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Palmar and plantar hyperhidrosis: a practical management algorithm

Antranik Benohanian, Adom Boudjikanian and Yetvart Paylan

Treatment modalities for palmar and plantar hyperhidrosis include aluminum chloride hexahydrate formulations, either in ethanol or in a salicylic acid gel, iontophoresis, oral anticholinergics, botulinum toxin type A injections and surgical procedures. Failure to respond to these conservative measures is often an indication to use surgical interventions such as thoracic or lumbar sympathectomy, which can be complicated by compensatory hyperhidrosis. Extemporaneous formulations containing appropriate concentrations of aluminum chloride hexahydrate, tailored to the patient’s need, prepared by knowledgeable pharmacists, may avert the need for surgery. This report will focus on strategies for optimizing treatment outcomes in palmar and plantar hyperhidrosis used in our hyperhidrosis clinic in Canada over the last 28 years.