Excessive Sweating Could be a Medical Condition Called Hyperhidrosis; It is More Common Than You Think

Adam Friedman, MD, FAAD, of George Washington School of Medicine and Health Sciences, delivered an engaging presentation in LA reviewing hyperhidrosis, noting that up to 10 million individuals in the U.S. are affected by the condition.  Hyperhidrosis can be defined as the excessive, bilateral and generally symmetrical sweating at abnormal levels unprompted by activity or environment. Another way to quantify the condition is sweating at 4-5 times greater than the average rate of healthy controls. While patients tend to present with hyperhidrosis in early adulthood, Dr. Friedman conveyed the importance of identifying pediatric hyperhidrosis due its effect on activities of daily living, such as handwriting.

Coverage: SDPA 19th Annual Fall Dermatology Conference in Los Angeles Nov. 4-7, 2021

Diagnosis of hyperhidrosis is best accomplished with a thorough history and physical exam.  Secondary causes of hyperhidrosis may be elucidated with a positive review of systems and will require a laboratory work-up in these patients.  Dr. Friedman recommends the use of a hyperhidrosis disease severity scale to measure the effect of the condition on a patient’s quality of life.  He emphasizes “a unique approach to every patient” as key before moving forward with a treatment algorithm. Due to misinformation spread on social media, Dr. Friedman felt it important to clarify that sweat does not spread COVID-19. Furthermore, he reports simply telling a patient that what they have is a medical condition may give them validation and can take the burden of this condition off their plate.

Next, treatment options were discussed including non-invasive, minimally invasive, systemic and surgical options. Educating patients regarding the difference between antiperspirants and deodorants should be a priority.  When choosing aluminum-based products, Dr. Friedman reports he tends to choose aluminum zirconium products over aluminum chloride due to irritant contact dermatitis. He emphasized there is zero evidence supporting aluminum-based products’ association with increased rates of breast cancer. While aluminum-based products are the most commonly used treatments for hyperhidrosis, it is key to note that they are also the least satisfactory to patients. Dr. Friedman declared it is important to document if a patient fails treatment in order to qualify for insurance coverage of additional treatment options. Other treatments discussed by Dr. Friedman include glycopyrronium tosylate and iontophoresis.

Dr. Friedman will use beta-blockers as a treatment for patients with hyperhidrosis due to social phobias or performance anxiety. When approaching this treatment option, he recommends a test run at home and evaluating the patient’s resting blood pressure and heart rate. Beta-blockers are contraindicated in patients with bradycardia, AV block and asthma and can worsen psoriasis. The proper use and technique of botulinum toxin injections was reviewed. He recommends reviewing the injection technique library provided by the International Hyperhidrosis Society (IHHS) as well as their master classes to help healthcare professionals provide this treatment in the least painful method possible. Lastly, Dr. Friedman discussed the future treatment of hyperhidrosis with sofpironium bromide, which is awaiting FDA approval.

Byline: Sarah B.W. Patton, PA-C