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Hyperhidrosis

 
Medical Encyclopedia: Hyperhidrosis
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Definition

A disorder marked by excessive sweating. It usually begins at puberty and affects the palms, soles, and armpits.

Description

Sweating is the body's way of cooling itself and is a normal response to a hot environment or intense exercise. However, excessive sweating unrelated to these conditions can be a problem for some people. Those with constantly moist hands may feel uncomfortable shaking hands or touching, while others with sweaty armpits and feet may have to contend with the unpleasant odor that results from the bacterial breakdown of sweat and cellular debris (bromhidrosis). People with hyperhidrosis often must change their clothes at least once a day, and their shoes can be ruined by the excess moisture. Hyperhidrosis may also contribute to such skin diseases as athlete's foot (tinea pedis) and contact dermatitis.

— Carol A. Turkington


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Sci-Tech Dictionary: hyperhidrosis
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(¦hī·pər′hī′drō·səs)

(medicine) Excessive sweating, which may be localized or generalized, chronic or acute, and often accumulating in visible drops on the skin. Also known as ephidrosis; polyhidrosis; sudatoria.

Dental Dictionary: hyperhidrosis
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(hī'pur-hī-drō'sis)
n

Excessive sweating, which may be generalized or localized.

Children's Health Encyclopedia: Hyperhidrosis
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Definition

Hyperhidrosis is a medical condition characterized by excessive sweating in the armpits, palms, soles of the feet, face, scalp, and/or torso.

Description

Hyperhidrosis involves sweating in excess of the amount required normally for the body's level of activity and temperature. There are two types of hyperhidrosis—primary and secondary. In primary hyperhidrosis, the cause is unknown and excessive sweating is localized in the armpits, hands, face, and/or feet. Primary hyperhidrosis begins during childhood or early adolescence, gets worse during puberty, and lasts a lifetime. In secondary hyperhidrosis, which is less common than primary hyperhidrosis, excessive sweating is caused by another medical condition and usually occurs over the entire body. Medical conditions that can cause secondary hyperhidrosis include hyperthyroidism, menopause, obesity, psychiatric disorders, and diabetes. Secondary hyperhidrosis may also be caused by use of certain medications.

In about 60 percent of cases, the hands and feet are affected, and in about 30–40 percent of cases, the armpits are affected.

Demographics

Axillary (underarm) hyperhidrosis occurs more frequently in females and in individuals of Asian or Jewish ancestry. Hyperhidrosis of the hands and feet occurs 20 times more frequently in the Japanese. Previously, it was thought that hyperhidrosis was rare, occurring in only 0.6–1 percent of adolescents and young adults; however, a national survey conducted in 2004 found that up to 2.8 percent of Americans (approximately 7.8 million individuals) may have hyperhidrosis.

Causes and Symptoms

The exact cause of hyperhidrosis is as of 2004 unknown. Excessive sweating in the affected area is caused by overactivity of the nerves linked to the sweat glands. Specifically, acetylcholine, a chemical in the body that transmits nerve signals, is released from nerve endings and stimulates secretion of sweat. Genetics may also be a factor, since 25–40 percent of individuals with hyperhidrosis also have a family member with the condition.

In hyperhidrosis, sweating may be continuous or start suddenly. Usually, excessive sweating does not occur in response to exercise and does not occur during sleep. Emotional stress, high room/environmental temperature, and digestion of certain foods can aggravate hyperhidrosis. Symptoms of hyperhidrosis vary depending on the body area affected:

  • In palmar hyperhidrosis, the palms of the hands are excessively wet or moist and also cold to the touch.
  • In axillary hyperhidrosis, excessive sweating in the underarm area occurs, leaving large wet marks and staining clothes.
  • In scalp/facial hyperhidrosis, excessive sweating of the face and scalp occurs, as well as moderate to severe facial blushing.
  • In plantar hyperhidrosis, the soles of the feet sweat excessively. This condition is often associated with hyperhidrosis in other body areas.
  • In truncal hyperhidrosis, the torso area sweats excessively. This condition is rare alone and usually occurs with hyperhidrosis in other areas.

When to Call the Doctor

Parents should call the doctor if their child or adolescent experiences excessive sweating unrelated to an obvious medical condition (e.g., high fever) or physical exertion. Usually, consultation and treatment will be given by a dermatologist.

Diagnosis

Hyperhidrosis is diagnosed by physical examination. For suspected secondary hyperhidrosis, laboratory and imaging tests may be performed to determine the underlying medical condition causing the hyperhidrosis.

Treatment

Topical agents applied to the skin in the affected area are the first course of treatment for hyperhidrosis. Topical applications include anticholinergic drugs, boric acid, tannic acid solutions, and glutaraldehyde. Drysol, an aluminum chloride solution, is the most commonly used and most effective topical application; it is applied nightly on dry skin. Systemic medications may be taken orally and include anticholinergic drugs, sedatives or tranquilizers, and calcium channel blockers. These oral drugs do have side effects, such as dry mouth and eyes, blurry vision, and constipation, and may not be appropriate for pediatric patients.

Iontophoresis, which involves the application of an electrical current across the skin, can be used to treat plantar and palmar hyperhidrosis but requires daily treatment for about 30 minutes, often multiple times daily.

As a last resort, surgery is used to treat palmar, plantar, and axillary hyperhidrosis. Surgical procedures involve removing portions of the nerves responsible for excessive sweating and removing sweat glands during an open or minimally invasive surgical procedure. Liposuction may be used to remove sweat glands in the underarm area.

In 2004, the U.S. Food and Drug Administration approved the use of botulinum toxin (Botox) for treatment of axillary (underarm) hyperhidrosis that resists treatment with topical drugs. Botox is commonly used for cosmetic treatment of wrinkles but is also used to treat neuromuscular problems, including migraine and cervical dystonia. In the early 2000s researchers are also investigating the use of Botox to treat hyperhidrosis of the hands, feet, and face. Although most studies of Botox for hyperhidrosis included adult patients, some physicians use Botox to treat hyperhidrosis in children with some success. Even though Botox has only been approved to treat axillary hyperhidrosis, physicians can legally use Botox "off-label" to treat other affected areas of the body. Botox is injected into the affected area, and one series of injections may last for several months. Botox is a likely treatment when topical applications fail.

In 2004, guidelines were proposed by expert physicians for treating primary hyperhidrosis. Topical treatments followed by Botox if the topical agent fails is recommended for treating axillary and facial hyperhidrosis. For palmar and plantar hyperhidrosis, topical treatment and iontophoresis, followed by Botox are recommended. Surgery is mentioned as an option only for palmar and axillary hyperhidrosis and only as a last resort.

Alternative Treatment

Although no evidence has documented an effective alternative treatment for hyperhidrosis, acupuncture, homeopathy, and/or herbal preparations are used by some individuals with hyperhidrosis. A common home remedy involves soaking the affected body parts in home-brewed tea, which contains tannic acid, a natural antiperspirant. Because stress can trigger sweating, relaxation techniques such as yoga, massage, and meditation can help with stress reduction.

Prognosis

Hyperhidrosis is not a life-threatening condition. However, it can severely affect quality of life and comfort in social situations. Children and adolescents who receive early treatment have a better quality of life. If left untreated, hyperhidrosis can result in physical, social, and occupational impairments.

Prevention

Hyperhidrosis treatments help to prevent excessive sweating but may not entirely eliminate the condition. Hyperhidrosis can be managed by using simple daily personal hygiene methods, such as the following:

  • bathing daily to reduce bacteria
  • washing and changing clothes frequently
  • changing socks or pantyhose at least twice daily
  • airing out shoes and rotating shoes worn each day
  • wearing absorbent socks, clothing shields, and natural fabrics
  • using antiperspirants in the evening and gently massaging them into the skin
  • using foot powders and going barefoot frequently to air out feet

Nutritional Concerns

Although no foods cause hyperhidrosis, certain foods and food ingredients can stimulate sweating and should be avoided. These include caffeine, alcohol, and spicy foods. Hot beverages, like coffee and hot chocolate, may also increase sweating. Consuming foods with strong odors, such as those containing garlic and onions, should be avoided because it can cause a person's sweat to smell stronger.

Parental Concerns

Children and adolescents with hyperhidrosis suffer extreme social embarrassment related to their condition, and hyperhidrosis can result in low self-esteem, difficulties in school, and difficulties in and avoidance of social situations. For example, children with palmar hyperhidrosis may have difficulties holding a pen to write, and adolescents may be reluctant to shake or hold hands with others. Children with axillary hyperhidrosis may be made fun of for excessive body odor and sweat stains. Early treatment is essential to improve children's quality of life. Joining a support group or participating in online hyperhidrosis chat groups may help individuals better manage their condition through peer support.

Resources

Books

ABBE Research Division Staff. Sweat, Sweating, Sweat Gland Problems: Index and Analysis of New Information, Research, and Clinical Results. Washington, DC: ABBE Publishers Association of Washington, DC, 2003.

Bartone, John C., Sr. Human Sweat and Sweating, Normal and Abnormal, including Hyperhidrosis and Bromhidosis, with Index of New Information and Guidebook for Reference and Research. Washington, DC: ABBE Publishers Association of Washington, DC, 2001.

Periodicals

Bhakta, B. B., and S. H. Roussounnis. "Treating Childhood Hyperhidrosis with Botulinum Toxin Type A." Archives of Disease in Childhood 86 (January 2002): 68.

Hilton, Lisette. "Stopping Sweat . . . and Soon: Botulinum Toxin Effective for Pediatric Hyperhidrosis." Dermatology Times, April 1, 2003.

Organizations

International Hyperhidrosis Society. 18 South 3rd Street Philadelphia, PA 19106. Web site: www.ihhs.net/index.html.

Web Sites

Altman, Rachel. "Hyperhidrosis." eMedicine, August 18, 2004. Available online at www.emedicine.com/derm/topic893.htm (accessed November 10, 2004).

"National Survey Finds Hyperhidrosis Affects Nearly Three Times as Many People as Previously Thought." International Hyperhidrosis Society, August 2, 2004. Available online at www.ihhs.net/about_hhs/press10.asp (accessed November 10, 2004).

[Article by: Jennifer E. Sisk, M.A.]


Sports Science and Medicine: hyperhidrosis
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Excessive sweating not directly related to exercise. It may be associated with a hot environment, wearing inappropriate clothing, fever, and certain hormonal conditions such as hyperactivity of the thyroid gland. Hyperhidrosis is not in itself a problem in sport as long as there is sufficient replacement of fluids. However, it can cause problems in gripping equipment and may produce a moist environment for fungal infections of the skin.

Veterinary Dictionary: hyperhidrosis
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Excessive sweating.

  • bovine h. syndrome — inherited in Shorthorn cattle and associated with conjunctivitis, pityriasis and digestive disturbances.
Wikipedia: Hyperhidrosis
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Hyperhidrosis
Classification and external resources
ICD-10 R61.
ICD-9 780.8
OMIM 144110 144100
DiseasesDB 6239
MedlinePlus 007259
eMedicine topic list
MeSH D006945

Hyperhidrosis is the condition characterized by abnormally increased perspiration,[1] in excess of that required for regulation of body temperature.

Contents

Classification

Hyperhidrosis can either be generalized or localized to specific parts of the body. Hands, feet, armpits, and the groin area are among the most active regions of perspiration due to the relatively high concentration of sweat glands; however, any part of the body may be affected.

Hyperhidrosis can also be classified depending on if it is a congenital or acquired trait. Primary hyperhidrosis is found to start during adolescence or even before and seems to be inherited as an autosomal dominant genetic trait. Primary hyperhidrosis must be distinguished from secondary hyperhidrosis, which can start at any point in life. The latter form may be due to a disorder of the thyroid or pituitary gland, diabetes mellitus, tumors, gout, menopause, certain drugs, or mercury poisoning.

Hyperhidrosis may be also divided into palmoplantar (symptomatic sweating of primarily the hands or feet), gustatory or generalized hyperhidrosis.[1]

Alternatively, hyperhydrosis may be classified according to the amount of skin that is affected and its possible causes.[2]:700 In this approach, excessive sweating in an area that is greater than 100 cm2 (up to generalized sweating of the entire body) is differentiated from sweating that affects only a small area.

Cause

Further information: diaphoresis

The cause of primary hyperhidrosis is unknown, although some surgeons claim that it is caused by sympathetic overactivity. Anxiety can exacerbate the situation for many sufferers. A common complaint of patients is that they get nervous because they sweat, then sweat more because they are nervous. Other factors can play a role; certain foods and drinks, nicotine, caffeine, and smells can trigger a response.

Hyperhidrosis of a relatively large area (>100 square cm or generalized)
Hyperhidrosis of relatively small area (<100 square cm)

Treatment

Hyperhidrosis can often be very effectively managed.

Medications

Aluminium chloride is used in regular antiperspirants. However, hyperhidrosis sufferers need solutions with a much higher concentration to effectively treat the symptoms of the condition. Its main secondary effect is that it can cause irritation. For severe cases of palmar and plantar hyperhidrosis there is some success using conservative measures such as aluminium chloride antiperspirants.[citation needed]

Botulinum toxin type A injections are used to disable the sweat glands.[3] The effects can last from 4–9 months depending on the site of injections. This procedure used for underarm sweating has been approved by the U.S. Food and Drug Administration (FDA).

Several anticholinergic drugs reduce hyperhidrosis. Oxybutynin (brand name Ditropan) is one that has shown promise.[4] although it has important side effects, which include drowsiness, visual symptoms and dryness in the mouth and other mucus membranes. A time release version of the drug is also available (Ditropan XL), with purportedly reduced effectiveness. Glycopyrrolate (Robinul) is another drug used on an off-label basis. The drug seems to be almost as effective as oxybutynin and has similar side-effects. Other anticholinergic agents that have been tried include propantheline bromide (Probanthine) and benzatropine (Cogentin).

Antidepressants and anxiolytics were formerly used on the belief that primary hyperhidrosis was related to an anxious personality style.

Surgical procedures

In endoscopic thoracic sympathectomy (ETS), the main sympathetic chain that runs alongside the spine, often with the addition of nearby nerve ganglia, are either cut out, burned, or clamped. Clamping is intended to permit the reversal of the procedure. ETS is generally considered a "safe, reproducible, and effective procedure and most patients are satisfied with the results of the surgery".[5] Satisfaction rates above 80% have been reported, and are higher for children.[6][7] The procedure causes relief of excessive hand sweating in about 85-95% of patients.[citation needed] ETS may be helpful in treating axillary hyperhidrosis, facial blushing and facial sweating; however, patients with facial blushing and/or excessive facial sweating experience higher failure rates, and patients may be more likely to experience unwanted side effects,[8] although this has not been established in a controlled trial or independent study.

ETS side effects have been described as ranging from trivial to devastating.[9] The most common secondary effect of ETS is compensatory sweating. Major drawbacks related to compensatory sweating are seen in 20-80%.[10][11] Most people find the compensatory sweating to be tolerable while 1-51% claim that their quality of life decreased as a result of compensatory sweating."[6] Total body perspiration in response to heat has been reported to increase after sympathectomy.[12] Compensatory sweating is often a temporary, self-limiting condition.

Additionally, the original sweating problem may recur due to nerve regeneration, sometimes within 6 months of the procedure.[10][11][13]

Other side effects include Horner's Syndrome (about 1%), gustatory sweating (less than 25%) and on occasion very dry hands (sandpaper hands).[citation needed] Some patients have also been shown to experience a cardiac sympathetic denervation, which results in a 10% lowered heartbeat during both rest and exercise; leading to an impairment of the heart rate to workload relationship.[14]

Lumbar sympathectomy is a relatively new procedure aimed at those patients for whom endoscopic thoracic sympathectomy has not relieved excessive plantar (foot) sweating. With this procedure the sympathetic chain in the lumbar region is clipped or divided in order to relieve the severe or excessive foot sweating. The success rate is about 90% and the operation should be carried out only if patients first have tried other conservative measures.[15] This type of sympathectomy is also controversial, as patients undergoing the procedure often end up with hypotension, (a sign of autonomic dysfunction), and in males retrograde ejaculation (male infertility) and inability to maintain erection has been reported.[16] New information has become available and shown that the issues of retrograde ejaculation, inability to maintain erection and hypertension are not validated. In a 2007 paper none of the patients experienced sexual dysfunction.[17]

Other used techniques are sweat gland suction and percutaneous sympathectomy. Sweat gland suction is a technique adapted from liposuction,[18] in which approximately 30% of the sweat glands are removed, with a proportionate reduction in sweat.[citation needed] Percutaneous sympathectomy is a minimally invasive procedure in which the nerve is blocked by an injection of phenol.[19] The procedure allows for temporary relief in most cases. Some medical professionals advocate the use of this more conservative procedure before the permanent surgical sympathectomy.[citation needed]

Other

Iontophoresis was originally described in the 1950s, and its exact mode of action remains elusive to date.[20] The affected area is placed in a device that has two pails of water with a conductor in each one. The hand or foot acts like a conductor between the positively- and negatively-charged pails. As the low current passes through the area, the minerals in the water clog the sweat glands, limiting the amount of sweat released. Some people have seen great results while others see no effect. The device can be painful (pain is usually limited to small wounds and over time the body adjusts to the procedure) and the process is time-consuming. The device is usually used for the hands and feet, but there has been a device created for the axillae (armpit) area and for the stump region of amputees.

Hypnosis has been used with some success in improving the process of administering injections for the treatment of hyperhidrosis .[21] Talc or baby powder can be used as a temporary treatment because the powder will absorb the sweat; however, it may also become a messy white coating on the place of application.[citation needed] Absorbent shoe insoles decrease the sweat in shoes. Relaxation and meditation and weight loss have also been proposed to be of help.[citation needed]

Prognosis and impact

Excessive sweating of the hands interferes with many routine activities,[22] such as securely grasping objects. Some hyperhidrosis sufferers avoid situations where they will come into physical contact with others, such as greeting a person with a handshake. Hiding embarrassing sweat spots under the armpits limits the sufferers' arm movements and pose. In severe cases, shirts must be changed several times during the day. Additionally, anxiety caused by self-consciousness to the sweating may aggravate the sweating. Excessive sweating of the feet makes it harder for patients to wear slide-on or open-toe shoes, as the feet slide around in the shoe because of sweat.

Some careers present challenges for hyperhidrosis sufferers. For example, careers which require the deft use of a knife may not be safely performed by people with excessive sweating of the hands. Employees, such as sales staff, who interact with many new people can be negatively affected by social rejection. The risk of dehydration can limit the ability of some sufferers to function in extremely hot (especially if also humid) conditions.[citation needed] Even the playing of musical instruments can be uncomfortable or difficult because of sweaty hands.

Epidemiology

Primary hyperhidrosis is estimated at 2.8% of the population.[22] It affects men and women equally, and most commonly occurs among people aged 25–64 years.[22] About 30–50% have another family member afflicted, implying a genetic predisposition.[22]

References

  1. ^ a b James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. Page 777-8. ISBN 0721629210.
  2. ^ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0071380760.
  3. ^ Bhidayasiri R, Truong DD (2007). "Evidence for effectiveness of botulinum toxin for hyperhidrosis". Journal of Neural Transmission 115: 641. doi:10.1007/s00702-007-0812-7. PMID 17885725. 
  4. ^ Mijnhout GS, Kloosterman H, Simsek S, Strack van Schijndel RJ, Netelenbos JC (2006). "Oxybutynin: dry days for patients with hyperhidrosis". The Netherlands journal of medicine 64 (9): 326–8. PMID 17057269. 
  5. ^ Henteleff HJ, Kalavrouziotis D (May 2008). "Evidence-based review of the surgical management of hyperhidrosis". Thorac Surg Clin 18 (2): 209–16. doi:10.1016/j.thorsurg.2008.01.008. PMID 18557593. 
  6. ^ a b Steiner Z, Cohen Z, Kleiner O, Matar I, Mogilner J (March 2008). "Do children tolerate thoracoscopic sympathectomy better than adults?". Pediatr. Surg. Int. 24 (3): 343–7. doi:10.1007/s00383-007-2073-9. PMID 17999068. 
  7. ^ Dumont P, Denoyer A, Robin P (November 2004). "Long-term results of thoracoscopic sympathectomy for hyperhidrosis". Ann. Thorac. Surg. 78 (5): 1801–7. doi:10.1016/j.athoracsur.2004.03.012. PMID 15511477. 
  8. ^ Reisfeld, Rafael. "Sympathectomy for hyperhidrosis: should we place the clamps at T2-T3 or T3-T4 - Clinical Autonomic Research, December 2006, Volume 16, Number 6." (PDF). http://www.sweaty-palms.com/hyperhidrosis_sweating.pdf. Retrieved 2007-11-04. 
  9. ^ Schott GD (March 1998). "Interrupting the sympathetic outflow in causalgia and reflex sympathetic dystrophy". BMJ 316 (7134): 792–3. PMID 9549444. PMC: 1112764. http://bmj.com/cgi/pmidlookup?view=long&pmid=9549444. 
  10. ^ a b Gossot D, Galetta D, Pascal A, et al. (April 2003). "Long-term results of endoscopic thoracic sympathectomy for upper limb hyperhidrosis". Ann. Thorac. Surg. 75 (4): 1075–9. doi:10.1016/S0003-4975(02)04657-X. PMID 12683540. 
  11. ^ a b Yano M, Kiriyama M, Fukai I, et al. (July 2005). "Endoscopic thoracic sympathectomy for palmar hyperhidrosis: efficacy of T2 and T3 ganglion resection". Surgery 138 (1): 40–5. doi:10.1016/j.surg.2005.03.026. PMID 16003315. 
  12. ^ Kopelman D, Assalia A, Ehrenreich M, Ben-Amnon Y, Bahous H, Hashmonai M (2000). "The effect of upper dorsal thoracoscopic sympathectomy on the total amount of body perspiration". Surg. Today 30 (12): 1089–92. doi:10.1007/s005950070006. PMID 11193740. http://link.springer.de/link/service/journals/00595/bibs/0030012/00301089.htm. 
  13. ^ Walles T, Somuncuoglu G, Steger V, Veit S, Friedel G (January 2009). "Long-term efficiency of endoscopic thoracic sympathicotomy: survey 10 years after surgery". Interact Cardiovasc Thorac Surg 8 (1): 54–7. doi:10.1510/icvts.2008.185314. PMID 18826967. 
  14. ^ Abraham P, Picquet J, Bickert S, et al. (December 2001). "Infra-stellate upper thoracic sympathectomy results in a relative bradycardia during exercise, irrespective of the operated side". Eur J Cardiothorac Surg 20 (6): 1095–100. doi:10.1016/S1010-7940(01)01002-8. PMID 11717010. http://linkinghub.elsevier.com/retrieve/pii/S1010794001010028. 
  15. ^ Reisfeld, Rafael (2008-05-04). "Lumbar Sympathectomy". http://www.sweaty-palms.com/lumbar_sympathectomy.html. Retrieved 2008-05-04. 
  16. ^ Kawamata YT, Kawamata T, Omote K, et al. (January 2004). "Endoscopic thoracic sympathectomy suppresses baroreflex control of heart rate in patients with essential hyperhidrosis". Anesth. Analg. 98 (1): 37–9, table of contents. doi:10.1213/01.ANE.0000094984.90178.33. PMID 14693579. http://www.anesthesia-analgesia.org/cgi/pmidlookup?view=long&pmid=14693579. 
  17. ^ Rieger R, Pedevilla S (January 2007). "Retroperitoneoscopic lumbar sympathectomy for the treatment of plantar hyperhidrosis: technique and preliminary findings". Surg Endosc 21 (1): 129–35. doi:10.1007/s00464-005-0690-8. PMID 16960674. 
  18. ^ Bieniek A, Białynicki-Birula R, Baran W, Kuniewska B, Okulewicz-Gojlik D, Szepietowski JC (2005). "Surgical treatment of axillary hyperhidrosis with liposuction equipment: risks and benefits". Acta dermatovenerologica Croatica : ADC / Hrvatsko dermatolosko drustvo 13 (4): 212–8. PMID 16356393. 
  19. ^ Wang YC, Wei SH, Sun MH, Lin CW (2001). "A new mode of percutaneous upper thoracic phenol sympathicolysis: report of 50 cases". Neurosurgery 49 (3): 628–34; discussion 634–6. doi:10.1097/00006123-200109000-00017. PMID 11523673. 
  20. ^ Kreyden OP (2004). "Iontophoresis for palmoplantar hyperhidrosis". Journal of cosmetic dermatology 3 (4): 211–4. doi:10.1111/j.1473-2130.2004.00126.x. PMID 17166108. 
  21. ^ Maillard H, Bara C, Célérier P (2007). "[Efficacy of hypnosis in the treatment of palmar hyperhidrosis with botulinum toxin type A.]" (in French). Annales de dermatologie et de vénéréologie 134 (8): 653–4. PMID 17925688. 
  22. ^ a b c d Haider, A; Solish N (January 2005). "Focal hyperhidrosis: diagnosis and management". Canadian Medical Association Journal 172 (1): 69–75. doi:10.1503/cmaj.1040708. PMID 15632408. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15632408. 

External links

v • d • e
Symptoms and signs: general / constitutional (R50-R61, 780.6-780.9)
Temperature
heat: Fever (Fever of unknown origin, Drug-induced fever) • Hyperhidrosis (e.g., Sleep Hyperhidrosis; "Sweating") • Hyperpyrexia • Hyperthermia
cold: Chills
Aches/Pains
Malaise and fatigue
Miscellaneous

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