Mixed diagnoses – 10 cases (10 of 11)

The starting point is the use of antiperspirant solution to plug the sweat ducts. These contain aluminium chloride 20% in alcohol, e.g. Hidrosol, and are applied as a thin smear to dry skin, nightly at first then twice weekly as maintenance. They may irritate, so if dryness or dermatitis arise emollients must also be used.


Iontophoresis, available at some hospital physiotherapy departments. This directs a mild electrical current through the skin and blocks the sweat ducts. Drionic® battery powered units for personal use can be purchased for about US$150.

Oral propantheline 15 -30mg orally up to four times daily. Adverse effects include dry mouth, blurred vision, and other anticholinergic effects.

BOTOX® injection. Recent reports of experimental use of Botulinum toxin injected subcutaneously into palmar skin are promising. There is a risk of motor muscle paralysis.

Transthoracic endoscopic sympathectomy may be appropriate for selected cases with severe symptoms. Complications include recurrent hidrosis, pneumothorax, Horner's syndrome, neuralgia and compensatory hyperhidrosis in nondenervated areas.