The Treatment of Primary Focal Hyperhidrosis

Todd Wechter, BSc; Steven R. Feldman, MD, PhD; Sarah L. Taylor, MD, MPH


Skin Therapy Letter. 2019;24(1) 

In This Article


Primary focal hyperhidrosis afflicts a significant number of patients in the United States and greatly impacts their quality of life. Treatment decisions should take into consideration disease location, severity and patient preference. Topical antiperspirants remain a reasonable primary treatment option for all forms of disease. BTX-A is an effective second-line therapy, particularly for axillary disease. Iontophoresis is a superior option for palmoplantar disease and further investigation into the utilization of iontophoresis to deliver sweat reducing medications may yield additional treatment prospects. More recent procedural interventions such as microwave thermolysis, focused ultrasound and laser therapies have also demonstrated considerable promise in the treatment of refractory disease. Oral systemic therapies, specifically anticholinergic medications, appear to be a safe and effective alternative option for all forms of primary hyperhidrosis. More invasive options such as suction curettage and surgical sympathectomy, while effective, should be reserved for more severe refractory cases. Continued research into novel treatment options and methods of improving the efficacy and reducing the side effects of existing treatment options is needed.