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Hyperhidrosis — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

HardDermatological SurgeryHyperhidrosisSCE Dermatology

An adult has severe palmar and axillary primary hyperhidrosis despite correctly used aluminium chloride. Palmar function is the dominant problem. Which next treatment best targets that site before irreversible surgery?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Use a course of tap-water iontophoresis for palmar disease before sympathectomy

Explanation lettering: D = shown as A · E = shown as B · A = shown as C · C = shown as D · B = shown as E

D is correct. Iontophoresis is a standard site-directed option for palmar or plantar hyperhidrosis after topical aluminium chloride fails. Axillary disease can be assessed separately for botulinum toxin, microwave treatment or other local procedures. Sympathectomy is reserved for selected severe refractory cases because compensatory sweating and other complications can be substantial. Microwave ablation is an axillary procedure, not a palmar treatment, and systemic corticosteroids do not address primary focal hyperhidrosis. The original multi-answer format obscured this important anatomical treatment distinction.

Reference: NICE IPG527: transcutaneous microwave ablation for severe primary axillary hyperhidrosis: https://www.nice.org.uk/guidance/ipg527