Hyperhidrosis

Hyperhidrosis (hi-pur-hi-DROE-sis) is abnormally excessive sweating that's not necessarily related to heat or exercise. You may sweat so much that it soaks through your clothes or drips off your hands. Besides disrupting normal daily activities, this type of heavy sweating can cause social anxiety and embarrassment.

Hyperhidrosis treatment usually helps, beginning with prescription-strength antiperspirants. If antiperspirants don't help, you may need to try different medications and therapies. In severe cases, your doctor may suggest surgery either to remove the sweat glands or to disconnect the nerves responsible for the overproduction of sweat.

Sometimes an underlying cause may be found and treated.

Symptoms

Most people sweat when they exercise or exert themselves, are in a hot environment, or are anxious or under stress. The excessive sweating experienced with hyperhidrosis far exceeds such normal sweating.

The type of hyperhidrosis that usually affects the hands, feet, underarms or face causes at least one episode a week, during waking hours. And the sweating usually occurs on both sides of the body.

When to see a doctor

Sometimes excessive sweating is a sign of a serious condition.

Seek immediate medical attention if your heavy sweating is accompanied by lightheadedness, chest pain or nausea.

See your doctor if:

• Sweating disrupts your daily routine
• Sweating causes emotional distress or social withdrawal
• You suddenly begin to sweat more than usual
• You experience night sweats for no apparent reason

Causes

Sweating is your body's mechanism to cool itself. Your nervous system automatically triggers your sweat glands when your body temperature rises. Sweating also normally occurs, especially on your palms, when you're nervous.

The most common form of hyperhidrosis is called primary focal (essential) hyperhidrosis. With this type, the nerves responsible for signaling your sweat glands become overactive, even though they haven't been triggered by physical activity or a rise in temperature. With stress or nervousness, the problem becomes even worse. This type usually affects your palms and soles and sometimes your face.

There is no medical cause for this type of hyperhidrosis. It may have a hereditary component, because it sometimes runs in families.

Secondary hyperhidrosis occurs when excess sweating is due to a medical condition. It's the less common type. It's more likely to cause sweating all over your body. Conditions that may lead to heavy sweating include:

• Diabetes
• Menopause hot flashes
• Thyroid problems
• Low blood sugar
• Some types of cancer
• Heart attack
• Nervous system disorders
• Infections

Certain medications also can lead to heavy sweating, as can opioid withdrawal.

Complications

Complications of hyperhidrosis include:

• Infections. People who sweat profusely are more prone to skin infections.
• Social and emotional effects. Having clammy or dripping hands and perspiration-soaked clothes can be embarrassing. Your condition may affect your pursuit of work and educational goals.

Diagnosis

During your appointment, your doctor will ask about your medical history and symptoms. You may also need a physical exam or tests to further evaluate the cause of your condition.

Lab tests

Your doctor may recommend blood, urine or other lab tests to see if your sweating is caused by another medical condition, such as an overactive thyroid (hyperthyroidism) or low blood sugar (hypoglycemia).

Sweat tests

A number of tests are available to pinpoint the areas of sweating and estimate the severity of your condition, including an iodine-starch test, skin conductance and a thermoregulatory sweat test.

Treatment

If an underlying medical condition is contributing to the problem, that condition will be treated first. If no clear cause can be found, treatment focuses on controlling excessive sweating. Sometimes you may need to try a combination of treatments. And even if your sweating improves after treatment, it may recur.

Medications

Drugs used to treat hyperhidrosis include:

• Prescription antiperspirant. Your doctor may prescribe an antiperspirant with aluminum chloride (Drysol, Xerac Ac). This product can cause skin and eye irritation. It's usually applied to the affected skin before you go to bed. Then you wash the product off when you get up, taking care to not get any in your eyes. If your skin becomes irritated, hydrocortisone cream might help.
• Prescription creams. A prescription cream that contains glycopyrrolate may help hyperhidrosis that affects the face and head.
• Nerve-blocking medications. Some oral medications block the chemicals that permit certain nerves to communicate with each other. This can reduce sweating in some people. Possible side effects include dry mouth, blurred vision and bladder problems.
• Antidepressants. Some medications used for depression can also decrease sweating. In addition, they may help decrease the anxiety that worsens the hyperhidrosis.
• Botulinum toxin injections. Treatment with botulinum toxin (Botox, Myobloc, others) temporarily blocks the nerves that cause sweating. Your skin will be iced or anesthetized first. Each affected area of your body will need several injections. The effects last six to 12 months, and then the treatment needs to be repeated. This treatment can be painful, and some people experience temporary muscle weakness in the treated area.

Surgical and other procedures

Other hyperhidrosis treatments include:

• Microwave therapy. With this therapy, a device that delivers microwave energy is used to destroy sweat glands. Treatments involve two 20- to 30-minute sessions, three months apart. Possible side effects are a change in skin sensation and some discomfort. This therapy may be expensive and not widely available.
• Sweat gland removal. If excessive sweating occurs just in your armpits, removing the sweat glands there may help. A minimally invasive technique called suction curettage may be an option, too, if you aren't responding to other treatments.
• Nerve surgery (sympathectomy). During this procedure, the surgeon cuts, burns or clamps the spinal nerves that control sweating in your hands. In some cases, this procedure triggers excessive sweating in other areas of your body (compensatory sweating). Surgery is generally not an option for isolated head and neck sweating. A variation on this procedure interrupts the nerve signals without removing the sympathetic nerve (sympathotomy).

Lifestyle and home remedies

The following suggestions may help you cope with sweating and body odor:

• Use antiperspirant. Nonprescription antiperspirants contain aluminum-based compounds that temporarily block the sweat pore. This reduces the amount of sweat that reaches your skin. This type of product may help with minor hyperhidrosis.
• Apply astringents. Apply over-the-counter products containing tannic acid (Zilactin) to the affected area.
• Bathe daily. Regular bathing helps keep the number of bacteria on your skin in check. Dry yourself thoroughly, especially between the toes and under the arms.
• Choose shoes and socks made of natural materials. Shoes made of natural materials, such as leather, can help prevent sweaty feet by allowing your feet to breathe. When you're active, moisture-wicking athletic socks are a good choice.
• Change your socks often. Change socks or hose once or twice a day, drying your feet thoroughly each time. You may want to try pantyhose with cotton soles. Use over-the-counter foot powders to help absorb sweat.
• Air your feet. Go barefoot when you can, or at least slip out of your shoes now and then.
• Choose clothing to suit your activity. Generally, wear natural fabrics, such as cotton, wool and silk, which allow your skin to breathe. When you exercise, you might prefer fabrics designed to wick moisture away from your skin.
• Try relaxation techniques. Consider relaxation techniques such as yoga, meditation and biofeedback. These can help you learn to control the stress that triggers sweating.

Coping and support

Hyperhidrosis can be the cause of discomfort and embarrassment. You may have trouble working or enjoying recreational activities because of wet hands or feet or wet stains on clothing. You might feel anxious about your symptoms and become withdrawn or self-conscious. You may be frustrated or upset by other people's reactions.

Besides talking with your doctor, you may want to talk with a counselor or a medical social worker. Or you may find it helpful to talk with other people who have hyperhidrosis.

Preparing for an appointment

You may start by seeing your primary care provider. He or she may refer you to a specialist in skin diseases (dermatologist). If your condition is not responding to initial treatments, your care may also involve a neurologist or a surgeon.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, you might want to list answers to the following questions:

• Has anyone in your immediate family ever had similar symptoms?
• Does your sweating stop when you're asleep?
• What medications and supplements do you take regularly?

What to expect from your doctor

Your doctor is likely to ask you several questions, such as:

• When did you first experience heavy sweating?
• Where on your body does it occur?
• Have your symptoms been continuous or occasional?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

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