Hyperhidrosis

What is hyperhidrosis?

Hyperhidrosis, also known as “excessive sweating,” is when you sweat more than you need to or when you sweat at times when you should not be sweating.

This can occur all over your body or it can happen only in particular parts of your body, which is called focal hyperhidrosis. Most commonly, it affects the armpits, face, hands, and feet.

Sometimes the sweating comes on without a reason and sometimes it is caused by stress or emotions.

Treatment starts with antiperspirants. Hyperhidrosis can be a symptom of another condition, such as hyperthyroidism or menopause, so it is important to see a doctor to get checked for other medical problems.

Most common symptoms

The main symptom of hyperhidrosis is inappropriate and excessive sweating. Usually, this sweating happens on the palms, soles, armpits, or face. It can also happen between your legs, in between the cheeks of the buttocks, or on the scalp.

It is often made worse by heat or stress. Some people will soak through clothing.

These symptoms usually occur during the daytime, but when hyperhidrosis is caused by another medical condition, you might also sweat while you sleep. Sweating that only occurs at night is known as “night sweats.”

Main symptoms

• Sweating a lot when it is inappropriate to be sweating (such as when it is not very hot or you are not exercising)
• Sweating from palms, soles, face, or armpits
• Lasts for 6 months or more
• Clothing stains in the areas where you sweat
• Moisture causes skin breakdown in the areas where you sweat
• Cold and clammy hands
• Dehydration (from sweating too much)

Other symptoms you may have

You may be diagnosed with hyperhidrosis if you have at least two of the following additional symptoms:

• Sweating must be on both sides of your body (affects both hands rather than just the left hand)
• Sweating makes it difficult to do daily activities, such as gripping or grasping
• Sweating causes you to worry that you will soak through your clothing
• You have one or more bouts of excessive sweating per week
• Sweating started before age 25
• Other family members have the same symptoms
• Sweating does not occur while you sleep

Types of hyperhidrosis

Generalized hyperhidrosis

In generalized hyperhidrosis, the whole body breaks out in a sweat. This is less common than the other types. In fact, if you have generalized hyperhidrosis, this typically suggests that some other condition is causing the sweating.

Focal hyperhidrosis

In focal hyperhidrosis, the sweating is limited to particular areas of your body. For example, it may only be on your palms or in your armpits and not in your groin.

Palmoplantar hyperhidrosis

In palmoplantar hyperhidrosis, the sweating is just on the palms of your hands and the soles of your feet.

Palmar hyperhidrosis

In palmar hyperhidrosis, the sweating happens only on your palms and not the soles of your feet.

Craniofacial hyperhidrosis

In craniofacial hyperhidrosis, the sweating is on your scalp and face, but not elsewhere in your body.

Causes

Hyperhidrosis is caused by overactive sweat glands, called the “eccrine glands.” These glands are located on your palms, soles of your feet, and in your armpits, which is why people with hyperhidrosis frequently sweat in those places.

Primary hyperhidrosis happens on its own (without another condition causing it). It’s also known as “idiopathic hyperhidrosis,” which means that the cause is unknown.

Secondary hyperhidrosis is caused by another medical condition. Some of these conditions include use of certain medications or recreational drugs, menopause, spinal cord injury, tumors, diabetes, some viral infections (such as shingles), and metabolic problems like hyperthyroidism.

Hyperhidrosis also runs in families.

Next steps

Hyperhidrosis is not a medical emergency, so you don’t need to get urgent care. You should make an appointment to see a doctor if you think you have the condition.

It’s important to rule out other conditions that can cause sweating.

Your doctor may refer you to a specialist. You may also want to talk to a mental health professional or therapist about the social issues that come with excessive sweating. Anxiety and depression are common in patients with hyperhidrosis, so treating those conditions may help your sweating. A therapist might also help you deal with your emotions effectively, which can decrease the number of sweat attacks you have.

Treatment

It is important to get treatment for your hyperhidrosis, not just so that you can feel better and start sweating less, but because excessive sweating can cause other complications. It can lead to the breakdown of your skin, which makes you susceptible to skin infections and ingrown toenails.

Medication

• Prescription antiperspirant is used to treat underarm hyperhidrosis. A 6% to 20% aluminum chloride hexahydrate antiperspirant clogs up the sweat glands to reduce the amount of sweat. You should use these antiperspirants at night for at least one week. After it starts to improve, cut back to once per week.
• Prescription hydrocortisone (steroid) cream can soothe the irritation that the antiperspirants can cause. It should be applied when you are not sweating.
• Prescription glycopyrronium 2.4% cream works differently than the antiperspirant. It dries up the sweat glands (rather than clogging them). It can be a good option for people who do not like the antiperspirant.
• If these treatments do not work, you may want to consider prescription medications that are taken as pills, such as glycopyrrolate and oxybutynin. These medicines have more side effects. Dry mouth is the most common side effect, which some people cannot tolerate.

Procedures

• Botulinum toxin (Botox) injections are usually only used if medications do not work. Botox blocks the nerve signal to the sweat glands. This can be used for sweating affecting the palms, soles, underarms, or face. The injections must be repeated every few months. This treatment can be painful and expensive.
• Microwave thermolysis and laser treatments use heat to injure the sweat glands. They are mostly for treating armpit hyperhidrosis. The procedures are effective but are not widely available.
• Iontophoresis is used for hyperhidrosis of the palms and soles. The hands and feet are placed in water while a direct electric current is applied. This treatment can be done at home and has minimal side effects.
• Armpit surgery or liposuction can remove or destroy sweat glands. Though symptoms may come back after a few months.
• Sympathectomy is surgical clipping of the nerve that feeds the sweat glands. The nerves are inside the chest space under the ribs, but this procedure can be done with cameras and robotic tools. While it usually works well, sometimes the body compensates by increasing sweating in other areas.

Follow up

Follow up with your doctor if your hyperhidrosis is caused by a medical condition that requires treatment. You should also follow up with your doctor if your symptoms are not getting better, because there are other therapy options.

Preventative tips

There is no way to prevent hyperhidrosis, but there are steps you can take to decrease its effect on your life or the chance that you will break into a sweat:

• Wear darker clothing that doesn’t show sweat stains.
• Bring a change of clothes with you just in case you sweat through your clothes.
• If heat makes you sweat more, avoid warm environments.
• If emotions trigger your sweating, consider seeing a mental health professional or a therapist. They may be able to treat an underlying mental health issue, or help you learn ways to reduce the effects, such as learning deep breathing exercises.