Clinical, Cosmetic and Investigational Dermatology (Oct 2019)
Management Strategies Of Palmar Hyperhidrosis: Challenges And Solutions
Abstract
Stamatios Gregoriou,1 Polytimi Sidiropoulou,1 Georgios Kontochristopoulos,2 Dimitrios Rigopoulos1 11st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, “A. Sygros” Hospital for Cutaneous & Venereal Diseases, Athens, Greece; 2State Department of Dermatology-Venereology, “A. Sygros” Hospital for Cutaneous & Venereal Diseases, Athens, GreeceCorrespondence: Stamatios GregoriouDermatology, “A. Sygros” Hospital for Skin Diseases, 5 Ionos Dragoumi str, Athens GR-16121, GreeceTel +30 21 2107265198Fax +30 21 2107211122Email [email protected]: Palmar hyperhidrosis is a potentially disabling condition for which management remains a therapeutic challenge. Given the significant impact on quality of life, various treatment options are available, ranging from topical agents and medical devices to systemic therapies and surgical interventions. Nonsurgical approaches, i.e. topical antiperspirants, botulinum toxin injections, iontophoresis, and systemic agents, are all supported by the current literature. Patients with mild-to-moderate disease can often benefit from topical therapies only. As disease severity progresses, systemic oral medication, such as anticholinergic drugs, usually becomes necessary. Last-line surgical approaches (sympathetic denervation) should be reserved for severe refractory cases. Recently, therapeutic strategies have been evolving with several new agents emerging as promising alternatives in clinical trials. In practice, however, each modality comes with its own benefits and risks. An individual therapeutic ladder is generally recommended, taking into account disease severity, benefit-to-risk profile, treatment cost, patient preference, and clinician expertise. This review will provide an update on current and emerging concepts of management for excessive hand sweating to help clinicians optimize therapeutic decision-making.Keywords: iontophoresis, aluminum chloride, botulinum toxin, anticholinergics, oxybutynin, glycopyrrolate, sympathectomy
