Hyperhidrosis Overview

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 struggles with sweat are an everyday, normal occurrence. Others may notice sweat started after taking medication or being diagnosed with a disease like diabetes. However, because the condition can affect people both physically and psychologically and drastically impact one's confidence, treatment can really improve quality of life.

What Is It?

Sweating helps regulate your body temperature, and so sweat glands—rather necessarily—are located all over your body (with the exception of very specific areas, like the nail beds). There are three main types of sweat glands: eccrine, apocrine, and apoeccrine. Eccrine sweat glands are the most numerous—there are two to four million across your body, with the highest numbers found on the palms and soles. Unlike eccrine glands, which secrete a clear fluid that does not stink, apocrine glands produce a different type of sweat that gives off body odor. (Apoeccrine glands have characteristics of both eccrine and apocrine glands.)

While everyone sweats, hyperhidrosis is characterized by sweating excessive amounts that are enough to disrupt your functioning during the day. In someone with hyperhidrosis, eccrine glands are particularly overreactive to triggers such as warm temperatures, hormones, anxiety and stress, certain foods, and physical activity. 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 with them, like paper towels or changes of clothes, in order to counteract all of the extra moisture.

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 it's not triggered by another condition or medication. If it's primary hyperhidrosis, you'll sweat in distinct places, such as:

• Palms of the hands
• Soles of the feet
• Underarms
• Groin
• Face
• Head
• Under the breasts

It's also likely that you may think this is just the nature of how you sweat, as this type of hyperhidrosis typically begin in childhood or around puberty. Excessive sweating also runs in families.

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. Two clues that it's secondary? 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, or you may start sweating all over the 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 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; or 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, such as flushing, white or pink skin, or heat rash, as well as 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.

Causes

Sweat glands may become overreactive to triggers like stress and heat because of:

Genes: The cause of primary hyperhidrosis isn't known, though because the condition tends to run in families, there's likely a genetic link.

Medications: A side effect of certain medications can be excessive sweating, including certain antidepressants and insulin.

Other medical conditions: Hyperthyroidism (overactive thyroid), diabetes, menopause, gout, and cancer can cause excessive sweating.

Diagnosis

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

Physical exam and health history

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, as that 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. Your doctor will also go over any medications you may be taking to see how they may impact the amount 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.

Additional testing

Doctors can also perform tests to check for sweat levels. There's one called a starch-iodine test that helps visualize excessive sweating. Another involves a device called a vapometer to look at water loss from the skin.

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.) If sweating is triggered by starting a new medication, you can also talk to your doctor about if there are other options that will address your health concern without the side effect of sweating.

For primary hyperhidrosis, a dermatologist can talk about several options, from topical options to in-office procedures, including:

Antiperspirants: Over-the-counter, clinical strength, or prescription antiperspirants can be used to 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. If OTC versions are not effective, talk to your dermatologist about stepping up to clinical or Rx strength.

Oral medication: 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 mouth.

Wipes: 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.

Botox: When given in specific spots, Botox (onabotulinumtoxinA) injections can stop the activation of sweat glands for months.

Medical devices: Iontophoresis is a device that can be used at your doctor's office or at home 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.

In-office treatments: miraDry (a device that delivers electromagnetic energy) and laser treatments may be recommended for underarm sweating.

Underarm surgery: In certain instances, a few surgical techniques, including underarm liposuction, may be recommended.

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), as well as lifestyle changes, like wearing lightweight, loose-fitting clothing or applying antiperspirants to sweaty areas.

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