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Options for Tx of hyperhidrosis in children

The diagnosis and treatment of hyperhidrosis can have a significant impact on the quality of life in the pediatric population of patients, according to Dr. Adelaide Hebert.

It is important to consider that hyperhidrosis is not just a sweating issue—this condition makes a person quite vulnerable to developing depression and anxiety, said Dr. Hebert, chief of pediatric dermatology at McGovern School of Medicine and Children’s Memorial Hermann Hospital in Houston.

“Hyperhidrosis can be extremely detrimental to the child’s development of confidence and sense of self,” she said during a presentation at the annual meeting of the American Academy of Dermatology in Orlando, Fla.

Embarrassing for young patients

The presence of hyperhidrosis can be embarrassing for pediatric patients. For example, young patients often experience rejection from their peers who do not want to hold their hand when playing a game or crossing the street. Also, these patients have reported that due to excessive hand sweating that they have ruined or smeared their homework and artwork, explained Dr. Herbert.

“Teenagers often describe to me that their condition makes them feel isolated, insecure and embarrassed. They are certain that they are the only person on earth who has this condition,” she said and added that “it is tough for people to grow up having this ostracizing condition. The treatment that these patients receive is appreciated.”

During Dr. Hebert’s presentation, she noted Gillette clinical strength and Secret clinical strength deodorant can be helpful for pediatric patients.

“These products are a stronger deodorant, and should be applied twice a day in order to obtain maximum efficacy,” she said.

Other options available

Aluminum chloride might also benefit pediatric patients with hyperhidrosis, said Dr. Hebert. Aluminum chloride can be applied once or twice a day, but it should be applied onto dry skin.

Applying aluminum chloride onto a moist surface will cause a weak hydrochloric acid to form and cause irritation, making the patient worse instead of better, she said.

Another potential beneficial treatment for pediatric patients with hyperhidrosis is glycopyrrolate. “In the Houston area, we [prescribed] glycopyrrolate 1 mg per day and then increase to twice a day—especially for teenage boys,” she said.

“Glycopyrrolate does not cross the blood/brain barrier. So, there are zero to a few adverse effects,” Dr. Hebert said, adding that common side effects include dry mouth, constipation, and dry eyes.

“We do not use glycopyrrolate for infants less than one month of age, and that is because it contains benzyl alcohol.”

One treatment useful for pediatric patients less than five years of age who have hyperhidrosis is oxybutynin. “There are some extended release forms of oxybutynin, but I do not personally recommend those for children with hyperhidrosis. They do well with multiple daily doses and tolerate it nicely,” she said.

An additional option for the treatment of young patients with hyperhidrosis is iontophoresis. “This is a great tool for kids. We usually do the first session in the clinic to see if the patient can tolerate it. Ideally, the patient uses iontophoresis for about 10 to 20 minutes three times a week for two to three weeks, and then they do maintenance therapy about once a week," she said. “Iontophoresis works best for the treatment of palmar hyperhidrosis; however, some patients have reported a reduction in plantar hyperhidrosis as well.”

Iontophoresis is not recommended for patients who are pregnant or for those with a pacemaker or a defibrillator. It is also not well suited for people with arrhythmia or epilepsy.

OnabotulinumtoxinA can also be beneficial for pediatric patients with palmar and plantar hyperhidrosis, but the problem with using the treatment in this population of patients is pain control, she explained. Dr. Hebert added that when injecting the palms and feet of pediatric patients with hyperhidrosis she usually conducts such procedures in an operative suite setting.

She recommends against endoscopic thoracic sympathectomy for the treatment of hyperhidrosis patients because it can result in problematic post-operative sweating (Pediatric Surg Int 2008; 24(8):343–347).

At the conclusion of Dr. Hebert’s presentation, she noted that “it is important for dermatologists to embrace the management and education for patients who have hyperhidrosis. This condition often begins during childhood or adolescence, and these

patients truly have special needs.”

Reading recommendations

Dr. Hebert recommends the following articles relating to the treatment of pediatric patients with hyperhidrosis:

  • Diagnosis and treatment of primary focal hyperhidrosis in children and adolescents (Semin Cutan Med Surg 2010; 29:121–126).

  • Update on pediatric hyperhidrosis (Dermatol Ther 2013; 26(6):452–461).

  • Special considerations for children with hyperhidrosis (Dermatologic Clinics Oct. 2014; 32(4):477–484).

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