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Delusional hyperhidrosis — Clinical Guidelines

Overview

Hyperhidrosis is characterized by excessive sweating beyond thermoregulatory needs, affecting approximately 4.8% of the U.S. population 1 2. It significantly impacts quality of life through physical discomfort, social embarrassment, and psychological distress 1 3. Primary focal hyperhidrosis, accounting for 93% of cases, is idiopathic and can affect various body regions 1.

Diagnosis

Clinical Presentation: Excessive sweating localized to specific areas (axillae, palms, soles, face) 1 5.

Diagnostic Criteria: Symptom onset before age 25, positive family history, and impact on daily activities 1.

Tests: No specific diagnostic tests; clinical evaluation and patient history are primary 1.

Grading: Hyperhidrosis severity can be graded using the Hyperhidrosis Disease Severity Score (HDSS) 1.

Management

First-Line Treatments:

- Topical Antiperspirants: Aluminum chloride hexahydrate solutions 1. - Iontophoresis: For palmar and axillary hyperhidrosis, often effective when performed regularly 12.

Adjunctive Treatments:

- Botulinum Toxin Type A (Botox): Injections into affected areas; effective for up to 6 months 6 8. - Thoracic Sympathectomy: Surgical intervention for severe refractory cases 9. - Oral Medications: Anticholinergics like glycopyrrolate (off-label use) 1.

Special Populations

Pediatrics: Approximately 1.6% of adolescents and 0.6% of prepubertal children are affected; early intervention can improve quality of life 3.

Comorbidities: No specific management differences noted in the abstracts, but psychological support may be beneficial 1 3.

Key Recommendations

Initiate with Topical Antiperspirants for mild to moderate hyperhidrosis (Evidence: Moderate) 1.

Consider Iontophoresis for localized palmar and axillary hyperhidrosis (Evidence: Moderate) 12.

Use Botulinum Toxin Type A Injections for refractory cases or when topical treatments fail (Evidence: Strong) 6 8.

Evaluate Surgical Options such as thoracic sympathectomy for severe, treatment-resistant hyperhidrosis (Evidence: Expert opinion) 9.

Provide Psychological Support for patients experiencing significant emotional distress (Evidence: Expert opinion) 1 3.

References

1 Liu V, Farshchian M, Potts GA. Management of Primary Focal Hyperhidrosis: An Algorithmic Approach. Journal of drugs in dermatology : JDD 2021. link 2 Gorelick J, Friedman A. Diagnosis and Management of Primary Hyperhidrosis: Practical Guidance and Current Therapy Update. Journal of drugs in dermatology : JDD 2020. link 3 Bohaty BR, Hebert AA. Special considerations for children with hyperhidrosis. Dermatologic clinics 2014. link 4 Mason MC. No sweat. Nursing standard (Royal College of Nursing (Great Britain) : 1987) 2009. link 5 Gelbard CM, Epstein H, Hebert A. Primary pediatric hyperhidrosis: a review of current treatment options. Pediatric dermatology 2008. link 6 Pena MA, Alam M, Yoo SS. Complications with the use of botulinum toxin type A for cosmetic applications and hyperhidrosis. Seminars in cutaneous medicine and surgery 2007. link 7 Said S, Meshkinpour A, Carruthers A, Carruthers J. Botulinum toxin A: its expanding role in dermatology and esthetics. American journal of clinical dermatology 2003. link 8 Glogau RG. Review of the use of botulinum toxin for hyperhidrosis and cosmetic purposes. The Clinical journal of pain 2002. link 9 Chaudhuri N, Birdi I, Ritchie AJ. Current practice in thoracic sympathectomy. Hospital medicine (London, England : 1998) 1999. link 10 Parslew R, Lewis-Jones MS. Localized unilateral hyperhidrosis secondary to an eccrine naevus. Clinical and experimental dermatology 1997. link 11 Rufli T, Itin P, Gilli L. Localized unilateral hyperhidrosis. Dermatology (Basel, Switzerland) 1992. link 12 Levit F. Treatment of hyperhidrosis by tap water iontophoresis. Cutis 1980. link 13 Harahap M. Management of hyperhidrosis axillaris. The Journal of dermatologic surgery and oncology 1979. link 14 Jensen O. 'Rusters'. The corrosive action of palmar sweat: I. Sodium chloride in sweat. Acta dermato-venereologica 1979. link 15 Jensen O, Nielsen E. 'Rusters'. The corrosive action of palmar sweat: II. Physical and chemical factors in palmar hyperhidrosis. Acta dermato-venereologica 1979. link 16 Ajmani SK, Lerner SR, Pircher FJ. Bone scan artifact caused by hyperhidrosis: case report. Journal of nuclear medicine : official publication, Society of Nuclear Medicine 1977. link

Delusional hyperhidrosis