What is hyperhidrosis?

Hyperhidrosis is a medical condition in which a person sweats excessively and unpredictably. People with hyperhidrosis may sweat even when the temperature is cool or when they are at rest.

Causes, incidence, and risk factors

Sweating helps the body stay cool. In most cases, it is perfectly natural. People sweat more in warm temperatures, when they exercise, or in response to situations that make them nervous, angry, embarrassed, or afraid. However, excessive sweating occurs without such triggers. Those with hyperhidrosis appear to have overactive sweat glands. The uncontrollable sweating can lead to significant discomfort, both physical and emotional.

When excessive sweating affects the hands, feet, and armpits, it's called primary or focal hyperhidrosis. Primary hyperhidrosis affects 2 - 3% of the population, yet less than 40% of patients with this condition seek medical advice. In the majority of primary hyperhidrosis cases, no cause can be found. It seems to run in families.
If the sweating occurs as a result of another medical condition, it is called secondary hyperhidrosis. The sweating may be all over the body, or it may be in one area.

Conditions that cause second hyperhidrosis include:

• Acromegaly
• Anxiety conditions
• Cancer
• Carcinoid syndrome
• Certain medications and substances of abuse
• Glucose control disorders
• Heart disease
• Hyperthyroidism
• Lung disease
• Menopause
• Parkinson’s disease
• Pheochromocytoma
• Spinal cord injury
• Stroke
• Tuberculosis or other infections

Symptoms

The primary symptom of hyperhidrosis is wetness.

Signs and tests

Visible signs of sweating may be noted during a doctor's visit. A number of tests may also be used to diagnose excessive sweating. Tests include:

Tests include:

• Starch-iodine test. An iodine solution is applied to the sweaty area. After it dries, starch is sprinkled on the area. The starch-iodine combination turns a dark blue color wherever there is excess sweat.
• Paper test. Special paper is placed on the affected area to absorb the sweat, and then weighed. The heavier it weights, the more sweat has accumulated.
  You may be also be asked details about your sweating, such as:

Location

• Does it occur your face, palms, or armpits, or all over the body?
• Time pattern
• Does it occur at night?
• Did it begin suddenly?
• Triggers
• Does the sweating occur when you are reminded of something that upset you (such as traumatic event)?

What other symptoms do you have, for example:

• Weight loss
• Pounding heartbeat
• Cold or clammy hands
• Fever
• Lack of appetite

Treatment

Treatments may include:

• Antiperspirants. Excessive sweating may be controlled with strong anti-perspirants, which plug the sweat ducts. Products containing 10% to 20% aluminum chloride hexahydrate are the first line of treatment for underarm sweating. Some patients may be be prescribed a product containing a higher dose of aluminum chloride, which is applied nightly onto the affected areas. Antiperspirants can cause skin irritation, and large doses of aluminum chloride can damage clothing. Note: Deodorants do not prevent sweating, but are helpful in reducing body odor.
• Medication. Anticholinergics drugs help to prevent the stimulation of sweat glands. Although effective for some patients, these drugs have not been studied as well as other treatments. Side effects include dry mouth, dizziness, and problems with urination. Beta-blockers or benzodiazepines may help reduce stress-related sweating.
• Iontophoresis. This FDA-approved procedure uses electricity to temporarily turn off the sweat gland. It is most effective for sweating of the hands and feet. The hands or feet are placed into water, and then a gentle current of electricity is passed through it. The electricity is gradually increased until the patient feels a light tingling sensation. The therapy lasts about 10-20 minutes and requires several sessions. Side effects include skin cracking and blisters, although rare.
• Botox. Botulinum toxin type A (Botox) is FDA approved for the treatment of severe underarm sweating, a condition called primary axillary hyperhidrosis. Small doses of purified botulinum toxin injected into the underarm temporarily block the nerves that stimulate sweating. Side effects include injection-site pain and flu-like symptoms. If you are considering Botox for other areas of excessive sweating talk to your doctor in detail. Botox used for sweating of the palms can cause mild, but temporary weakness and intense pain.