A 22-year-old woman has bilateral palmar sweating that interferes with writing and social contact since adolescence. Episodes occur while awake, never during sleep, and there is no secondary cause on evaluation. After failure of topical measures, the next standard conservative treatment is:

• A Oral oxybutynin as first-line systemic therapy before local measures
• B Topical capsaicin applied nightly
• C Immediate referral for thoracic sympathectomy
• D Tap water iontophoresis of the palms ✓

Explanation

Primary focal palmar hyperhidrosis follows a treatment ladder: topical aluminium chloride first, then tap water iontophoresis, then intradermal botulinum toxin or oral anticholinergics such as oxybutynin, with endoscopic thoracic sympathectomy reserved for refractory cases because of compensatory hyperhidrosis. Iontophoresis is the accepted second step and is well suited to palms and soles. Capsaicin is used in neuropathic itch and pain, not hyperhidrosis.

Reference: Bolognia Dermatology, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.