Maazi Mahan, Leung Alexander Kc, Lam Joseph M
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Department of Pediatrics, The University of Calgary, and The Alberta Children's Hospital, Calgary, Alberta, Canada.
Drugs Context. 2025 Jun 16;14. doi: 10.7573/dic.2025-3-2. eCollection 2025.
Hyperhidrosis (HH) is a condition characterized by excessive sweating beyond the physiological needs of thermoregulation. HH can be classified as primary (idiopathic) hyperhidrosis (PHH) or secondary hyperhidrosis (SHH), which is associated with underlying medical conditions, medications or systemic disorders. This narrative review provides an updated overview of PHH, with a focus on epidemiology, aetiopathogenesis, clinical manifestations, diagnostic approaches and current management strategies, particularly highlighting pharmacological and procedural treatment options.
A literature search was conducted in February 2025 across Ovid Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) using the key term "hyperhidrosis". The review included observational studies, clinical trials, narrative reviews, guidelines and meta-analyses published in the past 10 years. Additional references were identified through manual searches of relevant bibliographies.
The global prevalence of PHH is estimated to range between 0.072% and 9%, with PHH accounting for 93% of all HH cases. Whilst the precise pathophysiology remains unclear, PHH is believed to result from sympathetic overactivity, whereas SHH is associated with endocrine, neurological, infectious, malignant and medication-induced causes. PHH is diagnosed clinically and distinguishing between primary and secondary forms is essential. Management options vary based on severity, ranging from topical therapies (antiperspirants, anticholinergics), systemic medications (oral anticholinergics, adrenergic modulators), device-based interventions (iontophoresis, microwave thermolysis), injectable therapies (botulinum toxin) and surgical approaches (sympathectomy, excision, liposuction/curettage). Whilst these interventions can significantly improve symptoms and quality of life, long-term efficacy, recurrence and adverse effects remain concerns.
PHH significantly impacts the quality life of patients contributing to both physical discomfort and psychosocial distress. An individualized, multi-modal approach is crucial to optimizing management. Further research is warranted to refine existing therapies and evaluate emerging treatment modalities for improved long-term outcomes.
多汗症（HH）是一种以出汗超过体温调节生理需求为特征的病症。HH可分为原发性（特发性）多汗症（PHH）或继发性多汗症（SHH），后者与潜在的疾病、药物或全身性疾病有关。本叙述性综述提供了PHH的最新概述，重点关注流行病学、病因发病机制、临床表现、诊断方法和当前的管理策略，特别强调了药物和程序性治疗选择。
2025年2月在Ovid Medline、EMBASE和Cochrane对照试验中央注册库（CENTRAL）中使用关键词“多汗症”进行文献检索。该综述纳入了过去10年发表的观察性研究、临床试验、叙述性综述、指南和荟萃分析。通过手动检索相关参考文献确定了其他参考文献。
据估计，PHH的全球患病率在0.072%至9%之间，PHH占所有HH病例的93%。虽然确切的病理生理学尚不清楚，但PHH被认为是由交感神经过度活跃引起的，而SHH与内分泌、神经、感染、恶性和药物诱导的原因有关。PHH通过临床诊断，区分原发性和继发性形式至关重要。管理选择因严重程度而异，范围从局部治疗（止汗剂、抗胆碱能药物）、全身性药物（口服抗胆碱能药物、肾上腺素能调节剂）、基于设备的干预（离子电渗疗法、微波热解）、注射疗法（肉毒杆菌毒素）和手术方法（交感神经切除术、切除术、抽脂/刮除术）。虽然这些干预措施可以显著改善症状和生活质量，但长期疗效、复发和不良反应仍然令人担忧。
PHH对患者的生活质量有显著影响，会导致身体不适和心理社会困扰。个性化的多模式方法对于优化管理至关重要。有必要进行进一步研究以改进现有疗法并评估新兴治疗方式，以改善长期结果。
