What Is Hyperhidrosis?

Hyperhidrosis is the medical term for excessive sweating. The condition can begin in childhood, adolescence, or as an adult. For many people, excessive sweating runs in the family, and problems with sweat are an everyday, normal occurrence.

Others may notice excess sweat began after taking medication or being diagnosed with a disease like diabetes. However, because hyperhidrosis can affect people physically and psychologically and drastically affect one's confidence, treatment can improve your quality of life.

Types

There are two types of hyperhidrosis, primary and secondary, which are diagnosed based on the cause of excessive sweating.

Primary Focal Hyperhidrosis

This is the term for when excessive sweating is the diagnosis, and medications or other conditions don't trigger it. If it's primary hyperhidrosis, you'll sweat in distinct places, such as:

• Armpits
• Face and head
• Palms of the hands
  
• Soles of the feet
• Underarms
  

This type of hyperhidrosis typically begins in childhood or around puberty. Excessive sweating also runs in families; one study found family history in 30 to 50% of primary hyperhidrosis cases.

Secondary Hyperhidrosis

Many medical conditions, such as thyroid and pituitary disorders, diabetes, and menopause, as well as medications, may cause excessive sweating. In this case, this is dubbed secondary hyperhidrosis. With secondary hyperhidrosis, you'll sweat over a larger (generalized) area of your body rather than in distinct spots, and you may also sweat at night.

Symptoms

Excessive sweating is the main symptom of hyperhidrosis. This may be in certain places in the body and appear symmetrically, such as the palms of hands or soles of the feet. You may also start sweating all over your body.

This is more than just your average sweating, however, because people with hyperhidrosis find themselves worrying all day about the amount they sweat. You might also notice that:

• Your feet leave footprints as you walk.
• You try to sop up sweat with towels or napkins in your underarms during the day.
• You have to change multiple shirts during the day because you sweat through them.
• You sweat without physical exertion.
• You avoid touching others, or typing on a computer is challenging, because your hands are dripping with sweat.

Because of exposure to sweat, you may also notice skin changes like flushing, white or pink skin, heat rash, and skin peeling. You may also be more likely to develop skin infections, like athlete's foot, as fungus and bacteria thrive in warm, wet environments.

Hyperhidrosis Causes

In someone with hyperhidrosis, eccrine glands—the most numerous of sweat glands—are overreactive to triggers. These triggers include warm temperatures, hormones, anxiety and stress, certain foods, and physical activity. They may also be reactive due to:

• Genes: The cause of primary hyperhidrosis isn't known, though there's likely a genetic link because the condition tends to run in families.
• Medications: Excessive sweating can be a side effect of certain medications, including certain antidepressants, opioid analgesics, insulin, antibiotics, antiviral, and ADHD medications.
• Other medical conditions: Hyperthyroidism (overactive thyroid), diabetes, menopause, and cancer can cause excessive sweating.

Diagnosis

Talk to a healthcare provider about your concerns with excessive sweating. You may be referred to a dermatologist—as experts in skin, they also specialize in hyperhidrosis.

Conducting a physical exam and getting your health history will be important. There, they can talk to you about when you first noticed excessive sweating, which will provide a clue as to the type of hyperhidrosis. You'll also talk about where you sweat and how it impacts your day-to-day life.

A healthcare provider will also go over any medications you may be taking to see how they may affect the amount of sweat you sweat. If they suspect that an underlying disease or disorder is the cause of sweating, you may also receive additional testing specific to the suspected medical condition.

Blood Tests

A blood test can help a healthcare provider get more clues about any conditions responsible for the sweating. They may order this test if they suspect you have, for example, thyroid problems causing the hyperhidrosis.

Imaging Tests

Imaging tests can be important for hyperhidrosis. A healthcare provider may use an imaging test if they believe a tumor may be causing you to sweat excessively.

Paper Tests

The paper test is a way to measure how much sweat occurs. Higher amounts of sweat absorbed by the special paper make the paper feel heavier.

Starch-Iodine Tests

With a starch-iodine test, a provider applies an iodine solution to the affected areas, allows it to dry, and sprinkles starch on the area. A dark blue to black color indicates an area with a high amount of sweat.

Hyperhidrosis Treatment

Secondary hyperhidrosis can be controlled by treating or managing the underlying condition causing the sweating—like keeping blood sugar regulated if you have diabetes. You can also talk to a healthcare provider about whether other medication options will address your health concern without the side effect of sweating.

A dermatologist can discuss several options for primary hyperhidrosis, from topicals to in-office procedures.

At-Home Treatment

Over-the-counter, clinical strength, or prescription antiperspirants can plug sweat ducts to quell sweat production. Antiperspirants can be used on other parts of your body—such as the feet—in addition to underarms and are most effective when applied at night. If OTC versions are ineffective, talk to a dermatologist about stepping up to clinical or prescription strength.

Iontophoresis is a device that's not only for in-office use but for at-home use as well for your hands and feet. After submerging your hands or feet in water, the device sends a small electrical current through the water to these body parts to temporarily stop the sweat glands from working.

A prescription wipe called Qbrexza (glycopyrronium tosylate) is a topical treatment that can dramatically reduce underarm sweating. The active ingredient is an anticholinergic, though when applied to skin, there are fewer side effects. Specifically, side effects can include redness and burning or stinging of the area where you use the wipes.

Medications

You may be prescribed medications to help reduce sweating. Anticholinergics are one class of medications that help turn down signals for your body to sweat. However, these do come with side effects that make many people uncomfortable, such as dry eyes and mouth.

Surgery

In certain instances, a few surgical techniques, including underarm liposuction, may be recommended. Generally, the surgery involves removing armpit sweat glands.

Another procedure called endoscopic thoracic sympathectomy (ETS) might be an option for severe cases of hyperhidrosis. It involves cutting a nerve that signals to the body that it should sweat. However, it's not a very effective treatment if you have excessive sweating in your armpits. It may also be associated with compensatory hyperhidrosis, sometimes called reflex or rebound sweating, when you have increased sweating in new areas.

Therapies

You may be recommended Botox (onabotulinumtoxinA) injections. When given in specific spots, the injections can stop the activation of sweat glands for months. You can get further treatment if you start having excessive sweat again. The primary side effect is short-term muscle weakness.

Prevention

Unfortunately, it's not possible to prevent primary hyperhidrosis. If you are diagnosed with secondary hyperhidrosis, you may be able to decrease sweating by changing medication or properly managing the medical condition causing it.

Otherwise, it may be possible to help prevent or diminish the symptoms of excessive sweating with:

• Trigger avoidance or management, such as controlling stress or avoiding certain foods
• Lifestyle changes, like wearing lightweight, loose-fitting clothing or applying antiperspirants to sweaty areas

Complications

Hyperhidrosis is not considered a life-threatening condition. However, a person may experience the following complications if they have hyperhidrosis:

• Disability related to work or school
• Emotional and psychological distress
• Social embarrassment

Living With Hyperhidrosis

Living with hyperhidrosis can be extremely tough. Many patients talk about a fear of going out or interacting with others in public or the constant need to bring various supplies, like paper towels or a change of clothes, to counteract all the extra moisture.

Still, there are things you can do to help you manage hyperhidrosis daily. They include:

• Avoiding foods that can make sweating worse
• Bathing with antibacterial soap to reduce odor
• Drying off completely to decrease germ growth
• Keeping a change of clothes on hand
• Letting shoes dry before putting them on
• Trying relaxation techniques
• Washing and drying clothing completely
• Wearing dress shields, which are pads that go under your arms
• Wearing moisture-wicking and natural fiber-based clothing