Symptoms

• Primary hyperhidrosis affects the palms, axillae, plantar surfaces, face and neck, and torso in decreasing frequency, but also in different combinations.

• Areas of involvement are usually symmetrical.

• The condition is typically absent during sleep, and classic symptoms of Raynaud's syndrome are usually not present.

• The excessive sweating may be episodic, continuous or seasonal and can be exacerbated or precipitated by thermal, gustatory, or emotional stimuli specific to the individual patient.

• Although sweating may be more intense during hot weather, climate is not considered a major causal factor.

• The clinical picture is usually so clear-cut that extensive investigation is not required.

• It is not a severe, life-threatening disease, but represents an extremely uncomfortable situation.

• This discomfort can be seen in a great number of routine activities, leading to significant unease, embarrassment and shame, severely compromising the affective, professional and social life of those affected.

• Socially and economically disabling symptoms occur particularly in palmar hyperhidrosis. Copious palmar sweating (Fig. 3.2.2) causes difficulty in social contact, writing, manual activities, car driving and handling objects, among others.

• Sweaty feet, besides the discomfort they produce, render the use of sandals or even barefoot walking difficult.

• Axillary hyperhidrosis dampens and stains clothes in addition to embarrassing their wearers, who usually wear only black or white clothes.

• Craniofacial hyperhidrosis intensely embarrasses those who present it, by drawing attention to them and at the same time making them feel insecure, afraid and lacking in confidence. In a significant number of cases this insecurity is aggravated by the lack of importance given to the patient's complaint (both by relatives and even by the attending physicians), diagnosis failure and a succession of previously proposed ineffective measures.

Fig. 3.2.2 Palmar hyperhidrosis

3.2.2.4 Treatment

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