Sweat and tears: treating the patient with primary hyperhidrosis

Hyperhidrosis is a distressing disorder characterised by excessive sweating. Whereas some cases are secondary to underlying conditions, primary hyperhidrosis is the more common form affecting around 3% of the population. Typically starting in childhood or adolescence, primary hyperhidrosis has a significant impact on an individual's quality of life and self-esteem, which is similar to that of more well recognised skin conditions, such as psoriasis, severe pruritus and acne. Treatment options for primary hyperhidrosis are varied, including topical treatments, Botulinum toxin A, systemic medication, iontophoresis and surgery; however, each method has drawbacks that are discussed in this article. Case examples within the article illustrate the potential of several of these treatments. Particular issues surrounding the treatment of children and adolescents with this condition are also discussed.