Case Report What is Hyperhidrosis? Eccrine gland CC: “Sweating is going to dysfunction with central dysregulation commonly with family history. ruin my wedding in 6wks.” Prevalence ~3% of population have ADLs S: 24yo F with 15-yr hx of excessive negatively impacted by excessive sweating sweating face, chest, hands, axillae, feet. Affect on Patient Medical sequelae typically Symptoms occur daily, not while modest, but personal costs can be very high sleeping. The patient denies weight loss, -social, emotional, professional fatigue, night sweats, heart palpitations, jitteriness, polyuria/polydipsia, flushing, Comforting patient presentation pruritis, fever, or edema. Only med is Focal sweating >1X/wk, >6m duration, onset <25yo, levothyroxine 50mcg. PMH depression. no constitutional Sx, + FH, no night time sweating. No surgeries. No allergies. Dad has Concerning patient presentation excessive sweating. Non-smoker, no HYPERHIDROSIS Generalized sweating, recent onset, >50+ at onset, drugs, light alcohol intake, SAD, BMI 37, night time Sx, constitutional Sx light irregular exercise. Causes of Generalized HH O: Normal vitals. Distraught, crying, IS EASY Endocrine: menopause, hyperthyroid, DM, pheochromatosis, anxious. Copious diaphoresis face, chest, hyperpituitarism, carcinoid syndrome hands, axillae, feet. Minor skin irritation Medications: propranolol, TCA, cholinesterase inhibitors, axillae. Remainder of exam FOR SSRI, opioids unremarkable. Labs TSH 2.6, Febrile Illness: malaria, tuberculosis, endocarditis, HIV unremarkable CBC, CMP, prolactin. CHF A: Primary Focal Hyperhidrosis. FAMILY MEDICINE Neurologic: Parkinson’s, peripheral neuropathies, brain lesions Severe. Multiple regions of complaint. Malignancy No indication of underlying pathology. P: Initial tx aluminum hexahydrate, but not effective and pt had too much skin Treatment options irritation. Next step oxybutynin 5mg. Topical: Aluminum hexahydrate, limited by dermatitis This was well tolerated and titrated up to Oral: oxybutynin et al, limited by side effects 15mg ER. No tx limiting side effects. Injections: Botox, limited by pain and cost Dramatic improvement in diaphoresis. Surgery: Sympathectomy, limited by death and RESULT: disfigurement Michael Nelson, MD Wedding of her dreams.