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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.

Alternative Names

Sweating - excessive; Perspiration - excessive; Diaphoresis

Causes

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.

Sweating
Sweating

Excessive sweating occurs without such triggers. Persons 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 is called primary or focal hyperhidrosis. In most 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:

Symptoms

The primary symptom of hyperhidrosis is wetness.

Exams and Tests

Visible signs of sweating may be noted during a doctor's visit. Tests may also be used to diagnose excessive sweating, including:

  • 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)?
  • Other symptoms: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: Medicines may prevent stimulation of sweat glands. These are prescribed for certain types pf hyperhidrosis such as excessive sweating of the face. Medicines have side effects and are not right for everyone.
  • Iontophoresis: This 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 to 20 minutes and requires several sessions. Side effects include skin cracking and blisters, although rare.
  • Botox: Botulinum toxin type A (Botox) is used to treat severe underarm sweating. This condition is called primary axillary hyperhidrosis. Botulinum toxin injected into the underarm temporarily block the nerves that stimulate sweating. Side effects include injection-site pain and flu-like symptoms. Botox used for sweating of the palms can cause mild, but temporary weakness and intense pain.
  • Endoscopic thoracic sympathectomy (ETS) : In severe cases, a minimally-invasive surgical procedure called sympathectomy may be recommended when other treatments do not work. The procedure turns off the signal that tells the body to sweat excessively. It is usually done on patients whose palms sweat much more heavily than normal. It may also be used to treat extreme sweating of the face. ETS does not work as well for those with excessive armpit sweating.
  • Underarmsurgery: This is surgery to remove the sweat glands in the armpits. Methods used include laser, curettage (scraping), excision (cutting), or liposuction. These procedures are done using local anesthesia.

Support Groups

International Hyperhidrosis Society | www.sweathelp.org

Outlook (Prognosis)

With treatment, hyperhidrosis can be managed. Your doctor can discuss treatment options with you.

When to Contact a Medical Professional

Call your health care provider if you have:

  • Prolonged, excessive, and unexplained sweating
  • Sweating with or followed by chest pain or pressure
  • Sweating with weight loss
  • Sweating that most often occurs during sleep
  • Sweating with fever, weight loss, chest pain, shortness of breath, or a rapid, pounding heartbeat - these symptoms may be a sign of an underlying disease, such as hyperthyroidism

References

Miller JL. Diseases of the eccrine and apocrine sweat glands. In: In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 39.

Reisfeld R, Berliner KI. Evidence-based review of the nonsurgical management of hyperhidrosis. Thorac Surg Clin. 2008 May;18(2):157-66. Review.

Updated: 5/21/2013

Diane M. Horowitz, MD, North Shore Long Island Jewish Health System, Great Neck, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial Team.


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