Hyperhidrosis

Question 1

Eccrine sweat glands have ____ receptors and are effected by the _____nervous system

Answer 1

• muscarinic acetylcholine receptors
• sympathetic nervous system

Question 2

What is the MOA of botox for hyperhidrosis?

Answer 2

• inhibits release of presynaptic Ach (remember that eccrine sweat glands have muscarinic Ach receptors)

Question 3

Primary hyperhidrosis makes up ____ % of cases and secondary is ____ %

Answer 3

• 93% primary
• 7% secondary

Question 4

What are the warning signs to look for secondary cause of hyperhidrosis?

Answer 4

1. onset after 25 years of age
2. unilateral or generalized sweating (primary is typically bilateral in armpits, palms/soles commonly affected)
3. sweating at night (ask about other B symptoms)

Question 5

What are the diagnostic criteria for primary hyperhidrosis?

Answer 5

excessive sweating for 6 months without apparent cause plus 2 or more of these 6 criteria:

1. Bilateral and relatively symmetric sweating
2. Occurrence of excessive sweating at least once per week
3. Impairment of daily activities
4. Onset less than 25 years old
5. A positive family history of hyperhidrosis
6. Lack of sweating during sleep

Question 6

mnemonic for secondary causes of hyperhidrosis:

Answer 6

DENIM makes you sweat:

D: Drugs- antidepressants, antibiotics like ciprofloxacin, NSAIDS, alcohol, or cocaine

E: Endocrine- diabetes or hypoglycemia, hyperthyroidism, pheochromocytoma, or carcinoid syndrome

N: neurologic- Parkinson’s disease, stroke, psychiatric disorders

I: Infections- acute viral or bacterial infections causing fevers, tuberculosis or malaria

M: Metabolic/malignancy- Lymphomas or myeloproliferative disorders

Question 7

What is the general order of treatment for tx of primary hyperhidrosis?

Answer 7

1. topical aluminum chloride (6%-40%)- should be applied at night before bed when patient is not sweating! Takes 2 weeks to take effect.
2. Glycopyrrolate wipes (competitively inhibits AcH receptors)
3. At this point can try orals or see if botox will be covered

Oral options include: glycopyrrolate and oxybutinin (check to make sure patient isn’t on any other anticholinergic medications like Tricyclic antidepressants)

4. iontophoresis

Question 8

What is the MOA of glycopyrrolate for hyperhidrosis?

Answer 8

competitively inhibits AcH receptors