Classification

Primary - Typically presents earlier in life -less than 25 yrs age with more localized symptoms affecting bilateral palms, feet, axilla or forehead. There is excessive sweating for more than 6 months with decreased or no sweating at night.

Secondary - Due to adverse effects of medications or systemic disorders such as fever, infections, hyperthyroidism, diabetes, neurological disorders, chronic alcohol consumption.

Evaluation-

Thorough history, physical examination and blood tests are done to rule out primary or secondary hyperhidrosis as this distinction is important because treatment and management significantly differ between the two groups.

Treatment

Treatment depends on the type of hyperhidrosis and where the excessive sweating occurs on the body.

Antiperspirants - Regular or clinical-strength antiperspirants are the first line of treatment. They are affordable and used for underarms, hands, feet, or hairline. The antiperspirant sits on top of your skin. As you sweat, the antiperspirant is pulled into your sweat glands. This plugs the sweat glands. When your body senses that its sweat glands are plugged, this should signal your body to stop producing so much sweat.

Iontophoresis (the no-sweat machine) - Here hands or feet are immersed in a shallow pan of tap water in which a medical device sends a low-voltage current through the water. Mild tingling sensation is experienced during the procedure. The electric current shuts down the treated sweat glands temporarily. A treatment session usually takes 20 to 40 minutes. Initially 6-10 treatments are required at 2 or 3 times per week , following which for maintenance can be achieved once a week to once a month

Botulinum toxin injections - These injections temporarily block a chemical in the body that stimulates the sweat glands. Commonly used for underarms and palmar hyperhidrosis. Most patients notice results four to five days after receiving treatment. Reduced sweating lasts about four to six months, and sometimes longer. When the excessive sweating returns, you can be retreated.

MNRF- Fractional radiofrequency microneedling, offers a promising avenue in the treatment of hyperhidrosis or excessive sweating. By delivering precise energy deep into the dermis, MNRF targets sweat glands and disrupts their function, reducing sweat production. This is one of our favourite approaches to tackle hyperhydrosis on the face or the underarms,

Oral medications that prevent the sweat glands from working are also available. But they reduce sweating from the entire body causing dry mouth, dry eye, blurry vision, heart palpitations therefore to be used very cautiously.

Hyperhidrosis while not life-threatening can be cosmetically unacceptable and may even lead to difficulties with work. It can however be controlled by combining above treatments with tips for managing.