Primary essential hyperhidrosis (EHH) occurs typically in young patients experiencing mental stress without other pathogenic factors. Intradermal injections of botulinum toxin has become a safe and highly effective treatment for properly selected patients.1- 3 We describe a 22-year-old patient demanding to be treated with botulinum toxin for palmar hyperhidrosis despite a complete lack of hyperhidrotic symptoms. After undergoing thoracic sympathectomy, he presented at the Department of Dermatology at the University Hospital in Zurich (Switzerland) with conspicuously dry hands, showing partly erosive and partly hyperkeratotic plaques on an erythematous base on the palms and back of his fingers (Figure 1) after a self-treatment with tanning lotions and tap water iontophoresis. Instead of botulinum toxin treatment, he was treated with ointments and was referred to a psychiatrist, whom the patient refused to see. Instead, he presented at 2 other dermatological university medical centers, in Munich and Freiburg (Germany), in the same fashion. Gravimetric and iodine starch tests revealed virtual anhidrosis (Figure 2). His obsession with being a hyperhidrotic patient culminated in an elaborate letter to the chairman of the dermatological department of the Munich university medical center complaining about an absence of care despite his desperate need for botulinum toxin injections.
Kreyden OP, Heckmann M, Peschen M. Delusional Hyperhidrosis as a Risk for Medical Overtreatment: A Case of Botulinophilia. Arch Dermatol. 2002;138(4):538-539. doi:10.1001/archderm.138.4.533