Focal hyperhidrosis

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Focal hyperhidrosis
Synonym primary hyperhidrosis
Classification and external resources
ICD-10 Xxx.x
ICD-9-CM xxx

Focal hyperhidrosis is a condition characterized by excessive sweating in certain body regions. Unlike its counterpart, that is, generalized or secondary hyperhidrosis, the cause is unknown and it is not associated with an underlying condition. Typical regions of excessive sweating include the underarms, palms, soles, groin, face, and scalp. Sweating patterns are typically bilateral or symmetric and rarely occur in just one palm or one underarm. Night sweats or sweating while sleeping is also rare. The onset of focal hyperhidrosis is usually before the age of 25 years. This is in contrast to generalized hyperhidrosis which tends to occur in an older age group. Evidence demonstrates that a positive family history is also present.[1]

The condition occurs in approximately 3% of the general population. Rates among men and women are similar. Profuse sweating is present mostly in the underarms, followed by the feet, palms and facial region.[2]

Focal hyperhidrosis can have a significant impact on quality of life. Individuals can be affected from a social, psychological, emotional and professional perspective.[3] The condition has been referred to as "The Silent Handicap" for this reason.[4] The Canadian Hyperhidrosis Advisory Committee has published a comprehensive set of guidelines which outlines key aspects of treatment related to this condition. Topical hyperhidrosis gels containing aluminum chloride hexahydrate are usually first choice treatments for this condition.[3]


In addition to topical antiperspirants (whose main active ingredients usually are aluminum or zirconium salts) treatment options include: iontophoresis (hands, feet), onabotulinumtoxinA (Botox) injections (underarms, hands, feet, and other localized areas),[5] electromagnetic/microwave energy thermolysis of underarm sweat glands,[6] laser-assisted removal of the sweat glands (underarms),[7] other local procedures such as liposuction and curettage of the sweat glands (underarms), medications of the anticholinergic type that are taken by mouth, and sympathectomy surgery for sweating of the hands or head that can't be controlled by other means.[7]

As of 2015 microwave thermolysis is supported by tentative evidence.[8]


  1. ^ Walling, Hobart W. (2011). "Clinical differentiation of primary from secondary hyperhidrosis". Journal of the American Academy of Dermatology. 64 (4): 690–695. doi:10.1016/j.jaad.2010.03.013. 
  2. ^ Haider, Aamir & Solish, Nowell (2005). "Focal hyperhidrosis: diagnosis and management". Canadian Medical Association Journal. 172 (1): 69–75. doi:10.1503/cmaj.1040708. PMC 543948Freely accessible. PMID 15632408. 
  3. ^ a b Solish, Nowell; et al. (2007). "A Comprehensive Approach to the Recognition, Diagnosis, and Severity-Based Treatment of Focal Hyperhidrosis: Recommendations of the Canadian Hyperhidrosis Advisory Committee". Dermatologic Surgery. 33: 908–923. doi:10.1111/j.1524-4725.2007.33192.x. PMID 17661933. 
  4. ^ Swartling, Carl; et al. (2011). "Hyperhidros - det "tysta" handikappet". Läkartidningen (in Swedish). 108 (47): 2428–2432. 
  5. ^ Stashak, AB; Brewer, JD (29 October 2014). "Management of hyperhidrosis.". Clinical, cosmetic and investigational dermatology. 7: 285–99. doi:10.2147/CCID.S53119. PMC 4218921Freely accessible. PMID 25378942. 
  6. ^ Jacob, C (March 2013). "Treatment of hyperhidrosis with microwave technology.". Seminars in cutaneous medicine and surgery. 32 (1): 2–8. PMID 24049923. 
  7. ^ a b Brown, AL; Gordon, J; Hill, S (August 2014). "Hyperhidrosis: review of recent advances and new therapeutic options for primary hyperhidrosis.". Current Opinion in Pediatrics. 26 (4): 460–5. doi:10.1097/mop.0000000000000108. PMID 24905102. 
  8. ^ Singh, S; Davis, H; Wilson, P (October 2015). "Axillary hyperhidrosis: A review of the extent of the problem and treatment modalities.". The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland. 13 (5): 279–85. doi:10.1016/j.surge.2015.03.003. PMID 25921800.