Hyperhidrosis (Excessive Sweating)

Hyperhidrosis (Excessive Sweating)

Hyperhidrosis is excessive sweating that occurs even when the temperature isn’t hot and you’re not exercising. In some people who have hyperhidrosis, the sweat literally drips off their hands. You sweat more than usual and you experience night sweats for no apparent reason.

Hyperhidrosis usually affects the palms of the hands, soles of the feet and underarms. Besides disrupting normal daily activities, hyperhidrosis can cause social anxiety or embarrassment.

One of the first options for treatment involves using prescription-strength antiperspirants on the affected areas. 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.


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

Hyperhidrosis usually affects the hands, feet, underarms and sometimes the face. Rarely, the entire body is affected. The excessive sweat may soak through clothes or drip off your hands. Episodes usually occur at least once a week without an obvious reason.

Causes of Hyperhidrosis

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.

In hyperhidrosis, the nerves responsible for triggering your sweat glands become overactive and call for more perspiration even when it’s not needed. The problem worsens if you’re under stress or nervous.

The type of hyperhidrosis that occurs primarily in your palms and soles may have a genetic component, because it sometimes clusters in families. If you have excessive sweating all over your body, it may be caused by an underlying health factor, such as:

Certain medications


hot flashes

Low blood sugar

Overactive thyroid gland

Some types of cancer

Heart attack

Infectious disease

Complications of Hyperhidrosis

Infections. People who sweat profusely are more prone to skin infections. These infections can range from ringworm to warts.Other skin conditions. Certain skin conditions, such as eczema and skin rashes, occur more frequently in people with hyperhidrosis. Excessive sweating may worsen skin inflammation.

Social and emotional effects. Having clammy or dripping hands and perspiration-soaked clothes can be embarrassing. Palm sweat can soak into paperwork, affecting occupational and educational pursuits.

Tests and Diagnosis

During your appointment, your doctor will ask about your medical history and conduct a physical exam. If your symptoms are obvious, it may be relatively easy for your doctor to diagnose hyperhidrosis.

Lab tests
Your doctor may order blood or urine tests to determine if the excessive sweating is caused by another medical condition, such as an overactive thyroid (hyperthyroidism) or low blood sugar (hypoglycemia).

Thermoregulatory sweat test: During this test, your skin is coated with a powder that changes color when it gets wet. The test begins in a room heated to a comfortable temperature, and then you enter a heating cabinet that brings your core temperature up to 100.4 F (38 C). Most people who have hyperhidrosis sweat enough to make the powder turn purple before they go into the heating cabinet.

Treatment and Drugs

Hyperhidrosis treatment varies, depending on the severity of the problem. In most cases, your doctor will want to try conservative treatments before suggesting more-invasive options such as surgery.

Drugs used to treat hyperhidrosis may include:
Prescription antiperspirant. If over-the-counter antiperspirants don’t help, your doctor may prescribe stronger products to apply at bedtime. Prescription-strength antiperspirants can cause skin irritation, so wash the product off your body in the morning. If your skin becomes irritated, hydrocortisone cream might help.
Pills that block nerve communication. Some oral medications block the chemicals that permit certain nerves to communicate with each other. This can reduce sweating in some people, but can also cause dry mouth, blurred vision and bladder problems.
Botulinum toxin injections. Commonly used to help smooth facial wrinkles, botulinum toxin (Botox, Myobloc, others) can also block the nerves that trigger sweat glands. However, each affected area of your body will need several injections, which are painful and expensive. And the effects may last for only a few months.

Iontophoresis. In this procedure, a dermatologist uses a device to deliver a low level of electrical current to the hands or feet, and sometimes the armpits, while that part of the body is immersed in water. Treatments are often performed once a day for several weeks, followed by less frequent maintenance therapy.
Sweat gland removal. If excessive sweating occurs just in your armpits, removing the sweat glands there may help. This can be accomplished via liposuction through very small incisions.
Nerve surgery. In severe cases of hyperhidrosis, your doctor might suggest a procedure that 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

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