Case report of psychosomatic illness: The management of primary hyperhidrosis with oral escitalopram

Abstract

Hyperhidrosis is excessive, visible sweating without physical activity, which is not associated with physiological homeostatic response to maintain body temperature. The severity can be assessed by the Hyperhidrosis Disease Severity Scale. Hyperhidrosis causes severe psychological impairment, and left untreated may cause cutaneous infections. Topical 20% aluminum chloride is the first-line treatment for all cases of primary, focal hyperhidrosis irrespective of disease severity. Here, we report a case of primary hyperhidrosis with no response to topical aluminum chloride, iontophoresis, and oral anticholinergics who was not interested in invasive treatment modalities. On developing symptoms of anxiety, the patient was subsequently referred to the psychiatry department and successfully treated with clonidine and oral escitalopram. Primary hyperhidrosis did not recur even when clonidine was tapered off, and the patient was maintained on escitalopram. The use of selective serotonin reuptake inhibitors as a long-term maintenance agent for hyperhidrosis requires further study.