Hyperhidrosis

For 2 years, a 40-year-old oil-field worker wore heavy, steel-toed work boots all day. He experienced weeping and white discoloration at the center of both distal soles. At night, with his boots off, the feet would dry and hurt. There was no pruritus.

Results of a potassium hydroxide evaluation were negative. Cultures from both feet revealed Fonsecaea pedrosoi.

Aluminum sulfate and calcium acetate soaks were prescribed. The patient’s foot lesions resolved; daily applications of medicated talcum powder keep his feet dry and free of problems.

Commonly used antiperspirants, such as those that contain 6% or 30% aluminum chloride, may also be effective. Iontophoresis—driving salts into the eccrine glands to reduce their function—may be helpful. Ultimately, excision of the glands in the hyperhidrotic area, especially
in the axilla, may be warranted.