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. 2022 Mar 7;10(3):e4172. doi: 10.1097/GOX.0000000000004172

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Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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Fig. 1. — Treatment algorithm for PH. After scoring patients with PH through the HDSS, two treatment algorithms may be followed.^{5,17,22,23,24} Those with an HDSS score of 1 or 2 should start with a topical antiperspirant. If this fails, either iontophoresis or botulinum toxin A can be attempted. If either of these leads to unsatisfactory results, the other should be considered. If both iontophoresis and botulinum toxin A lead to unsatisfactory results, then topical or oral anticholinergic treatments, either alone or in combination with prior treatments, are recommended. In those with an HDSS score of 3 or 4, one may start with either a topical antiperspirant, iontophoresis, botulinum toxin type A, or a combination of any of these. For refractory cases, topical and/or oral anticholinergic medications may be utilized, either alone or in combination with prior treatments. If all of these fail, sympathetic denervation can be considered as a last resort.