Diagnostic tests

Focal hyperhidrosis is a clinical diagnosis, diagnosable by a hand shake or stained clothes. In severe localised excessive sweating, pearls of sweat form even when the person is resting. In addition, the amount of sweat and the area affected can be measured. The amount of sweat can be measured by gravimetry (milligrams of sweat produced over a period of time). However there is no standardisation on the time period for which sweat should be collected. In the two randomised clinical trials (RCTs) on botulinum toxin A, Heckmann et al.6 report the sweat rate in mg/minute whereas Naumann et al.7 used units of mg/5 minutes. In other trials a volume per 10 minutes has been used.8,9 The area that is affected by increased sweating can be defined by the ninhydrin test or the iodine starch test. Both tests use a change in colour to indicate the hyperhidrotic area. Studies on validity or reproducibility are not available for either test.

In most studies - especially the studies evaluating surgical interventions - patient satisfaction is used as a marker of therapeutic success.3,10

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