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Maral Skelsey, MD, Discusses Treatment Options for Hyperhidrosis

Hyperhidrosis affects about 5% of the population, or roughly 15 million people. Fewer than half of these patients will consult a professional regarding their condition, said Maral K. Skelsey, MD, FAAD, during her presentation at the 2019 American Academy of Dermatology Summer Meeting.

It has a tremendous impact on patients, according to Dr Skelsey. Negative impact on quality of life for hyperhidrosis is greater than psoriasis, acne, vilitigo, Darier disease, and Hailey-Hailey disease, she said.

Among children, hyperhidrosis not only impacts their ability to socialize but also results in more refusals to attend school as children report difficulty with writing, using utensil, and computers, among other tasks. This condition also has a big impact on work performance, said Dr Skelsey, with 80% of adults reporting they are not satisfied with their abilities to work and 42% saying hyperhidrosis prevents them from taking a specific career path.

Dr Skelsey also discussed comorbid medical and mental health conditions, such as risk for skin maceration, skin infections, anxiety, and depression, as well as attention deficit/hyperactivity disorder. Secondary hyperhidrosis is not as common and is associated with febrile illnesses, endocrine, neurologic, and metabolic disorders, as well as medication.

Overall, 93% of patients with hyperhidrosis are primary, focal, and idiopathic, she stated. This includes excessive bilateral sweating affecting the axillae, palms, soles, and/or craniofacial areas. In younger children, palmar plantar hyperhidrosis is more common. There is an absence of sweating a night, which is an important distinction between primary and secondary hyperhidrosis. Dr Skelsey also reviewed what is known about the genetic components of the disease and pathology.

For examining patients, no lab testing is necessary, said Dr Skelsey. When performing physical exams, clinicians should establish severity, as well as rule out secondary hyperhidrosis if patients present with late-onset disease.

For treatment, “you have to tailor the treatment to the location of the hyperhidrosis,” she said. Not all therapies are applicable to all areas and are for all patients. “It needs to be tailored to the location and age of the patient,” Dr Skelsey emphasized.

Behavioral options for managing hyperhidrosis include using products, such as moisture wicking clothing, insoles for shoes, and bedding, as well as avoiding triggers, such as consuming hot beverages and spicy foods.

Mainstay are topical antiperspirants, said Dr Skelsey. These must be applied 6 to 8 hours prior to initiation of perspiration, said Dr Skelsey, as the products cannot penetrate when patients are actively sweating. She also recommended patients apply antiperspirants at night and reapply in the morning to maximize efficacy. Evidence shows aluminum chloride hexahydrate, among other options, was found to be good to excellent for axillary regions. She noted that aluminum chloride hexahydrate lotions, a product designed for hands, have better absorption and coverage. For a list of all antiperspirants with strengths and cost, clinicians and patients can visit the hyperhidrosis network.

Adverse effects of antiperspirants are pruritus and stinging, said Dr Skelsey, which can be addressed by decreasing the interval between applications, using the lowest concentration possible, applying a moisturizer, or using a blow dryer on low setting. Patients sometimes ask about the relationship between Alzheimer disease and breast cancer and antiperspirant use, said Dr Skelsey, adding that there is no convincing evidence linking antiperspirant use with these diseases.


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