From the Guidelines
The workup of pre-adolescent hyperhidrosis should begin with a thorough history and physical examination to distinguish between primary (idiopathic) and secondary hyperhidrosis. Primary hyperhidrosis typically presents with focal, symmetric sweating (commonly affecting palms, soles, axillae, or face), occurs during waking hours, has at least one episode per week, onset before 25 years, and often has a family history. Secondary causes should be ruled out through targeted laboratory testing including complete blood count, comprehensive metabolic panel, thyroid function tests, and fasting glucose. Additional tests may include urine catecholamines if pheochromocytoma is suspected. Medications that can cause hyperhidrosis should be reviewed. For primary hyperhidrosis, first-line treatment includes topical antiperspirants containing aluminum chloride (such as Drysol 20%), applied nightly to dry skin.
Some key points to consider in the workup and management of pre-adolescent hyperhidrosis include:
- Distinguishing between primary and secondary hyperhidrosis through a thorough history and physical examination
- Ruling out secondary causes through targeted laboratory testing
- Considering the use of topical antiperspirants, oral anticholinergics, and iontophoresis as treatment options
- Addressing psychological aspects, as hyperhidrosis can significantly impact quality of life in children, causing social anxiety and embarrassment
- Individualizing treatment based on severity, location, and impact on daily functioning. Although the study by 1 discusses sweat testing for cystic fibrosis, it is not directly relevant to the workup of pre-adolescent hyperhidrosis. The study by 1 discusses hydration and thermal strain during tennis in the heat, but does not provide guidance on the workup of hyperhidrosis.
In terms of treatment, topical antiperspirants containing aluminum chloride are a first-line option, and oral anticholinergics like glycopyrrolate may be considered for children with moderate to severe symptoms unresponsive to topical treatments. Iontophoresis can be effective for palmar and plantar hyperhidrosis, and botulinum toxin injections are generally reserved for adolescents and adults. Overall, the goal of treatment is to improve quality of life and reduce the impact of hyperhidrosis on daily functioning.
From the Research
Workup of Pre-Adolescent Hyperhydrosis
- Hyperhydrosis is a condition characterized by excessive sweating that can have a significant impact on a person's quality of life, particularly in children and adolescents 2.
- The condition can be primary (idiopathic) or secondary, caused by an underlying medical condition or medication use 3.
- The Hyperhidrosis Disease Severity Scale is a validated survey used to grade the tolerability of sweating and its impact on quality of life, and can be used to guide treatment 3.
Treatment Options
- Topical aluminum chloride solution is often the initial treatment for primary focal hyperhydrosis 3, 4.
- Iontophoresis is a treatment option for hyperhydrosis of the palms and soles, and can be considered for pre-adolescents 5, 3, 4.
- Botulinum toxin injection is considered a first- or second-line treatment for axillary, palmar, plantar, or craniofacial hyperhydrosis, but may not be suitable for all pre-adolescents due to potential side effects and need for repeated treatments 5, 3, 4.
- Oral anticholinergics, such as glycopyrrolate, can be useful adjuncts in severe cases of hyperhydrosis when other treatments fail 3, 4.
Considerations for Pre-Adolescents
- Treatment of hyperhydrosis in pre-adolescents should be tailored to the individual patient's needs, characteristics, and goals 6.
- Topical preparations, iontophoresis, and anticholinergic medications may be suitable treatment options for pre-adolescents with hyperhydrosis 6.
- Botulinum toxin injection and other treatments may be considered on a case-by-case basis, taking into account the potential benefits and risks for the individual patient 5, 3, 4.