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American Family Physician Nov, 1989
Management of Hyperhidrosis
Primary hyperhidrosis occurs in response to psychologic stress and emotional stimuli. It usually involves the palms, soles and axillae and may lead to wetness and staining of clothes, damp hands, plantar infection and blisters. For some persons, sweating may be so excessive that it leads to social isolation, low self-esteem or even to medical illness. Manusov and Nadeau review the pathophysiology and treatment of hyperhidrosis.
Sweat production is controlled by circulating catecholamines and the autonomic nervous system. The amount of sweating is also modulated by local physical variables, such as local skin temperature, wetness and blood flow. The sweat rate is highly variable among individuals and seems to be a function of acclimatization, sex, age and, possibly, diet.
Treatment of hyperhidrosis has been disappointing. Treatment ranges from topical medication to surgical sympathectomy and axillary dissection (see table). Topical medications should be used before other interventions are considered. The preferred topical agent is aluminum chloride. It has been generally successful and is usually well tolerated. Glutaraldehyde and tannic acid are effective for control of plantar and palmar hyperhidrosis, although they cause brown staining of the skin. More aggressive therapy includes anticholinergic medications, alpha-adrenergic blocking agents and surgical sympathectomy.
Treatment of Hyperhidrosis
The authors report two case histories of patients with hyperhidrosis who were successfully treated with the alpha blocker phenoxybenzamine. Side effects were minimal, and the drug was well tolerated. For those patients in whom sweating is uncontrolled by topical antiperspirants, the use of phenoxybenzamine may be effective. (Journal of Family Practice, April 1989, vol. 28, p. 412.)
COPYRIGHT 1989 American Academy of Family Physicians