Definition

Hyperhidrosis is excessive sweating. It can be an embarrassing and serious problem. It can affect social, professional, and intimate relationships.

The sweating may be in just one area. It is most common in the palms of the hands, soles of the feet, or armpits. In some cases the sweating can also affect the entire body. Hyperhidrosis is divided into two categories:

  • Primary hyperhidrosis—has no known cause
  • Secondary hyperhidrosis—caused by an underlying condition

Sweat Gland

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Causes

Primary hyperhidrosis may be triggered by:

  • High emotional states (eg, intense sadness, fear, anger, stress)
  • Spicy foods
  • Hot climates
  • Certain medications:

Secondary hyperhidrosis may be caused by conditions such as:

  • Menopause
  • Fever
  • Infection
  • Cancer, such as lymphoma
  • Thyroid disease
  • Acromegaly or anterior pituitary tumor
  • Hypothalamic disorders
  • Adrenal tumor
  • Parkinson's disease
  • Nervous system disorders
  • Diabetes
  • Tuberculosis
  • Drug withdrawal
  • Certain medications:
    • Fever-lowering medicines
    • Insulin
    • Meperidine
    • Emetics (vomit-inducing medicines)
    • Alcohol
    • Pilocarpine

Risk Factors

Factors that increase your chance of secondary hyperhidrosis are the conditions that cause it (listed above).

Symptoms

Symptoms include:

  • Sweaty palms of the hands and/or soles of the feet
  • Sweaty armpits
  • Change in amount of sweating
  • Change in pattern of sweating
  • Change in the odor associated with sweating
  • Stained clothing

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. There are no specific tests for this condition.

A starch-iodine test is often used on armpits. It may be used to determine the areas of the most active sweat glands. Tests may be ordered if your doctor is concerned that you may have a specific medical condition.

Treatment

Treatment includes:

Lifestyle Changes

To help decrease the uncomfortable feeling and odor associated with sweating try:

  • Frequent clothing changes
  • Careful washing

Topical Treatments

A number of treatments can be applied to decrease sweating in a particular area. These include:

  • Aluminum chloride hexahydrate
  • Aluminum tetrachloride
  • Formalin compresses
  • Glutaraldehyde compresses
  • Iontophoresis (stimulation with electrical current)—needs to be repeated on a daily or weekly basis, eventually tapering off to every 1-2 weeks; may be used if prescription antiperspirants don't work

Medications

These are very rarely used due to their side effects, but may include:

Botulinum A Neurotoxin

This is the poison produced by the bacteria that cause botulism. Injections of this poison can decrease sweating in certain areas. It is often used on the palms of the hands and soles of the feet. The effect of one cycle of injections may last for 6-8 months for most patients.

Surgery

  • Endoscopic thoracic sympathectomy—the destruction of nerves that stimulate sweating
  • Curettage—local removal of sweat glands via surgical scraping
  • Ultrasound
  • Liposuction techniques

Prevention

There are no known ways to prevent hyperhidrosis.