Hyperhidrosis: an overview and more

Hyperhidrosis is a term used to describe excessive sweating that affects natural body temperature. It's not just heavy sweating that occurs with strenuous activity. Rather, it is a clinical disorder in which profuse sweating occurs, either in response to an underlying disorder or for no known reason.

Hyperhidrosis is not the same as excessive sweating during exercise or in response to hot or humid weather. It suggests an abnormal response in conditions where sweating does not occur (or occurs so abruptly) in most people and can be correctly diagnosed.

Get Medical Information / Emily Roberts

Symptoms of Hyperhidrosis.

Hyperhidrosis can be classified based on the parts of the body affected, as well as the underlying cause of the excessive sweating. Sweat glands, also known as sweat glands or diaphoretic glands, are found throughout the human body and their number can vary from person to person.

Eccrine sweat glands are distributed throughout most of the body and function as the body's main cooling system. Apocrine sweat glands, located primarily in the armpits and around the anus, do not serve regulatory purposes.

In its broadest sense, hyperhidrosis can be described as primary focal hyperhidrosis or secondary hyperhidrosis.

Primary focal hyperhidrosis

Primary focal hyperhidrosis, also known as primary hyperhidrosis or essential hyperhidrosis, is characterized by localized sweating in certain parts of the body. Sweating is usually bilateral (occurs on both sides of the body) and most often affects the apocrine glands in the armpits, followed by the eccrine glands in the feet, palms, scalp, and groin.

Primary hyperhidrosis is so named because it is caused by sweating. While there may be triggers that trigger the episode, they are not considered unusual and do not cause symptoms in other people.

About 3 percent of the population has primary hyperhidrosis. The condition is equally common in men and women.

Although primary hyperhidrosis is not considered dangerous, it is often debilitating and severely affects a person's quality of life. It is for this reason that this condition is often called "silent disability."

Primary hyperhidrosis can be destroyed by the affected part of the body. From them:

  • Axillary hyperhidrosis is confined to the armpits.
  • Craniofacial hyperhidrosis affects the head and face.
  • Palmar-plantar hyperhidrosis affects the hands (palms) and / or feet (plantar).
  • Gustatory hyperhidrosis , also known as Frey's syndrome , affects the scalp, face, neck, and / or chest immediately after eating certain foods.
  • Idiopathic unilateral limited hyperhidrosis is a condition of unknown origin in which profuse sweating is localized on one side of the body.

Primary hyperhidrosis often begins in childhood, especially palmoplantar hyperhidrosis. Although people with primary focal hyperhidrosis often experience seizures one or more times a week, they generally do not sweat excessively while sleeping.

Secondary hyperhidrosis

Secondary hyperhidrosis is the second form of hyperhidrosis, characterized by generalized sweating of the whole body.

Secondary hyperhidrosis is so named because sweating is a secondary consequence of an underlying cause, most often a disease, a physiological disorder, or the side effects of medications.

Unlike primary focal hyperhidrosis, secondary hyperhidrosis can occur at any age. It can also occur during sleep in the form of night sweats .


The causes of hyperhidrosis are numerous. In some cases, the cause cannot be found, especially in primary hyperhidrosis. In other cases, the cause may be obvious and potentially curable, as may be the case in cases of secondary hyperhidrosis.

Primary hyperhidrosis

While the exact cause of primary hyperhidrosis remains a mystery, it has been hypothesized that certain triggers can over-excite the sympathetic nervous system in some people. The sympathetic nervous system is part of the autonomic nervous system that regulates the body's response to intense stimuli and triggers the so-called fight or flight response.

Anxiety, stress, and agitation are common triggers for primary hyperhidrosis, although the location and duration of the reaction can vary. "Flop pot" is colloquial language that is often attributed to a sudden, profuse flash of sweating, most often associated with nervous tremors.

Certain foods, drinks, caffeine, and nicotine can also cause sweating, which is not normal. While it is natural to sweat, for example when eating particularly hot or spicy foods, people with gustatory hyperhidrosis can sweat when they eat something cold. In some cases, even smelling or thinking about food can trigger a reaction.

Primary hyperhidrosis also has a genetic cause, since 30% to 50% of those affected have a family history of the disease.

That said, the variety of symptoms suggests that there may be many genetic causes. In 2006, scientists at Saga University in Japan were able to roughly identify the location of a genetic abnormality on chromosome 14q11.2-q13 that they believe predisposes a person to primary palmar hyperhidrosis.

Essentially, primary hyperhidrosis is a complex dysfunction of the autonomic nervous system and the endocrine system, which receives nerve signals and regulates sweating. Any problem along the way could cause excessive sweating.

Secondary hyperhidrosis

Secondary hyperhidrosis is sweating caused by a medical condition or medication. This is a symptom of the underlying disease, not the condition itself. The causes can be related to cancer, hormonal dysfunction, infections, medication, metabolic disorders, and systemic diseases.

Some of the more common conditions associated with secondary hyperhidrosis include:

Some of the medications that cause secondary hyperhidrosis include:

  • Anticholinesterases used to treat Alzheimer's disease
  • Antidepressants
  • Anxiolytic medications used to treat anxiety.
  • Asthma inhalers such as albuterol
  • Celebrex (celecoxib), used to treat inflammation
  • Depo-Provera birth control pills
  • Insulin used to treat diabetes
  • Methadone used to treat heroin addiction
  • Migraine medications such as triptan (rizatriptan) and sumatriptan
  • Opioids such as vicodin (hydrocodone) and oxycontin (oxycodone)
  • Salagen (pilocarpine) which is used to treat glaucoma
  • Propranol is used to treat angina pectoris and hypertension.
  • Testosterone
  • Thyroid stimulating drugs


Hyperhidrosis is diagnosed based on the severity of sweating in the absence of heat or excessive exercise. Also, the episodes must occur at least once a week. The first step in the diagnostic process is the differentiation of primary focal hyperhidrosis from secondary hyperhidrosis. This can often be done with a physical exam and lab tests.

Physical exam

There are several tips to help you distinguish between the two:

Primary hyperhidrosis

  • Limited to one or more parts of the body

  • Typically symptomatic before age 25 and peaks at age 35.

  • Night sweats are rare

  • It often affects other family members.

  • It will occur in the absence of other symptoms.

Secondary hyperhidrosis

  • More widely distributed throughout the body.

  • The risk increases with age

  • Often accompanied by night sweats.

  • Less often affects other family members

  • It often occurs at the same time as other symptoms.

A combination of medical history, family history, duration of symptoms, age of onset, and the absence or presence of an obvious cause is usually enough to differentiate.

Lab tests

Blood tests may also be ordered to confirm or rule out underlying causes. Depending on your symptoms and risk factors, your healthcare provider may want to test for low blood sugar ( hypoglycemia ), overactive thyroid function ( hyperglycemia ), or specific infections using blood antibody or antigen tests. .

Watch out

Treatment of hyperhidrosis depends on the cause.

If the hyperhidrosis is secondary to the underlying disorder, the focus should be on treating the disorder rather than sweating. In some cases, it may only be necessary to resolve a feverish infection in the short term or to stop the problem medication. Other conditions may require chronic medications, surgery, or more serious lifestyle changes.

As a general rule, if the underlying disease is cured or cured, the symptoms of hyperhidrosis will go away on their own.

However, if no clear cause is found, treatment will focus on controlling sweating. A combination of treatments is often required. Still, relapses are common and additional treatment or new treatment may be required.

Home remedies

The easiest way to deal with excessive sweating is to use an antiperspirant that contains aluminum salts on a daily basis. An antiperspirant works by blocking the pores of the sweat glands. This sends signals to the brain to stop sweat production. They are easy to find both over the counter and in prescription drugs.

Don't confuse antiperspirants with deodorants, which are used to mask odors. While most antiperspirants are equally effective, odorless antiperspirants can be less irritating to people with sensitive skin or contact dermatitis .

Although people often use them on the armpits, the ball-and-stick formulations can also be applied to the hairline, arms, groin, and feet. Always pre-test antiperspirant on the skin area. Skin irritation and a burning sensation are common side effects. It should also be washed regularly to avoid clogging the pores.

Contrary to popular belief, shaving the armpits does not reduce sweating.


If over-the-counter antiperspirants don't work, your doctor may prescribe several stronger and potentially more effective medications. From them:

  • Drysol and Xerac AC are prescription antiperspirants that apply at night and wash off in the morning. They are relatively strong and may require short-term use of a hydrocortisone cream if skin irritation occurs.
  • Anticholinergics taken by mouth are sometimes used off-label to treat hyperhidrosis. These include glycopyrrolate, oxybutynin, benztropine, and propantheline, which appear to block certain receptors responsible for perspiration. Side effects can include dry mouth, dry eyes, constipation, blurred vision, increased heart rate, and shortness of breath.
  • Qbrexza (glycopyrronium) cloth is an anticholinergic drug that is administered in a pre-moistened disposable cloth. Applied once daily to the armpits only, it is the first prescription drug of its kind approved by the US Food and Drug Administration (FDA) for the treatment of primary axillary hyperhidrosis. Side effects are similar to those seen with oral anticholinergics.


Various in-office treatments can be used to treat hyperhidrosis, either alone or in combination with over-the-counter or prescription medications. From them:

  • MiraDry was approved by the FDA in 2015 for the treatment of primary axillary hyperhidrosis. It uses electromagnetic pulses to deactivate the sweat glands through thermolysis (decomposition by heat). The procedure takes 20 to 30 minutes to perform in the doctor's office under local anesthesia. Several treatments may be necessary to achieve effective and consistent perspiration control. A light pain reliever and an ice pack can help relieve pain the day after the procedure.
  • Botulinum toxin (Botox) injections can block the nerves that cause sweating for three to six months. Although effective, the series of injections can be painful and cause temporary muscle weakness. It will be necessary to repeat the treatment when the effect wears off.
  • Iontophoresis involves the use of a medical device that passes a weak electrical current through water to stimulate the tissue of the foot or hand. Although a 15- to 40-minute procedure can help with palmar-plantar hyperhidrosis, treatment should be done with a regular supportive program (usually once a week). There are no significant side effects. Home iontophoresis machines are also available.


In severe cases, surgery may be considered if the hyperhidrosis is seriously affecting your quality of life and your ability to function normally. They should only be considered if all other forms of conservative therapy have not provided relief. The options include:

  • Sweat gland removal involves traditional surgery to remove the subcutaneous tissue that contains the sweat glands from the armpits or a form of liposuction (called suction curettage) in which the subcutaneous tissue and deeper dermal tissue is aspirated.
  • Sympathectomy is a type of nerve surgery in which the spinal nerve is removed to control sweating in the hands. In some cases, surgery can cause irreversible compensatory sweating, in which excessive sweating is forced onto other parts of the body. It is considered a last resort due to the risk of complications.
  • Sympathatomy is also used for palmar hyperhidrosis, but it involves cutting, pinching, or burning the spinal nerve to block the nerve signal. The procedure is considered less invasive than sympathectomy, with less risk of compensatory sweating.

Front facing

Whether it is primary or secondary hyperhidrosis, there are a few things you can do.

One of the best ways to avoid sweating episodes is to identify the triggers that trigger them (such as caffeine or nicotine). If you are unsure of the cause, keep a sweat diary to record what you were doing when the episode occurred.

What's more:

  • Avoid hot and humid weather whenever possible.
  • When you are outdoors or while exercising, lower your body temperature by drinking cold water.
  • Wear loose cotton clothing and socks (even at the gym).
  • Avoid caffeine, alcohol, and spicy foods.
  • Apply antiperspirant to hands and feet before bed or when preparing for a social situation.
  • Avoid shoes without fabric lining or buy absorbent insoles.
  • Let your athletic shoes dry completely before putting them on. They can also be thrown in the dryer if necessary.
  • Bring a very large absorbent pad with you to your workout.
  • Shower every day, but avoid saunas, steam rooms, or hot showers that raise your body temperature.
  • Explore relaxation and mind-body therapies, such as guided imagery, progressive muscle relaxation (PMR), and meditation, to help reduce underlying stress that can cause or worsen sweating episodes.

You may be surprised to learn that there are informal support groups for people with hyperhidrosis. You can find groups on the Internet on Facebook or seek advice and guidance from the nonprofit International Hyperhidrosis Society in Pennsylvania.

Get the word of drug information

If you suffer from uncontrolled excessive sweating, it is important to remember that you are not alone. There are treatments available that can at least minimize the occurrence of hyperhidrosis and lifestyle changes that you can make to better cope with the situation.

Start by talking with your healthcare provider to determine the root cause of your condition. Effective diagnosis and treatment are often a process of trial and error, so it is important to be patient and not give up due to frustration.

If hyperhidrosis causes you extreme anxiety or increases your distance from others, ask your doctor for a referral to a therapist who can help you better cope with psychological and social stress. Although hyperhidrosis is not life threatening, it can be life changing. Do yourself a favor and don't ignore your condition.

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