Incidence of clinically significant disease is 1% of the general population.

Predominantly affects females.

Thoracic sympathetectomy is the best treatment to cure palmar, axillary or plantar hyperhidrosis.

Optimal candidates for endoscopic thoracic sympathectomy have onset of hyperhidrosis before age 16 years, undergo surgery at age 25 years or younger, have a BMI less than 28 or less, are in good health and do not have bradycardia.

A condition characterized by abnormally increased sweating,

Sweating that occurs is in excess of that required for regulation of body temperature.

It can deteriorate quality of life from a psychological, emotional, and social perspective

Diaphoresis and hidrosis can mean either perspiration (in which sense they are synonymous with sweating or excessive perspiration.

The process can either be generalized, or localized to specific parts of the body.

The hands, feet, armpits, groin, and the facial area are among the most active regions of perspiration due to the high number of sweat glands.

Localized excessive sweating involving palms, soles, face, underarms, or scalp, it is referred to as primary hyperhidrosis or focal hyperhidrosis.

Excessive sweating involving the whole body is termed generalized hyperhidrosis or secondary hyperhidrosis.

Secondary hyperhidrosis s usually the result of some other, underlying condition.

Primary or focal hyperhidrosisis further divided by the area affected- palmoplantar hyperhidrosis or gustatory hyperhidrosis.

Hyperhidrosis can be classified by onset, either congenital or acquired.

Primary hyperhidrosis usually starts during adolescence or even earlier and seems to be inherited as an autosomal dominant genetic trait.

Secondary hyperhidrosis can start at any point in life, and may be due to a disorder of the thyroid or pituitary glands, diabetes mellitus, tumors, gout, menopause, certain drugs, or mercury poisoning.

Classification relates also to the amount of skin affected, with excessive sweating in an area of 16 square inches or more is differentiated from sweating that affects only a small area.

Anxiety or excitement can exacerbate the process.

Being nervous may increase sweating.

Additional factors including certain foods, drinks, nicotine, caffeine, and odors.

Idiopathic unilateral circumscribed hyperhidrosis association with:

Blue rubber bleb nevus

Glomus tumor

POEMS syndrome

Trench foot



Pretibial myxedema

Gustatory sweating is associated with:



Diabetic neuropathies

Herpes zoster


Parotid abscesses

Thoracic sympathectomy

Lacrimal sweating

Harlequin syndrome

Emotional hyperhidrosis

Secondary hyperhidrosis

Secondary hyperhidrosis has many causes including: cancer, disturbances of the endocrine system disease, infections, and medications.

Cancers associated with secondary hyperhidrosis include; lymphoma, pheochromocytoma, carcinoid tumors,and tumors of thoracic origin.

Certain endocrine conditions are also known to cause secondary hyperhidrosis: diabetes mellitus, hypoglycemia, acromegaly, hyperpituitarism, and various forms of thyroid disease.

Use of selective serotonin reuptake inhibitors is a common cause of medication-induced secondary hyperhidrosis.

Other medications associated with secondary hyperhidrosis include: tricyclic antidepressants, opioids, nonsteroidal anti-inflammatory drugs, diabetic medications, anxiolytic agents, adrenergic agonists, and cholinergic agonists.

Associated with:

Spinal cord injuries with autonomic dysreflexia, orthostatic hypotension, posttraumatic syringomyelia, peripheral neuropathies familial dysautonomia, associated with cold-induced sweating syndrome,

Episodic with hypothermia

Episodic without hypothermia


Associated with systemic medical problems: Parkinson’s disease, Fibromyalgia, Congestive heart failure,



Night sweats

Symmetry of excessive sweating is most consistent with primary hyperhidrosis.

Excessive sweating affecting only one side of the body is more suggestive of secondary hyperhidrosis.

Treatment requires solutions or gels with a high concentration of aluminum chloride, and such gels are especially effective for treatment of axillary or underarm regions.

For plantar and palmar hyperhidrosis, higher strength aluminium chloride antiperspirants are effective.

Treatment is the recommendation of topical antiperspirants as the first line of therapy.

Anticholinergics, are sometimes used in the treatment of both generalized and focal hyperhidrosis.

Anticholinergics used for include propantheline, glycopyrronium bromide or glycopyrrolate, oxybutynin, methantheline, and benzatropine.

If hyperhidrosis is made worse by anxiety-provoking situations taking an anticholinergic medicine before the event may be helpful.

Injections of botulinum toxin type A can be used to block neural control of sweat glands, and can last from 3–9 months depending on the site of injections.

Tap water Iontophoresis as a treatment for palmoplantar hyperhidrosis decreases sweating by about 80%.

Sweat gland surgical removal or destruction is an option available for axillary hyperhidrosis.

The main surgical option is endoscopic thoracic sympathectomy (ETS), which obliterates the thoracic ganglion on the main sympathetic chain that runs alongside the spine.

Satisfaction rates above 80% have been reported, and are higher for children treated with thoracic sympathectomy, and brings relief from excessive hand sweating in about 85–95% of patients.

Endoscopic thoracic sympathectomy may be helpful in treating axillary hyperhidrosis, facial blushing and facial sweating.

The most common side-effect of endoscopic thoracic sympathectomy is compensatory sweating.

Problems with compensatory sweating are seen in 20–80% of patients undergoing the surgery.

After sympathectomy total body perspiration in response to heat may increase.

Sweating problem may recur due to nerve regeneration, and about 1% have Horner’s Syndrome, gustatory sweating and excessive dryness of the palms.

After sympathectomy some patients have cardiac sympathetic denervation, which can result in a 10% decrease in heart rate both at rest and during exercise, resulting in decreased exercise tolerance.

Percutaneous sympathectomy is a minimally invasive procedure, which provides temporary relief in most cases.

Physiological consequences such as cold and clammy hands, dehydration, and skin infections secondary to maceration of the skin can occur.

Hyperhidrosis can also have devastating emotional effects

Incidence of focal hyperhidrosis may be as high as 2.8% of the population.

Most commonly occurs among patients aged 25–64 years, though some may have been affected since early childhood.

About 30–50% of people have another family member afflicted, implying a genetic predisposition.

Primary palmar hyperhidrosis maps suggest location gene locus 14q11.2–q13.

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