Hyperhidrosis

Excessive sweating: It’s normal to sweat when you get nervous or too hot. If you sweat for no apparent reason, you may have hyperhidrosis.

Hyperhidrosis: Overview

(Excessive sweating)

What is hyperhidrosis (hi-purr-hi-DROE-sis)?

This is a medical condition that causes excessive sweating. The word “hyperhidrosis” means too much (hyper) sweating (hidrosis).

Excessive sweating happens when a person sweats more than is necessary. Yes, it’s necessary to sweat. Sweating cools the body, which prevents us from overheating. People who have hyperhidrosis, however, sweat when the body does not need cooling.

Many people who have hyperhidrosis sweat from one or two areas of the body. Most often, they sweat from their palms, feet, underarms, or head. While the rest of the body remains dry, one or two areas may drip with sweat.

This excessive sweating can interfere with everyday activities. Hands can be so sweaty that it becomes difficult to turn a doorknob or use a computer. Sweat from the underarms often soaks through clothes, causing obvious sweat marks. Because the skin is often wet, skin infections can develop.

You can learn about other signs and symptoms, treatment, and more by visiting the pages below.

References:
Bellet J. “Hyperhidrosis and hypertrichosis in children and adolescents.” Focus session presented at the 2013 Annual Meeting of the American Academy of Dermatology: Miami. Mar 2013.
Walling H. “Primary hyperhidrosis increases the risk of cutaneous infection: A case-control study of 387 patients.” J Am Acad Dermatol.2009;61:242-6.

Primary focal hyperhidrosis: This type of hyperhidrosis affects one or a few areas of the body, like the underarms.

Hyperhidrosis: Signs and symptoms

If you have this medical condition, you may notice:

Visible sweating: When you are not exerting yourself, do you often see beads of sweat on your skin or have sweat-soaked clothing? Do you sweat when you’re sitting?
Sweating interferes with everyday activities: Does sweating cause difficulty holding a pen, walking, or turning a doorknob? Does sweat drip heavily on to your papers or computer?
Skin turns soft, white, and peels in certain areas: Does your skin stay wet for long periods?
Skin infections: Do you get frequent skin infections on the parts of your body that sweat heavily? Athlete’s foot and jock itch are common skin infections.

Two types of hyperhidrosis

Both types cause excessive sweating, but there are some differences.

In one or a few areas of the body: “Focal” means that the excessive sweating (hyperhidrosis) affects one or a few parts of the body. The areas of the body most commonly affected are the underarms, hands and/or feet, and forehead.
On both sides of the body: If the excessive sweating occurs in the underarms, the person usually notices both underarms sweat excessively. The same holds true for the hands and feet.
After waking up: Sweating may begin soon after the person wakes up, but the person usually does not notice damp sheets or wet clothing unless the room is hot.
At least once a week: For many people, it occurs much more often.
This type of hyperhidrosis usually begins when the person is a child or adolescent. Most people who have this type are otherwise healthy. In medical terminology, the word “primary” means that the cause is not another medical condition.

Secondary hyperhidrosis

In medical terminology, “secondary” means that the excessive sweating (hyperhidrosis) has an underlying cause. The cause could be a:

Medical condition
Side effect of taking a medicine or food supplement

Medical conditions that can cause excessive sweating include:

Diabetes
Frostbite
Gout
Injury, such as head trauma caused by an accident
Menopause
Obesity
Overactive thyroid (hyperthyroidism)
Tumor

If a person has this type of hyperhidrosis, the person may notice:

The entire body sweats excessively: Sometimes, only parts of the body sweat.
Sweating occurs during sleeping: If you sweat excessively while asleep, it is important to see a dermatologist to learn why this happens.

This type of sweating usually begins when the person is an adult. It also may begin after an accident or frostbite. Many medicines also can cause this type of hyperhidrosis.

Anxiety and embarrassment

Both types of hyperhidrosis can cause people to feel extremely anxious and embarrassed. Students often avoid raising their hand during class. Many teens never date. Adults may hide the sweat stains by wearing layers of clothing or changing frequently throughout the day.

References:
Bellet J. “Hyperhidrosis and hypertrichosis in children and adolescents.” Focus session presented at the 2013 Annual Meeting of the American Academy of Dermatology: Miami. Mar 2013.
Walling H. “Clinical differentiation of primary from secondary hyperhidrosis.” J Am Acad Dermatol. 2011;64:690-5.

Hyperhidrosis: Who gets and causes

Who gets hyperhidrosis?

It is difficult to say how many people have excessive sweating. Many people never see a doctor. Some are too embarrassed to talk with a doctor. Others do not realize that this is a treatable medical condition. Dermatologists estimate that 3% of people in the United States have excessive sweating.

We know that some people are more likely to get hyperhidrosis. Researchers have learned that most people have one of the following:

Family member who sweats excessively.
Medical condition that causes the sweating.
Medicine or food supplement that they take, which can cause excessive sweating.

When the excessive sweating occurs in one or two areas of the body, it is likely that a family member also has this condition.

Many medical conditions can cause excessive sweating. These include diabetes and gout. A tumor or injury also can cause excessive sweating.

Women often sweat excessively when they get hot flashes during menopause. The cause is obvious. Some women, however, develop excessive sweating after they have gone through menopause. This sweating does not have an obvious cause.

People of all races get hyperhidrosis. The excessive sweating can begin at any age. For many people, it begins when they are a child or teen. Dermatologists believe that more children and adolescents have this condition than are diagnosed.

Whether you live in a cold climate or a warm one, you can have hyperhidrosis.

What causes hyperhidrosis?

Certain nerves tell the body when to sweat. It is possible that these nerves overreact, causing excessive sweating.

We know that you cannot catch it from someone.

Dermatologists continue to study what causes this condition. They also continue improve treatments. If excessive sweating interferes with your life, you may want to see a dermatologist. Many effective treatments are available.

Hyperhidrosis: Diagnosis and treatment

Dermatologists help many patients control excessive sweating. Before treatment begins, it is important to find out why a patient has excessive sweating.

How do dermatologists diagnose hyperhidrosis?

To diagnose this condition, a dermatologist gives the patient a physical exam. This includes looking closely at the areas of the body that sweat excessively. A dermatologist also asks very specific questions. This helps the doctor understand why the patient has excessive sweating.

Sometimes medical testing is necessary. Some patients require a test called the sweat test. This involves coating some of their skin with a powder that turns purple when the skin gets wet.

To find an underlying medical condition, other medical tests may be necessary.

How do dermatologists treat hyperhidrosis?

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:

Antiperspirants

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.

Do antiperspirants increase risk of breast cancer, Alzheimer’s?

Some patients are concerned that antiperspirants can cause breast cancer. Others worry about getting Alzheimer’s disease. To date, we do not have evidence that using an antiperspirant causes breast cancer or Alzheimer’s disease.

If you want to know more about this, read:

Antiperspirants/Deodorants and Breast Cancer (National Cancer Institute)
Risk factors: Aluminum not a cause (Alzheimer’s Association)

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.

If this treatment is right for you, your dermatologist will teach you how to use the device and give you a prescription so that you can buy one. Some patients also receive a prescription for a medicine that they add to the tap water.

Side effects: Some people develop:

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.

Uses: Underarms

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 be retreated.

Side effects: The most common one is temporary muscle weakness, which can occur when this is injected into the hands.

Prescription medicine

Some patients receive a prescription for a medicine that temporarily prevents them from sweating. These medicines work throughout the body.

How it works: These medicines prevent the sweat glands from working. Athletes, people who work in a hot place, and anyone who lives in a warm climate should use extreme caution when using this treatment. The body may not be able to cool itself.

Uses: These medicines can effectively treat sweating that involves entire body. This medicine also can be an effective treatment for post-menopausal women who sweat excessively only from their head.

Side effects: The medicines that prevent the sweat glands from working can cause:

Dry mouth
Dry eyes
Blurry vision
Heart palpations (abnormal heartbeat)

The risk of side effects increases with higher doses. Before taking this medicine, you should talk with your dermatologist about your individual risks and benefits.

Surgery

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
Sympathectomy

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.

Uses:

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.

Other possible side effects from sympathectomy include damage to the nerves that run between the brain and eyes, extremely low blood pressure, irregular heartbeat, and inability to tolerate heat. Patients have died during this surgery.

Hand-held medical device destroys sweat glands: This is a newer treatment approved by the FDA. A medical doctor such as a dermatologist must give these treatments.

If this is an option, the dermatologist uses a machine that emits electromagnetic energy. This energy destroys the sweat glands. In one or two office visits, the glands can be destroyed. Once destroyed, the sweat glands are gone forever.

This device can only treat the underarms because this area of the body has enough underlying fat to protect itself. This device cannot be used to treat the hands and feet because these areas do not have enough fat.

This is a newer treatment option. Unlike other treatments, there is not a lot of information about this treatment for hyperhidrosis. We do not know how long the results last. Long-term side effects are not known.

Outcome

By seeing a dermatologist, many people find treatment that effectively controls their excessive sweating. This often greatly improves their quality of life.

Many people control their hyperhidrosis by combining treatment with tips for managing.

References:
Bechara F, Gambichler T, Bader A, et al. “Assessment of quality of life in patients with primary axillary hyperhidrosis before and after suction-curettage.” J Am Acad Dermatol. 2007;57:207-12.

Hyperhidrosis: Tips for managing

Many people who sweat excessively do not realize that they have a treatable medical condition. The following tips can help you gain control.

See a dermatologist for a diagnosis. A dermatologist is one of the few doctors who receives training in the diagnosis and treatment of hyperhidrosis. A dermatologist can tell you what type of hyperhidrosis you have and recommend appropriate treatment.
Prepare for your appointment with a dermatologist. You’ll get the most benefit from your appointment if you can answer the following questions:

Do any of your blood relatives have excessive sweating?
Do you sweat a lot while sleeping?
When did you first notice the excessive sweating?
Do you avoid certain activities or social situations because of your sweating?
How often do you sweat excessively?
Does anything seem to trigger your sweating?

Get the best results from an antiperspirant by following these tips:

Make sure you are using an antiperspirant rather than a deodorant. Antiperspirants can reduce sweating. Deodorants mask or stop body odor, but allow you to sweat.
Apply antiperspirant to dry skin before going to bed.

Your dermatologist may give you more tips for using antiperspirant that can help your individual situation. For example, your dermatologist may give you a prescription for an antiperspirant. You might apply the antiperspirant for 3 to 5 days in a row before going to sleep. Then you might use it once or twice a week.

Keep a sweat journal. For many people who sweat excessively, certain situations trigger their sweating. Learning whether you have triggers is important. This knowledge can tell you when you need more help controlling the sweating. You also may find that you can avoid some triggers.

Common triggers include heat, feeling anxious, and certain foods. Foods and beverages that are common triggers contain:

Monosodium glutamate (MSG).
Caffeine (chocolate, coffee, tea).
Hot sauce.
Spices such as curry or cumin.
Alcohol.

Sweaty feet? Follow these self-care tips: When feet stay wet or clammy, you increase your risk for foot odors and skin infections like athlete’s foot. Dermatologists recommend:

Wear sandals when you can.
Wear shoes made of a natural material like leather. This allows air to circulate.
Slip off your shoes when you can.
Avoid wearing the same shoes 2 days in a row. You want the shoes to dry completely before you wear them again.
Wear socks that wick moisture away from your skin. Cotton socks do not wick moisture away. If socks can wick moisture away, it will say so on the packaging.
Change socks daily or more often if the socks are wet.
Wash socks before you wear them again.
Apply antiperspirant to your feet before you go to bed, and wash it off when you wake up. Do this for 3 to 4 nights in a row. Then apply it once a week.

Related resources:

International Hyperhidrosis Society

References:
Hornberger J, Grimes K, Naumann M, et al. “Recognition, diagnosis, and treatment of primary focal hyperhidrosis.” J Am Acad Dermatol. 2004;51:274-86.
Miller J, Hurley H. “Diseases of the eccrine and apocrine sweat glands.” In: Bolgna J, Jorizzo J, Rapini R, et al. editors. Dermatology. 2nd ed. Spain, Elsevier Limited. 2008. p. 531-8.

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