Title: GZ / The Grenz Zone Season 3 / Ep 37
Tags: GZ DermnetNZ

Q: Which area is most commonly affected by hyperhidrosis?
[...]
A: Armpits
Back Extra: Armpit involvement seen in over 50% of affected hyperhydrosis patients

Q: 90% of hyperhidrosis cases that present before puberty affect which body part(s)
[...]
A: Palms and soles

Q: Forehead and scalp involvement in hyperhidrosis patients is more commonly seen in [men/women]
A: men

Q: Where can eccrine and apocrine glands be found in a 1:1 ratio?
[...]
A: Armpits
Back Extra: Elsewhere in the body, eccrine glands are MUCH more prevalent (90% of sweat glands are eccrine glands)

Q: The secretory portion of the sweat gland makes sweat, and is located in the [...] or at the [...] junction
A: bottom 1/3 of dermis; dermal-sub-Q

To diagnose primary hyperhidrosis, a patient must experience 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
Back Extra: Red flags for secondary HH: Begins at age > 25, unilateral or generalized involvement, night sweats
Ask about other B symptoms

The causes of secondary hyperhidrosis can be remembered with the mnemonic DENIM
Drugs
Endocrine
Neurologic disease
Infections
Menopause of Malignancies
Back Extra: Sweat soaking through your denim
o Drugs: antidepressants, antibiotics like ciprofloxacin, NSAIDS, alcohol, or cocaine
o Endocrine: diabetes or hypoglycemia, hyperthyroidism, pheochromocytoma, or carcinoid syndrome
o Neurologic disease: Parkinson’s disease, stroke, psychiatric disorders
o Infections: acute viral or bacterial infections causing fevers, tuberculosis or malaria
o Menopause or Malignancies: Lymphomas or myeloproliferative disorders

Q: How does aluminum chloride help patients with hyperhidrosis?
[...]
A: Forms precipitant with sweat to block sweat ducts
Back Extra: Make sure patients use
medication correctly - apply at
night when NOT actively sweating,
takes 1-2 weeks to work, continue
to use intermittently for
maintenance, can cause miliaria

Q: How does glycopyrrolate help patients with hyperhidrosis?
[...]
A: Competitively inhibits Ach receptors on sweat glands
Back Extra: Glycopyrrolate is an antimuscarinic that is available in topical and oral formulations

Q: How do botulinum toxin injections help patients with hyperhidrosis?
[...]
A: Blocks SNAP-25 protein, which prevents Ach release from pre-synaptic nerves
Back Extra: Start with 50 units/armpit, 10-20 injections spaced 1-2 cm apart, inject 2-3 mm deep
Secretory portion is at dermal subQ junction, so you only need to go 2-3 mm deep when injecting
Can also try botox with hands and feet, but this is less effective and greater risk for side effects

Q: Iontophoresis is particularly useful for hyperhidrosis affecting which body part(s)
[...]
A: Hands and feet
Back Extra: Works 80% of time in these areas
Patients soak hands or feet in fluid filled basin connected to the iontophoresis machine for 20-30 min, then positively charged electrode drives hydrogen ions into sweat ducts à stops sweating
Repeat 3-4x weekly, works in 2-4 weeks, then use as needed for maintenance

Q: [...] is a last resort surgical treatment for hyperhidrosis due to invasiveness and high likelihood of compensatory sweating
A: Sympathectomy