Palmoplantar hyperhidrosis commonly begins in childhood or around puberty. The sweating of the palms and soles is either continuous or phasic. When continuous, it is worse in the summer and not so clearly related to mentalstatus. When phasic, it is usually associated with minor emotionalor mental activity, and not markedly different in any season.

Complications and co-morbidities

Palmoplantar hyperhidrosis predisposes to vesicular eczema (pompholyx) and allergy to footwear constituents. Maceration of the skin in between toes maylead to both fungal and bacterial infection.

Disease course

Axillary and palmer hyperhidrosis may persist for few years, but usually spontaneously improve after the age of 25 years.

Investigations

Thyroid function is seldom contributory.

Management of hyperhidrosis

Topical anticholinergics. Topical 0.5% glycopyrronium bromide cream is useful in gustatory hyperhidrosis and at0.5–2.0% for axillary hyperhidrosis

Eccrine (Sweat) duct-blocking agents. These drugs block thedelivery of sweat to the skin surface. Formalin 1% soaks and Glutaraldehyde 10% swabbed onto the feet helps some patients, but skin staining is a concernso is suitable just for the feet. Aluminium chlorhydrates –20% aluminum chloride in absolute ethanol can be tried for axillary hyperhidrosis.

Iontophoresis. Tap water iontophoresis is a satisfactory option for palmo-planter hyperhidrosis.

Botulinum toxin A injection. Intradermal injection of BOTOX produces a marked reduction of sweating in hyperhidrotic areas. Benefit normally lasts for up to 8 months in axillary and 6 months in palmar hyperhidrosis.

Reference

Rook’s Textbook of Dermatology, Ninth Edition