Chapter 28: Diagnosis and Management of Hyperhidrosis

The following sections are included:

• Postganglionic sympathetic C fibres supply control the sweat gland function.

• Primary hyperhidrosis can impair the social, professional, psychological and physical aspects of patients’ lives.

• Local referral pathways and stepwise management protocols should be adopted by the multidisciplinary group.

• Conservative treatments such as topical treatment and iontophoresis should be tried first and patient compliance makes a difference.

• Botulin toxin injections are effective and well received by patients especially for the axillary and facial forms but repeated injections are required.

• Thoracoscopic sympathectomy of T2, T3 for palmar and T2, T3, T4 ganglia for axillary hyperhidrosis is effective and a lifelong solution.

• Extensive consultation should always take place and patients must be warned about complications especially compensatory sweating and the irreversibility of these procedures.

• Local surgical treatments such as elliptical excision, curettage and liposuction for axillary form are effective and less invasive.