Overview

The sweating can affect one specific area or the whole body. Although excessive sweating is not life-threatening, it may be uncomfortable and cause embarrassment and psychological trauma.

The excessive sweating is normally most active in the armpits, hands, feet, and groin because these areas of the body have a relatively high concentration of sweat glands.

Types of hyperhidrosis

Sweating is the body’s natural response to certain conditions, such as physical activity, warm weather, stress, and feelings of anger or fear. When you have hyperhidrosis, you sweat more than usual for no apparent reason. 

• Focal hyperhidrosis – This is a condition when the excessive sweating is localized. An example is palmoplantar hyperhidrosis which is excessive sweating of the palms and soles.
• Generalized hyperhidrosis – This is excessive sweating affecting the entire body.

Hyperhidrosis may be present from birth or it might develop later in life. However, many cases of hyperhidrosis started during the person’s teenage years.

The condition may be caused by an underlying health condition, or has no apparent reason:

• Primary idiopathic hyperhidrosis – Idiopathic means of unknown cause. In most cases of this type of hyperhidrosis, excessive sweating is localized.
• Secondary hyperhidrosis – The person sweats too much due to an underlying health condition, such as gout, obesity, a tumor, diabetes, or hyperthyroidism.

For some people, the symptoms of excessive sweating or hyperhidrosis are very severe that it becomes embarrassing, which causes anxiety and discomfort. It affects the patient’s relationships, career choices, self-image, free-time activities, and emotional well-being.

Symptoms

Hyperhidrosis is sweating that is disruptive to normal activities. It appears at least once weekly for no reason at all, affecting daily activities or social life.

The following are some of the symptoms of hyperhidrosis or excessive sweating:

• Frequent sweating
• Wet or clammy palms of the hands
• Wet or clammy soles of the feet
• Noticeable perspiration soaking through clothing

People with excessive sweating may experience the following:

• Painful or irritating skin problems, such as bacterial or fungal infections
• Self-conscious
• Worrying about stained clothing
• Reluctance to make physical contact
• Social withdrawal, which could lead to depression
• Spending a large amount of time every day dealing with stained clothes and other problems associated with excess sweating
• Selecting employment with less human interaction or physical contact
• Worrying too much about body odor

Experts do not have any explanation of why excessive sweating is not common among people with primary hyperhidrosis.

Causes

Primary hyperhidrosis is not well-understood and there are no explanations why they occur. Secondary hyperhidrosis, on the other hand, has many known causes.

Causes of primary hyperhidrosis

People used to have the idea that primary hyperhidrosis is linked to the mental and emotional state of a person. The belief was that excessive sweating was psychological  and affected people are anxious, stressed, or nervous. However, recent research suggested that individuals with primary hyperhidrosis are as prone to feeling nervousness or anxiety, or emotional stress than the general population when exposed to the same triggers.

Then, it is the other way around – that a person with hyperhidrosis experienced mental and emotional feelings because of their excessive sweating.

Causes of secondary hyperhidrosis:

• Alcohol abuse
• Spinal cord injury
• Fever of undetermined cause
• Generalized anxiety disorder
• Heat exhaustion
• Heart attack
• HIV/AIDS
• Endocarditis or infection of the inner lining of the heart
• Gout
• Malaria
• Leukemia
• Non-Hodgkin’s lymphoma
• Obesity
• Hyperthyroidism or overactive thyroid gland
• Pregnancy
• Parkinson’s disease
• Shingles
• Respiratory failure
• tuberculosis
• Some cancers
• Diabetic hypoglycemia
• Certain medications such as oxybutynin, antidepressants, pilocarpine, anticholinesterases, and propranolol
• Substance abuse

Complications of hyperhidrosis

If hyperhidrosis is not treated, it may lead to complications.

• Warts – These are skin growths caused by the human papillomavirus
• Nail infections – Toenail infection is common in people with hyperhidrosis
• Heat rash – It is a red, itchy skin rash that may cause a prickling or stinging sensation. Heat rash is usually the result of the blocking and trapping of perspiration in the sweat ducts under the skin.
• Bacterial infections – Infection usually occur around the hair follicles and between the toes that are always wet with perspiration

Diagnosis and Treatment

Diagnosis

Your doctor will ask you questions about your excessive sweating, such as the time and place it occurs. He may also perform some tests, such as urine and blood tests, to find out if you have hyperhidrosis. Most doctors will be able to identify primary hyperhidrosis based on your medical history and the results of the physical examination. He may also order some other tests to confirm the diagnosis, although these tests are not usually administered in the regular daily practice such as:

• A starch-iodine test – It requires putting iodine on the sweaty area of the body. Starch will be sprinkled on the area after the iodine dries. You have excess sweating if the starch turns dark blue.
• A paper test – It involves placing a special kind of paper on the area experiencing excessive sweating. The paper is weighed after absorbing the sweat. If the paper becomes heavier in weight, it means that you are sweating excessively.
• Thermoregulatory test – This test is similar to the start-iodine test. This one uses a special powder that is very sensitive to moisture. The powder will change color in the areas of excessive sweating.
• Sweat cabinet – You will be asked to sit in a sweat cabinet or sauna. If your palms sweat more than expected while you are inside the sweat cabinet, it means that you have hyperhidrosis.

Treatment options

A person who is experiencing excessive sweating may be referred by his doctor to a dermatologist or skin specialist. The dermatologist may recommend:

Iontophoresis – This procedure requires that the hands and feet are submerged in a bowl of water. A painless electric current will be passed through the water. It is usual for a patient to receive two or four treatments, which last 20 to 30 minutes.

Botox injection – Botulinum toxin injection blocks the nerves that are responsible for triggering the sweat glands. Several injections may be needed by an individual with hyperhidrosis to see effective results.

Anticholinergic drugs – These are medications that inhibit the transmission of parasympathetic nerve impulses. Patients receiving this treatment typically notice an improvement after two weeks.

Endoscopic thoracic sympathectomy – This is a surgical intervention that is recommended only in severe cases that did not respond to other treatments. The procedure involves the cutting of the nerves that carry the messages to the sweat glands. This procedure may be used for the treatment of excessive sweating in the face, armpits, or hands. It is not recommended to be used on the feet because it can cause permanent sexual dysfunction.

Specialized antiperspirant

Your dermatologist may prescribe a specialized antiperspirant that contains aluminum chloride. This is stronger than the over-the-counter antiperspirant available on the market. It is often used in the treatment of mild cases of hyperhidrosis.

Anticholinergic drugs

These drugs provide relief for generalized sweating. They prevent acetylcholine from working. Acetylcholine is a natural chemical produced by the body to help stimulate the sweat glands.

Home remedies

While you are trying out various antiperspirants and while you are carrying out the treatment plan made by your doctor, you can also try some of the at-home remedies to reduce sweating.

1. Do not wear heavy clothing that traps sweat. Wear instead light clothing that is made of breathable fabrics such as silk or cotton. When you go to the gym to exercise or when you go out outdoors in the heat, make sure you bring an extra shirt. Wear socks that wick the moisture away from them, such as merino wool.

2.  Bathe or shower every day – Make sure to use antibacterial soap as a way of controlling the bacteria that may inhabit the sweaty skin, causing odors. Thoroughly dry yourself after bathing or showering, and before you apply antiperspirant.

3.  Use underarm liners and shoe inserts to absorb the perspiration so it will not ruin your clothes or make you smell.

4.  Avoid spicy foods and alcohol. They can make you sweat more, so with hot drinks like coffee.

Risks of Having Excessive Sweating

People with the following medical conditions are at higher risk of excessive sweating:

• Diabetic people experiencing hypoglycemia
• People having a heart attack
• People suffering from heat exhaustion
• People with leukemia or malaria
• Menopausal women
• People with Non-Hodgkin’s lymphoma
• Obese people
• People with stress or anxiety
• People with tuberculosis

When to Seek Medical Attention

Excessive sweating could be a symptom of very serious conditions. Call your doctor immediately if you experience:

• Sweating and weight loss
• Sweating that occurs with a fever, shortness of breath, chest pain, and rapid heartbeat
• Sweating that occurs while you sleep
• Sweating and chest pain, or a feeling of pressure in the chest
• Sweating that is prolonged and unexplained

Get emergency medical help if your heavy sweating is accompanied by:

• Chest pain
• Chills
• Lightheadedness
• Nausea
• A body temperature of 104°F or higher

Schedule an appointment with your doctor if you experience any of the following:

• You suddenly experience sweating more than usual
• You experience night sweats for no clear reasons
• Sweating disrupts your daily routine

Table of Medications

• oxybutynin
• Drysol
• Hypercare
• aluminum chloride hexahydrate
• Hytrin
• clonidine
• terazosin
• benztropine
• gabapentin
• Xerac AC