Surgery and botulinum toxin are treatments of choice in severe cases

Physiological sweating from cutaneous eccrine glands maintains normothermia and skin hydration. Properly hydrated palmar skin contributes to the effectiveness of normal grip and permits tasks such as turning the pages of the BMJ. Hyperhidrosis is unphysiological and excessive sweating, which squanders water and electrolytes without compensatory cooling from the latent heat or enthalpy of evaporation. It affects about 1% of the United Kingdom population. What help can be offered to patients with this disabling condition?

Hyperhidrosis commonly affects the palms of the hands, the soles of the feet, or the armpits, but in a small number of patients it occurs over the whole body surface. In most patients palmar and/or axillary hyperhidrosis is the major problem, and it is freedom from sweating in the hands or armpits that they seek. In some patients hyperhidrosis affects only the hands or armpits or soles of the feet. Patients with palmar hyperhidrosis have a slippy grip and a cold wet handshake, and their sweat drips into computer keyboards, wets paper, and smudges ink. Exuberant axillary and plantar hyperhidrosis stains and damages clothing and shoes. Eccrine sweat is initially odourless, but patients are embarrassed and inconvenienced by having …