Hyperhidrosis palmaris et plantaris R61.0

Investigations in "hyperhidrosis families" revealed a family clustering. In 30-50% of cases, other family members are affected. Genetic studies on Asian collectives could show that predisposing, controlling genes are located on chromosomes 14q11.2-q13 and 2q31.1.

Iontophoresis: Used especially for increased hand and foot perspiration, sometimes also for severe underarm weeping. The therapy is not suitable for pregnant women and patients with cardiac arrhythmia, pacemakers or endoprostheses. Initial: Therapy trial with 10 min./day (pulse current device) 4-5 times/week for 3-4 weeks. With proven effectiveness, continuation as home therapy with 3-4 treatments/week (Intophoresis device available via http://www.iontophorese.de/iontophoresegeraete.htm).

Alternative: Botulinum toxin: In case of therapy resistance, treatment with botulinum toxin A is an alternative. Botulinum toxin A leads to an inhibition of the transmission of nerve stimuli to the sweat gland cells. The dosage for "Dysport®" is 250U per palm. In this case, local anesthesia by hand blockade is useful after prior treatment with EMLA. The effect is limited in time (6-11 months), but can be repeated if the effect wears off.

In case of therapy resistance: Endoscopic transthoracic sympathectomy (ETS): In suitable centers the "video-assisted-thoracic surgery" (VATS) is the method of choice. The transection/blockade should include the T2 and T3 ganglia (Cramer MN et al. 2011). The success rate of this surgical technique is high (95-98%).

1. Chen J et al (2015) A novel locus for primary focal hyperhidrosis mapped on chromosomes 2q31.1 Br J Dermatol 172: 1150-1153
2. Connolly M (2003) Management of primary hyperhidrosis: a summary of the different treatment modalities. At J Clin Dermatol 4: 681-697
3. Lecouflet M et al (2014) Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis: a study of 28 patients.
   J Am Acad Dermatol 70:1083-1087
4. Lowe NJ et al (2007) Botulinum toxin type A in the treatment of primary axillary hyperhidrosis: a 52-week multicenter double-blind, randomized, placebo-controlled study of efficacy and safety. J Am Acad Dermatol 56: 604-611
5. Naumann M et al (1998) Focal hyperhidrosis: effective treatment with intracutaneus botulinum toxin. Arch Dermatol 134: 301-304
6. Schauf G et al (1994) Modification and optimization of tap water iontophoresis. Dermatologist 45: 756-761
7. Simonetta Moreau M et al (2003) A double blind, randomized study of Dysport vs. Botox in primary palmar hyerphidrosis. Br J Dermatol 249: 1041-1045
8. Stolman LP (2003) Treatment of hyperhidrosis. J Drugs Dermatol 2: 521-527
9. Wollina U et al (1998) Therapy of hyperhidrosis with tap water iontophoresis. Positive effect on healing time and lack of recurrence in hand-foot eczema. dermatologist 49: 109-113