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Approach

• Expose to elbows
• Ask patient to place palm upwards on a pillow

1. Inspect
   • Excessive sweat on palms
2. Palpate
   • Excessive sweat on palms

Completion

1. Examine axillae, groins, soles
2. Enquire about social affects of symptoms
3. Exclude underlying causes

Differential diagnoses

1. Anxiety
2. Hyperthyroidism
3. Hyperhidrosis erythematosus traumatica - rare occupational form where vibration produces excessive sweating of skin
4. Phaeochromocytoma

Treatment

1. Reassurance
2. Medical - aluminium hexachloride solution
3. Surgical
   • Botulinum A-neurotoxin
   • Palmar: cervical sympathetcomy
   • Plantar: lumbar sympathetcomy

Complications  of surgery

1. Excessive dryness of skin
2. Compensatory sweating around trunk (in up to 50% or patients)
3. Horner's syndrome (damage to stellate ganglion)
4. Pneumothorax / haemothorax

Other  parts of the body that can be affected by hyperhidrosis

• Face: syringomyelia, Frey's syndrome