Understanding Primary Hyperhidrosis: Causes and Treatments

Hyperhidrosis manifests in two forms. The more common is Primary hyperhidrosis, also known as focal hyperhidrosis, which causes excessive sweating in specific areas such as the armpits, groin (axillary hyperhidrosis), or palms and soles (palmoplantar hyperhidrosis). Often a social concern rather than a medical issue, it can lead to embarrassment through clothing stains and secondary bacterial infections that produce foul odors. This condition impacts social interactions and professional life, affecting mental well-being.

Diagnosis
Diagnosing primary hyperhidrosis involves reviewing the patient's history to confirm that no other systemic health issues are causing excessive sweating. Additional tests may be necessary if underlying causes are suspected. Treatment options depend on the severity of symptoms.

Initial treatments typically include over-the-counter antiperspirants containing low concentrations of aluminum chloride. When these are ineffective, prescription-strength antiperspirants with aluminum chloride hexahydrate are recommended. These are applied to affected areas at bedtime over several nights and repeated weekly. This method works well for underarm sweating but less so for palms and soles. Skin irritation may occur, especially if the area is kept dry before application.

For more advanced cases, iontophoresis is often used. This involves passing ionized water over the skin using a device, delivering a mild electrical current that blocks sweat gland activity. Each session lasts 10 to 20 minutes and is scheduled every 1 to 3 weeks based on individual response. If other treatments fail, oral medications may be considered, but only after consultation with a healthcare professional as a last resort.