Hyperhidrosis, which is sweating in excess of that required for normal thermoregulation, is a condition that usually begins in either childhood or adolescence. Although any site on the body can be affected by hyperhidrosis, the sites most commonly affected are the palms, soles, and axillae. See the image below.
Types of Hyperhidrosis
Excessive sweating is divided into two categories to help clinicians and sufferers understand their cause and then approach treatment. The two types of hyperhidrosis are Focal hyperhidrosis and Secondary Generalized. Understanding the difference is one of the most important steps in understanding hyperhidrosis.
Focal hyperhidrosis, also known as primary hyperhidrosis, has an unknown cause. This type of hyperhidrosis is localized to one or more of the following areas:
- Underarms (axillary hyperhidrosis)
- Hands (palmar hyperhidrosis)
- Feet (plantar hyperhidrosis)
- Face (facial hyperhidrosis)
Although this type of hyperhidrosis has an unknown cause, the way it affects sufferers appears to be related to over-activity of the central nervous system thereby causing an overactive stimulation of local sweat glands.
Secondary generalized hyperhidrosis. This type of excessive sweating is caused by another medical condition or is a side effect of a medication. That’s why it’s called secondary – it’s secondary to something else. Unlike with primary focal hyperhidrosis, people with secondary hyperhidrosis experience sweating on larger or other areas of the body (described as generalized areas).
Sweating helps the body stay cool. In most cases, it is perfectly natural. People sweat more in warm temperatures, when they exercise, or in response to situations that make them nervous, angry, embarrassed, or afraid.
Excessive sweating occurs without such triggers. People with hyperhidrosis appear to have overactive sweat glands. The uncontrollable sweating can lead to significant discomfort, both physical and emotional.
When excessive sweating affects the hands, feet, and armpits, it is called primary or focal hyperhidrosis. In most cases, no cause can be found. It seems to run in families.
If the sweating occurs as a result of another medical condition, it is called secondary hyperhidrosis. The sweating may be all over the body or it may be in one area. Conditions that cause secondary hyperhidrosis include:
- Anxiety conditions
- Carcinoid syndrome
- Certain medicines and substances of abuse
- Glucose control disorders
- Heart disease, such as heart attack
- Overactive thyroid
- Lung disease
- Parkinson disease
- Pheochromocytoma (adrenal gland tumor)
- Spinal cord injury
- Tuberculosis or other infections
- Family history
- High emotional states
- Hot or humid climates
- Substance abuse
- Endocrine disorders
- Cardiovascular diseases
- Infectious diseases
- Neoplastic diseases
- Carcinoid tumors
- Neurologic injuries
Hyperhidrosis is defined as sweating that disrupts normal activities. Episodes of excessive sweating occur at least once a week for no clear reason and have an effect on social life or daily activities.
Signs and symptoms of hyperhidrosis may include:
- Clammy or wet palms of the hands
- Clammy or wet soles of the feet
- Frequent sweating
- Noticeable sweating that soaks through clothing
People with hyperhidrosis might experience the following:
- Irritating and painful skin problems, such as fungal or bacterial infections
- Worrying about having stained clothing
- Reluctant to make physical contact
- Socially withdrawn, sometimes leading to depression
- Select employment where physical contact or human interaction is not a job requirement
- Spend a large amount of time each day dealing with sweat, such as changing clothes, wiping, placing napkins or pads under the arms, washing, wearing bulky, or dark clothes
- Worry more than other people about body odor
- Social and emotional complications. Excessive sweating causes serious problems for many people. Many people with hyperhidrosis say their symptoms are intolerable or barely tolerable. They avoid social and professional opportunities because of embarrassment.
- This is a fancy word for the mushy, wet appearance skin gets when it’s continually moist. This general skin breakdown can lead to other skin conditions, which are usually mild.
- Jock itch (tinea cruris). This fungal infection takes hold in the folds of the groin. Heavy sweating creates a continuously moist environment that can make jock itch more likely.
- Athlete’s foot (tinea pedis). Similar to jock itch, athlete’s foot is a fungal infection of the feet. The fungus thrives in moist conditions. Athlete’s foot often starts in between the toes, where excessive sweating may be severe.
- Body odor (bromhidrosis). It’s not the sweat itself that smells bad. It’s the substances skin bacteria create when they come in contact with sweat. The sweat in the underarm and genital areas is most prone to create body odor.
- Warts and bacterial infections. The maceration or skin breakdown from heavy sweating can allow easier entry for bacteria and viruses that cause skin infections, including warts.
Diagnosis and Tests
To make the diagnosis, your doctor will perform a physical examination to determine the presence of sweat, and will usually do medical tests to rule out any underlying conditions that might be causing generalized hyperhidrosis. Hyperhidrosis can also be diagnosed based on your history of experiencing excessive sweating.
Simple tests to confirm the condition may also be used. Two common tests include:
- Starch-iodine test: A doctor applies iodine solution to the sweaty area and then sprinkles starch to look for a dark blue or purple color. This color indicates the area of excess sweat.
- Paper test: A doctor places a special paper on the area where sweating is observed. Sweat absorbs into the paper and then the paper is weighed. The weight of the paper after the test indicates how much sweat was absorbed.
Treatment and Medications
Treatment depends on the type of hyperhidrosis and where the excessive sweating occurs on the body. Your dermatologist also considers your overall health and other factors. Treatments that dermatologists use to help their patients control hyperhidrosis include:
This may be the first treatment that a dermatologist recommends. It is affordable. When applied as directed, an antiperspirant can be effective. Your dermatologist may recommend a regular or clinical-strength antiperspirant. Some patients need a stronger antiperspirant and receive a prescription for one.
Uses: Apply to underarms, hands, feet, or hairline
How it works: The antiperspirant sits on top of your skin. As you sweat, the antiperspirant is pulled into your sweat glands. This plugs the sweat glands. When your body senses that its sweat glands are plugged, this should signal your body to stop producing so much sweat.
Side effects: Where they apply the antiperspirant, some people develop:
- Burning sensation
- Irritated skin
If these occur, be sure to tell your dermatologist. Changing how you use the antiperspirant can reduce these side effects.
Iontophoresis (the no-sweat machine)
If excessive sweating affects your hands, feet, or both areas, this may be an option. You will use this treatment at home. It requires you to immerse your hands or feet in a shallow pan of tap water. As you do this, a medical device sends a low-voltage current through the water.
Many people obtain relief. Some people dislike that this treatment can be time-consuming.
Uses: Hands and feet
How it works: The electric current shuts down the treated sweat glands temporarily.
Most people need about 6 to 10 treatments to shut down the sweat glands. To get improvement, you begin by using the device as often your dermatologist recommends. At first, you may need 2 or 3 treatments per week. A treatment session usually takes 20 to 40 minutes.
Once you see results, you can repeat the treatment as needed to maintain results. This can range from once a week to once a month. Some people may develop side effects:
- Dry skin
- Irritated skin
- Discomfort during treatment
If you experience any side effects, tell your dermatologist. Making some changes often eliminates these side effects.
Botulinum toxin injections
Your dermatologist can inject a weak form of this medicine into your underarms. To treat excessive sweating, a patient will need to have very tiny amounts injected in many areas of the underarms. When performed properly, patients have little pain or discomfort.
The U.S. Food and Drug Administration (FDA) has approved this treatment for the underarms. Findings from some research studies suggest that this treatment may be effective for other areas of the body. It may help post-menopausal women who sweat excessively on the head. It may be effective for excessive sweating that affects the hands and feet.
How it works: The injections temporary block a chemical in the body that stimulates the sweat glands. Most patients notice results 4 to 5 days after receiving treatment.
Reduced sweating lasts about 4 to 6 months – and sometimes longer. When the excessive sweating returns, you can retreat.
Side effects: The most common one is temporary muscle weakness, which can occur when this is injected into the hands.
If other treatments fail to bring relief, surgery may be considered. Surgery is permanent and carries risks. The following surgeries can stop excessive sweating:
- Surgically remove sweat glands
How it works: A dermatologist can surgically remove sweat glands from the underarms. This surgery can be performed in a dermatologist’s office. Only the area to be treated is numbed, so the patient remains awake during the surgery.
A dermatologist may use one or more of the following surgical techniques to remove sweat glands from the underarms:
- Excision (cut out sweat glands)
- Liposuction (remove with suction)
- Curettage (scrape out)
- Laser surgery (vaporize)
Sympathectomy is another surgery used to treat hyperhidrosis. This is major surgery, which a surgeon performs in an operating room. During sympathectomy, the surgeon tries to stop the nerve signals that your body sends to the sweat glands. To do this, the surgeon will cut or destroy certain nerves. To find these nerves, the surgeon inserts a mini surgical camera into the patient’s chest just beneath the underarm. The patient’s lung must be temporarily collapsed so that the surgeon can cut or destroy nerves.
- Surgical removal of sweat glands is used to treat the underarms
- Sympathectomy is mainly used to treat the palms
Side effects: All surgeries carry some risk. When sweat glands are removed from the underarm, there is risk of developing an infection. Patients may have soreness and bruising. These will go away.
Permanent side effects also can occur. Loss of feeling in the underarm and scarring are possible.
Advances in endoscopic surgery have reduced some risks from sympathectomy. Serious side effects can still occur. Some patients develop a condition known as compensatory sweating. For some people, this causes them to sweat more heavily than did the hyperhidrosis.
Unfortunately, there is no way to prevent hyperhidrosis. However, treatment can bring relief to you or someone you know with this condition.