Excessive sweating may be caused by a variety of conditions or prescription drugs.
How best to assess a male patient with paroxysms of "sweating"?
- Lincy Mathew, MD
Hyperhidrosis, or sweating beyond what is necessary to maintain thermal regulation, may be primary or secondary to a number of diseases and prescribed drugs. It may be localized (focal) or generalized. Regardless of the type or the cause of hyperhidrosis, it is often socially embarrassing and occupationally disabling. It has a profound effect on quality of life.
Primary essential or focal hyperhidrosis begins in childhood or even infancy and usually affects the hands, feet, and axillae. This physiologic disorder is frequently inherited and is made worse by heat and anxiety. Characteristically, it occurs during waking hours and recedes or disappears completely during sleep.
Various drugs, including β-blockers, physostigmine, pilocarpine, and tricyclic antidepressants, may cause generalized hyperhidrosis and sometimes focal hyperhidrosis. A number of neoplastic conditions, infectious disorders, and neurologic disorders and lesions can also cause generalized hyperhidrosis. Metabolic disorders such as thyrotoxicosis, hypoglycemia, menopause, and pheochromocytoma may account for the onset of hyperhidrosis in adults.
In assessing a patient with hyperhidrosis, the following questions are important:
For focal palmar and plantar hyperhidrosis, iontophoresis is highly effective and safe, and it remains the therapy of choice. Endoscopic sympathectomy carries with it a significant risk of compensatory hyperhidrosis and should rarely be recommended. Botulinum toxin A is a highly effective treatment for axillary hyperhidrosis. Certain drugs, including anticholinergics and clonidine, are sometimes useful for the management of generalized hyperhidrosis.
- Lewis P. Stolman, MD
Associate Clinical Professor of Pediatrics and Dermatology
New Jersey Medical School
University of Medicine and Dentistry of New Jersey
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