A 17-year-old girl with a long-standing history of primary focal hyperhidrosis of the palms presented for botulinum toxin therapy. A 3-month trial of aluminum chloride hexahydrate, 20%, solution (Drysol; Person & Covey, Glendale, California) led to no substantial improvement. Treatment with supersaturated concentrations, a reasonable next step in the treatment of palmoplantar hyperhidrosis,1 was not attempted. An iodine-starch test of the palms (Figure) revealed hyperhidrosis involving both palms.
Lehman JS. Writer’s Block: “Texting” Impairment as a Complication of Botulinum Toxin Type A Therapy for Palmar Hyperhidrosis. Arch Dermatol. 2011;147(6):752. doi:10.1001/archdermatol.2011.143