hand, limited number of studies and discrepancies in surgical techniques contribute to the ambiguous evaluation of the long-term therapeutic efficacy [60].

Finally, thoracic or lumbar sympathectomy is an advanced surgical procedure requiring general anaesthesia. The disruption of the sympathetic trunk allows for the 95% complete regain of focal perspiration control confirmed by short- and long-term follow-up clinical studies. Furthermore, the method proved to ensure a significant increase in patients’ quality of life. Nevertheless, in some cases compensatory sweating in the abdominal-lumbar areas, groins and thighs might constitute a major procedure adverse consequence [61, 62].

In conclusion, the individual approach considering the hyperhidrosis aetiology, location and severity is vital to adjust efficacious and patient-acceptable therapy from various available treatment modalities.

Conflict of interest

The authors declare no conflict of interest.

References

1 

Moraites E, Vaughn O, Hill S. Incidence and prevalence of hyperhidrosis. Dermatol Clin 2014; 32: 457-65.

2 

Hasimoto EN, Cataneo DC, Reis TA, et al. Hyperhidrosis: prevalence and impact on quality of life. J Brasil Pneumol 2018; 44: 292-8.

3 

López-López D, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, et al. Relationship between depression scores and degree of skin perspiration: a novel cross-sectional study. Int Wound J 2019; 16: 139-43.

4 

Walling HW. Primary hyperhidrosis increases the risk of cutaneous infection: a case-control study of 387 patients. J Am Acad Dermatol 2009; 61: 242-6.

5 

Strutton D, Kowalski J, Glaser D, et al. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol 2004; 51: 241-8.

6 

Lear W, Kessler E, Solish N, et al. An epidemiological study of hyperhidrosis. Dermatol Surg 2007; 33: S69-75.

7 

Stefaniak T, Tomaszewski KA, Proczko-Markuszewska M, et al. Is subjective hyperhidrosis assessment sufficient enough? Prevalence of hyperhidrosis among young Polish adults. J Dermatol 2013; 40: 819-23.

8 

Hornberger J, Grimes K, Nauman M, et al. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 2004; 51: 274-86.

9 

Murota H, Matsui S, Ono E, et at. Sweat, the driving force behind normal skIn: an emerging perspective on functional biology and regulatory mechanisms. J Dermatol Sci 2015; 77: 3-10.

10 

Romero FR, Haddad GR. Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects. An Brasil Dermatol 2016; 91: 716-25.

11 

Haider A, Solish N. Focal hyperhidrosis: diagnosis and management. CMAJ 2005; 172: 69-75.

12 

Hexsel D, Dal’Forno T, Hexsel C. Inguinal, or hexsel’s hyperhidrosis. Clin Dermatol 2004; 22: 53-9.

13 

Kreyden OP, Schmid-Grendelmeier P, Burg G. Idiopathic localized unilateral hyperhidrosis. Case report of successful treatment with botulinum toxin type A and review of the literature. Arch Dermatol 2001; 137: 1622-5.

14 

Damagatla M, Ganne P, Upparakadiyala R, et al. Ross syndrome. Neuroophthalmology 2020; 44: 201-3.

15 

Yaşar Ş, Aslan C, Serdar ZA, et al. Ross syndrome: unilateral hyperhidrosis, Adie’s tonic pupils and diffuse areflexia. J Deutschen Dermatol Gesellschaft 2010; 8: 1004-6.

16 

Swartling C. Hyperhidrosis – an unknown widespread ‘silent’ disorder. J Neurol Neuromed 2016; 1: 25-33.

17 

Gordon J, Hill E. Update on pediatric hyperhidrosis. Dermatol Ther 2013; 26: 452-61.

18 

Motz KM, Kim YJ. Auriculotemporal syndrome (Frey syndrome). Otolaryngol Clin North Am 2016; 49: 501-9.

19 

Solish N, Bertucci V, Dansereau A, et al. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg 2007; 33: 908-23.

20 

Stefaniak T, Proczko M. Gravimetry in sweating assessment in primary hyperhidrosis and healthy individuals. Clin Autonomic Res 2013; 23: 197-200.

21 

Stashak AB, Brewer JD. Management of hyperhidrosis. Clin Cosmetic Investig Dermatol 2014; 7: 285-99.

22 

Jabłonowska A, Woźniacka A, Dziankowska-Bartkowiak B. Hyperhidrosis: causes and treatment options. Dermatol Rev 2020; 107: 246-56.

23 

Nawrocki S, Cha J. The etiology, diagnosis and management of hyperhidrosis: a comprehensive review. J Am Acad Dermatol 2019; 81: 669-80.

24 

Grabell D, Heber A. Current and emerging medical therapies for primary hyperhidrosis. Dermatol Ther 2017; 7: 25-36.

25 

Holzle E. Topical pharmacological treatment. Curr Probl Dermatol 2002; 30: 30-43.

26 

Pariser DM, Ballard A. Topical therapies in hyperhidrosis care. Dermatol Clin 2014; 32: 485-90.

27 

Allam MF. Breast cancer and deodorants/antiperspirants: a systematic review. Cent Eur J Public Health 2016; 24: 245-7.

28 

Chabicovsky M, Winkler S, Soeberdt M, et al. Pharmacology, toxicology and clinical safety of glycopyrrolate. Toxicol Appl Pharmacol 2019; 370: 154-69.

29 

Glaser DA, Herbert AA, Nast A, et al. Topical glycopyrronium tosylate for the treatment of primary axillary hyperhidrosis: results from the ATMOS-1 and ATMOS-2 phase 3 randomized controlled trials. Am J Clin Dermatol 2019; 80: 128-38.

30 

Glaser DA, Herbert AA, Nast A, et al. A 44-week open-label study evaluating safety and efficacy of topical glycopyrronium tosylate in patients with primary axillary hyperhidrosis. Am J Clin Dermatol 2019; 20: 593-604.

31 

Kirsch B, Smith S, Cohen J, et al. Efficacy and safety of topical sofpironium bromide gel for the treatment of axillary hyperhidrosis treatment of axillary hyperhidrosis: a phase II, randomized, controlled double-blind trial. J Am Acad Dermatol 2020; 82: 1321-7.

32 

Nguyen NV, Gralla J, Abbott J, et al. Oxybutynin 3% gel for the treatment of primary focal hyperhidrosis in adolescents and young adults. Pediatr Dermatol 2018; 35: 208-12.

33 

Artzi O, Loizides C, Zur E, et al. Topical oxybutynin 10% gel for the treatment of primary focal hyperhidrosis: a randomized double-blind placebo-controlled split area study. Acta Derm Venereol 2017; 97: 1120-4.

34 

Lueangarun S, Sermsilp C, Tempark T. Topical botulinum toxin type a liposomal cream for primary axillary hyperhidrosis: a double-blind, randomized, split-site, vehicle-controlled study. Dermatol Surg 2018.

35 

Bajaj V, Langtry JA. Use of oral glycopyrronium bromide in hyperhidrosis. Br J Dermatol 2007; 157: 118-21.

36 

Glaser DA. Oral medications. Dermatol Clin 2014; 32: 527-32.

37 

Walling HW. Systemic therapy for primary hyperhidrosis: a retrospective study of 59 patients treated with glycopyrrolate or clonidine. J Am Acad Dermatol 2012; 66: 387-92.

38 

Wolosker N, de Campos JR, Kauffman P, et al. A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis. J Vasc Surg 2012; 55: 1696-700.

39 

Gregoriou S, Sidiropoulou P, Kontochristopoulos G, et al. Management strategies of palmar hyperhidrosis: challenges and solutions. Clin Cosmet Investig Dermatol 2019; 12: 733-44.

40 

Pariser DM, Krishnaraja J, Tremblay TM, et al. Randomized, placebo- and active-controlled crossover study of the safety and efficacy of THVD-102, a fixed-dose combination of oxybutynin and pilocarpine, in subjects with primary focal hyperhidrosis. J Drugs Dermatol 2017; 16: 127-32.

41 

Hill AC, Baker GF, Jansen GT. Mechanism of action of iontophoresis in the treatment of palmar hyperhidrosis. Cutis 1981; 28: 69-70.

42 

Anliker MD, Kreyden OP. Tap water iontophoresis. Curr Probl Dermatol 2002; 30: 48-56.

43 

Kim DH, Kim TH, Lee SH, et al. Treatment of palmar hyperhidrosis with tap water iontophoresis: a randomized, sham-controlled, single-blind, and parallel-designed clinical trial. Ann Dermatol 2017; 29: 728-34.

44 

Kurta AO, Glaser DA. Emerging nonsurgical treatments for hyperhidrosis. Thorac Surg Clin 2016; 26: 395-402.

45 

Gujjar M, Banga AK. Iontophoretic and microneedle mediated transdermal delivery of glycopyrrolate. Pharmaceutics 2014; 6: 663-71.

46 

Davarian S, Kalantari KK, Rezasoltani A, et al. Effect and persistency of botulinum toxin iontophoresis in the treatment of palmar hyperhidrosis. Australas J Dermatol 2008; 49: 75-9.

47 

Khademi Kalantari K, Zeinalzade A, Kobarfard F, et al. The effect and persistency of 1% aluminum chloride hexahydrate iontophoresis in the treatment of primary palmar hyperhidrosis. Iran J Pharm Res 2011; 10: 641-5.

48 

Campanati A, Martina E, Giuliodori K, et al. Botulinum toxin off-label use in dermatology: a review. Skin Appendage Disord 2017; 3: 39-56.

49 

de Bree R, van der Waal I, Leemans CR. Management of Frey syndrome. Head Neck 2007; 29: 773-8.

50 

Ballestero‐Díez M, García‐Río I, Daudén E, et al. Ross syndrome, an entity included within the spectrum of partial disautonomic syndromes. J Eur Acad Dermatol Venereol 2005; 19: 729-31.

51 

Reinauer S, Schauf G, Hölzle E. Ross syndrome: treatment of segmental compensatory hyperhidrosis by a modified iontophoretic device. J Am Acad Dermatol 1993; 28: 308-12.

52 

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; 323: 596-9.

53 

Weinberg T, Solish N, Murray C. Botulinum neurotoxin treatment of palmar and plantar hyperhidrosis. Dermatol Clin 2014; 32: 505-15.

54 

Lecouflet M, Leux C, Fenot M, et al. 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; 70: 1083-7.

55 

Karlqvist M, Rosell K, Rystedt A, et al. Botulinum toxin B in the treatment of craniofacial hyperhidrosis. J Eur Acad Dermatol Venereol 2014; 28: 1313-7.

56 

Patel R, Halem M, Zaiac M. The combined use of forced cold air and topical anesthetic cream for analgesia during the treatment of palmar hyperhydrosis with botulinum toxin injections. J Drugs Dermatol 2009; 8: 948-51.

57 

Sharma P, Czyz CN, Wulc AE. Investigating the efficacy of vibration anesthesia to reduce pain from cosmetic botulinum toxin injections. Aesthet Surg J 2011; 31: 966-71.

58 

Iannitti T, Palmieri B, Aspiro A, et al. A preliminary study of painless and effective transdermal botulinum toxin A delivery by jet nebulization for treatment of primary hyperhidrosis. Drug Des Devel Ther 2014; 14: 931-5.

59 

Trindade de Almeida AR, Fonseca Noriega L, Bechelli L, et al. Randomized controlled trial comparing the efficacy and safety of two injection techniques of incobotulinumtoxin A for axillary hyperhidrosis. J Drugs Dermatol 2020; 19: 765-70.

60 

Rzany B, Bechara FG, Feise K, et al. Update of the S1 guidelines on the definition and treatment of primary hyperhidrosis. JDDG 2018; 16: 945-52.

61 

Stefaniak TJ, Dobosz Ł, Kaczor M, et al. Diagnosis and treatment of primary hyperhidrosis. Pol J Surg 2013; 85: 527-43.

62 

Araújo CA, Azevedo IM, Ferreira MA, et al. Compensatory sweating after thoracoscopic sympathectomy: characteristics, prevalence and influence on patient satisfaction. J Bras Pneumol 2009; 35: 213-20.

Copyright: © 2022 Termedia Sp. z o. o. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
 
Quick links
© 2024 Termedia Sp. z o.o.
Developed by Bentus.