Hyperhidrosis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at September 27, 2016
StartDiseasesHyperhidrosis

People who sweat too often and too much may suffer from a medical condition called hyperhidrosis. These individuals are often uncomfortable and embarrassed by visibly excessive amounts of sweating and sweat stains on clothing. Without proper treatment, people with hyperhidrosis can’t control the amount of sweat they produce. Too much sweating can deeply affect the patient’s quality of life.

Contents

Definition & Facts

Hyperhidrosis—“hyper,” or too much and “hydrosis,” or sweating—is a medical condition. When an individual sweats more than his or her body needs to prevent overheating, he or she may have hyperhidrosis. 

All people sweat. Especially fit individuals tend to produce more sweat because of high metabolic activity. In comparison, people suffering from hyperhidrosis sweat even when their bodies don’t need to cool down. Hyperhidrosis patients typically produce too much sweat on hands, head, feet, and underarms. Other parts of their bodies remain dry while one or more areas are dripping with sweat.

When an individual sweats too much and too often, it may be difficult for him or her to participate in normal daily activities. For instance, sweaty palms may make it difficult to open doors or use electronic equipment at work. Constant underarm sweat and sweat stains can cause difficulty for the individual in social situations, prompting other people to stare or make comments. Sweating too much in any part of the body can also increase the individual’s likelihood of skin infections.

There are two forms of hyperhidrosis: primary/focal and secondary/generalized. Primary hyperhidrosis has no known cause or trigger. Secondary hyperhidrosis has a known or suspected cause.

Symptoms & Complaints

Symptoms of primary hyperhidrosis may include:

  • Visible sweat: The patient isn’t exerting himself or herself but beading sweat on skin or wet spots on clothing are visible. In many cases, the individual continues to sweat when at complete rest, such as when sitting or resting.
  • Interference with daily tasks: The individual finds it difficult to walk, turn a doorknob, hold a pencil, or operate electronics. Sweat may drip onto a workspace or papers.
  • Skin irritation: Wet skin may peel, turn white, or feel soft to the touch over time.
  • Infections: Wet skin becomes irritated, breaks, and attracts bacteria and fungus that cause bacterial infections or fungal infections. Jock itch, scalp irritation, acne, or athlete’s foot are some examples.

Unlike primary hyperhidrosis, the individual suffering secondary excessive sweats typically reports that his or her entire body sweats too much. It’s also common for individuals to say they sweat at night and when they’re sleeping.

Either type of hyperhidrosis can cause the individual to feel anxious or embarrassed, and he or she may be clinically depressed and socially isolated.

  • Younger patients may skip class or avoid participation because they’re embarrassed about others seeing their dripping sweat or sweat stains. Many avoid socializing or dating.
  • Adults with this condition tend to dress in layers to hide soaked clothing or sweat stains. If one layer becomes wet, it’s easy to change during the day.
  • Not every hyperhidrosis patient deals with all symptoms all the time. Some individuals report that excessive sweating occurs in fewer areas of the body (commonly on hands/feet, forehead, or armpits) and/or on both sides of the patient’s body.

In some cases:

  • Sweating begins after waking but he or she sleeps relatively soundly and without dampening sheets or clothing in most circumstances. Warmer temperatures may stimulate excessive sweating.
  • The individual may not suffer from round-the-clock excessive sweating. He or she has an episode of excessive sweating on a regular basis, such as once per week.

Causes

Researchers say that the cause of primary hyperhidrosis is unknown. Some people who sweat too much may never tell a doctor because they’re embarrassed. The International Hyperhidrosis Society (IHS) says that up to three percent of the world - about 220 million people - may suffer from this medical condition. 

Hyperhidrosis may run in families. It’s present in all races, age groups, and climates. It’s not a transmittable or communicable disease. Some researchers believe that a dysfunction with the central nervous system may cause hyperhidrosis. 

Secondary hyperhidrosis happens when the individual has a primary illness causing excessive sweating. A medicine or supplement the individual is taking may also cause too much sweating. Some of the known causes of secondary hyperhidrosis include: tumor(s); diabetes mellitus; overactive thyroid (hyperthyroidism); frostbite; obesity; brain injury; menopause; or gout.

Diagnosis & Tests

Diagnosis of hyperhidrosis involves the clinician assessing the patient's presentation of symptoms: when an individual reports his or her shoes fill with sweat, his or her hands drip with sweat, or he or she soaks through at least two shirts during the day. Some doctors use the IHS questionnaire to confirm diagnosis. Questions include:

  • How many times the patient thinks or worries about excessive sweating per day?
  • How many times the patient bathes or changes clothing per day?
  • Supplies the patient carries, including extra clothes, powder, towels, antiperspirants, pads, etc., to manage the condition?
  • How many hours/day does he/she spend in managing symptoms?
  • How often does the patient buy new shoes/clothing?
  • How effective are topical preparations? What types has he or she used?
  • What social impact does excessive sweating have on the patient’s life? 
  • Does the patient report damaged paperwork, reading-writing material, electronic-metallic-musical devices from excessive sweat?
  • Has the condition affected career or work performance or has the patient lost a job because of the condition?
  • What skin irritations or infections has the patient experienced?
  • Does the patient suffer distress about sweating in public or in social situations?

Diagnosis will also need to rule out secondary hyperhidrosis. It could involve medical imaging like computed tomography (CT) scans and magnetic resonance imaging (MRI)s to assess the function and structure of the brain. This will help rule out problems with the brain and central nervous system as the culprit for hyperhidrosis. It’s important to see a doctor when in doubt about excessive sweat production.

Treatment & Therapy

Proven and new therapies to treat hyperhidrosis are available. Clinical strength antiperspirants work for some patients.

Iontophoresis is often used when the doctor believes stronger therapy is needed. Excessive sweating of the feet/hands is commonly treated with iontophoresis. Studies show that the method may reduce sweating by 80 to 90 percent. People have used iontophoresis medical devices since the 1940s. No serious or significant side effects have been reported from long-term use. Many patients manage hyperhidrosis symptoms with a weekly treatment.

Oral medicines are also used to treat hyperhidrosis. Anticholinergic medicines such as FDA-approved liquid glycopyrrolate, beta blockers, and benzodiazeprines are available by prescription only.

OnabotulinumtoxinA injections are also used to relieve excessive sweating. The treatment inactivates the patient’s nerves controlling sweat gland activity. Each treatment lasts from several months to about a year. Studies show that onabotulinumtoxin A injections help from 82-87 percent of hyperhidrosis patients. Some patients report a loss of underarm sensation.

Laser therapy can sometimes be used to treat hyperhidrosis. Laser therapy prevents regrowth of underarm sweat glands. In studies, patients showed underarm sweat activity was reduced by about 78 percent at six months after treatment. 

Surgery may be an option to relieve symptoms. The patient’s sweat glands from feet, hands, underarms, groin, etc., are removed to stop sweat production. Individuals suffering from sweaty hands may consider an endoscopic thoracic sympathectomy (ETS) to end their distress. In this surgery, the doctor clamps the major peripheral nerve running through each hand. Some patients report they’re symptom-free after surgery.

Hyperhidrosis patients may experience scarring, pain, swelling, infection, and excessive bleeding after surgery. Some patients report post-surgical axillary wrinkles developed afterwards.

Managing sweaty feet involves wearing proper-fitting shoes and “moisture-wick” socks which can reduce foot sweat production. Shoes made of natural leather are preferred to man-made materials or “vegan” leather. Going barefoot when possible can also help overly sweaty feet. Giving shoes a rest, too instead of wearing a pair of shoes two days in a row.

Although cotton and wool are natural fibers, these won’t help to wick away sweat from skin. Reading labels with care is important. Additional treatment methods include changing socks daily or after sports activity, washing socks after wear, using antiperspirant on the feet before bedtime for four nights (or according to doctor’s directions) and washing off in the morning. Afterwards, applying antiperspirant to feet once each week (or according to doctor’s directions) can be helpful.

Most people with excessive sweating issues find they can manage symptoms after discussing concerns with an internal medicine specialist or dermatologist. 

Prevention & Prophylaxis

Understanding how to prevent hyperhidrosis in susceptible children, adolescents, and adults is still a mystery. If hyperhidrosis prevention and prophylaxis are a concern, doctors recommend the proper antiperspirant use as a first step. While deodorants manage body odor, antiperspirants are used to reduce sweat production. For best results, apply antiperspirants to completely dry skin at bedtime.

Food, beverages, and nutritional supplements may cause excessive sweating, and one may reduce the risk of hyperhidrosis by avoiding certain sweat-producing foods and drinks. Hot sauce, foods prepared with MSG or hot spices like cumin and curry, caffeinated drinks (tea, coffee, and hot chocolate), or alcoholic beverages can increase sweating or cause certain individuals to feel anxious. It is important to refrain from using nutritional supplements without consultation with a medical professional.