• DOI:10.1136/bmj.f6800
• Corpus ID: 1383784

Diagnosis and management of hyperhidrosis

@article{Benson2013DiagnosisAM,
  title={Diagnosis and management of hyperhidrosis},
  author={Ruth A Benson and Rachel Palin and Peter E. Holt and Ian M. Loftus},
  journal={BMJ : British Medical Journal},
  year={2013},
  volume={347}
}

• R. Benson, R. Palin, +1 author I. Loftus
• Published 25 November 2013
• Medicine
• BMJ : British Medical Journal

#### Summary points

Primary hyperhidrosis is characterised by sweating in excess of that needed for normal thermoregulation.1 The condition often goes unreported because of embarrassment,2 and management is hindered by a poor evidence base and lack of clinical guidelines. Anxiety about social situations and relationships, and problems with daily living, such as an inability to hold a pen at work, can affect quality of life.3 Hyperhidrosis may be associated with bromhidrosis (unpleasant odour) from the byproducts of bacteria that colonise sweaty areas.4 5 Subjective perceptions of the condition’s impact on the person’s life, and therefore its severity, can make confirmation of diagnosis and effective management challenging.6 This review aims to provide an update on identifying this condition, instigating appropriate management, and when to refer to a specialist.

#### Sources and selection criteria

We searched Medline, Embase, and the Cochrane database. Terms used alone and cross referenced were hyperhidrosis, botulin, iontophoresis, tumescent liposuction, oral therapy, topical therapy, and sympathectomy. We considered reviews, meta-analyses, randomised and non-randomised controlled trials, and large case series (owing to the lack of large volume trials). When possible, we used trials published within the past 10 years. The evidence for many treatments used in primary …