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Management Strategies Of Palmar Hyperhidrosis: Challenges And Solutions

Authors Gregoriou S, Sidiropoulou P, Kontochristopoulos G, Rigopoulos D

Received 13 August 2019

Accepted for publication 24 September 2019

Published 4 October 2019 Volume 2019:12 Pages 733—744


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Jeffrey Weinberg

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, Greece

Correspondence: Stamatios Gregoriou
Dermatology, “A. Sygros” Hospital for Skin Diseases, 5 Ionos Dragoumi str, Athens GR-16121, Greece
Tel +30 21 2107265198
Fax +30 21 2107211122

Abstract: 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

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