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Excessive Sweating (Hyperhidrosis)


Man with hyperhidrosis sweating through his shirt on the chest and armpits

What is Hyperhidrosis?

Hyperhidrosis, or excessive sweating, is a condition that effects 3% of the American population. It manifests as persistent, usually unprovoked sweating of the underarms, palms, soles or face. Those suffering from underarm sweating may have to change clothes often to avoid staining. Sweating of the palms interferes with handshaking and simple tasks such as holding a pen or a steering wheel. Foot sweating leads to chronic athlete’s foot and odor, and makes it difficult to wear sandals. Hyperhidrosis is usually embarrassing and debilitating as it complicates romantic, social and business interactions.

Types of Hyperhidrosis

There are two main types of hyperhidrosis: primary focal and secondary generalized.

Primary focal hyperhidrosis

Primary focal hyperhidrosis does not develop as the result of another condition or as a side effect of medication – the excessive perspiration is the condition itself. The sweating occurs in specific locations, known as focal areas, and usually affects both sides of the body. Excessive perspiration often affects more than one area, which may include the hands, feet, underarms, face, and head. Sweating typically occurs only during the day and never while the patient is sleeping.

Primary focal hyperhidrosis usually starts in childhood. This condition may be inherited.

Secondary generalized hyperhidrosis

Secondary generalized hyperhidrosis is excessive perspiration that develops as the result of another medical problem, such as Parkinson’s disease and diabetes. Medications, such as naproxen and zinc supplements, can also cause generalized hyperhidrosis as a side effect. Sweating usually occurs on larger, generalized areas of the body. Secondary generalized hyperhidrosis is less common than primary focal hyperhidrosis.

Sometimes dermatologists discuss hyperhidrosis in terms describing the areas affected. Axillary hyperhidrosis affects only the armpits, for example. Palmoplantar hyperhidrosis is a condition in which excessive perspiration affects only the palms of the hands and soles of the feet. In many cases, the underlying cause for palmoplantar hyperhidrosis cannot be found.

Woman with hyperhidrosis excessively sweating through her shirt armpitHyperhidrosis Causes

Perspiration is a mechanism the body uses to cool itself. When body temperature rises, the nervous system activates the sweat glands to bring water to the surface of the skin as sweat. Once on the surface, the sweat evaporates, which cools the skin. Sweating also occurs normally as a response to stress.

In primary focal hyperhidrosis, the nerves responsible for activating sweat glands become overactive. These overactive nerves stimulate the production of sweat even without physical activity or increase in body temperature. Nervousness and stress can worsen the problem, and trigger perspiration on the person’s palms, soles, and even their face.

There is no medical cause for primary focal hyperhidrosis. It sometimes runs in families, though, so it may have a hereditary component.

Secondary hyperhidrosis is different from primary focal hyperhidrosis in that there is a direct cause – this type of hyperhidrosis is the result of a medical condition or side effect of a medication. Conditions that may lead to heavy sweating associated with secondary generalized hyperhidrosis include:

    • Diabetes
    • Hot flashes associated with menopause
    • Thyroid problems
    • Low blood sugar (hyperglycemia)
    • Some types of cancer
    • Heart attack
    • Nervous system disorders
    • Infections
    • Certain medications
    • Opioid withdrawal

Hyperhidrosis Diagnosis

To diagnose hyperhidrosis, a skin doctor will review the patient’s medical history and symptoms. The dermatologist will ask how often the patient experiences hyperhidrosis symptoms, for example, and if the sweating occurs on both sides of the body. In some cases, the healthcare provider will recommend blood tests to rule out other conditions that cause excessive perspiration, such as an overactive thyroid or low blood sugar.

Dermatologist may also perform “sweat tests” that pinpoint the areas of sweating. A hyperhidrosis hands test might include the paper test in which the dermatologist places special paper on the affected area to absorb the sweat, and then weights the paper to measure the amount of sweat produced by the patient. A hyperhidrosis feet test may include the starch-iodine test, in which the skin doctor applies an iodine solution to the sweaty area then sprinkles starch onto the dried iodine; the starch-iodine combination turns a dark blue color in areas producing excess sweat.

Woman with hyperhidrosis getting a botulinum toxin injectionHyperhidrosis Treatment

The type of hyperhidrosis treatment a doctor recommends depends largely on the type of hyperhidrosis and where excessive sweating occurs on the patient’s body.

Treatment for hyperhidrosis is often stepwise, which means a patient will start with one treatment and add other therapies as necessary. Therapies include the use of home remedies, such as:

    • Using over-the-counter antiperspirant on the affected areas
    • Applying astringents to the areas
    • Bathing daily
    • Wearing socks and shoes made from natural materials
    • Changing socks often
    • Airing your feet
    • Choosing clothing that suits activity
    • Relaxation techniques

Other treatments include strong antiperspirants, hyperhidrosis medication, and laser therapy. With a stepwise approach to treatment, most patients with hyperhidrosis can achieve a lessening of symptoms and an increased quality of life.

One of the biggest problems people with hyperhidrosis on the face is that many conservative treatments, such as the use of antiperspirants, merely diminish the appearance of excessive sweating – they don’t resolve the problem. Furthermore, topical solutions can be messy and they can irritate the skin of the face, head or scalp. Advanced treatments, such as oral medications, botulinum toxin injections, and iontophoresis get to the root of the problem to stop excessive sweating before it starts.

For more information about hyperhidrosis, its diagnosis and treatment, consult with the skin doctors at the Center for Dermatology and Laser Surgery. Our team of dedicated skincare professionals can help you overcome unwanted excessive sweating.


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