​Hyperhidrosis

What Is Hyperhidrosis?

Hyperhidrosis, also called over-perspiration, occurs when the sweat glands in the face, hands, and underarms over-produce sweat secretions.

People with hyperhidrosis sweat excessively — above and beyond their body's need for cooling. Excessive sweating can occur without warning — even when resting or under cool temperature conditions.

Sweating is important and necessary for keeping the body’s temperature stable and healthy. But too much sweating — hyperhidrosis — means you are excessively sweating no matter the activity or temperature. Some people don’t even know they have the condition, they just think they sweat more than the average person.

Hyperhidrosis often causes people to sweat excessively in just one or two areas of the body, including the:

• Head.
• Palms.
• Soles of feet.
• Underarms.

People living with the disorder suffer social embarrassment at school or work due to excessive sweating. Even simple activities — such as shaking hands, reading a book, or wearing certain fabrics like silks and linens — can cause intense shame.

For children, simple tasks like holding a pencil or touching hands with another child can become intensely shameful and may make school and activities challenging.

For adults, excessive sweating may mean multiple changes of clothes a day and avoidance of social gatherings.

What are the types of hyperhidrosis?

Doctors divide hyperhidrosis into two categories: primary and secondary.

Primary hyperhidrosis

Most people have primary hyperhidrosis, also called focal hyperhidrosis or primary focal hyperhidrosis.  This term means the sweating is limited to one or two areas of the body. In most cases, the person is healthy outside of their hyperhidrosis condition.

Other factors that have to do with primary hyperhidrosis include:

• A blood relative also has hyperhidrosis.
• Excessive sweating episodes happen more than once a week.
• Sleeping causes the sweating to stop.
• You're younger than 24 years old.
• Your everyday life is impacted by the excessive sweating.

Secondary hyperhidrosis

Secondary hyperhidrosis is mainly due to a medical condition or medication. It involves sweating in either one area of the body or all over.

The medical conditions that are linked to hyperhidrosis include:

• Acromegaly.
• Anxiety.
• Cancer.
• Carcinoid syndrome.
• Diabetes.
• Lung disease.
• Heart disease and heart failure.
• Hyperthyroidism.
• Medications and substance abuse.
• Menopause.
• Other infections.
• Parkinson’s disease.
• Pheochromocytoma.
• Rheumatoid arthritis.
• Stroke.
• Tuberculosis.

Secondary hyperhidrosis may also be caused by withdrawal from addictive substances such as:

• Alcohol
• Cocaine
• Heroin

The medications that can cause secondary hyperhidrosis include:

• Antibiotics
• Antidepressants
• Antivirals
• Insulin

Characteristics of secondary hyperhidrosis that differ from primary hyperhidrosis include sweating all over the body and not just in one or two areas and sweating through the night while asleep.

How common is hyperhidrosis?

Hyperhidrosis affects a small, but statistically significant, portion of young people globally.

Primary hyperhidrosis affects about 3% of the population globally; yet less than half of them seek help for the condition.

What causes hyperhidrosis?

Experts believe over-stimulation of the sympathetic nerves that trigger the sweat glands of the face, hands, and underarms causes excessive sweating.

But while researchers do not understand what definitively causes primary hyperhidrosis, they do believe that lesions on the central nervous system or the presence of other systemic diseases may cause secondary hyperhidrosis.

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What Are the Signs and Symptoms of Hyperhidrosis?

The physical symptoms of hyperhidrosis include excessive sweating:

• After taking certain medications.
• All over your body.
• In one or two areas of the body, usually from the face, feet, hands, head, or underarms.
• That interferes physically and emotionally with daily social, school, or work activities.
• That is triggered by anxiety, caffeine, hot and humid weather, or physical exertion.
• That produces a body odor and wet clothes.
• That stops when you’re sleeping. (unless secondary hyperhidrosis).
• When the temperature is cool, and you are not physically exerting yourself.
• While eating certain foods or giving a speech.

Other symptoms include emotional distress, embarrassment, or shame.

When should I see a doctor about my hyperhidrosis symptoms?

If you are experiencing any of the above symptoms, it is best to set up an appointment with your primary care physician or a board-certified dermatologist to determine if you have hyperhidrosis.

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How Do You Diagnose Hyperhidrosis?

Doctors can diagnose hyperhidrosis by observing the visible signs of unprovoked and excessive sweating.

First, your doctor will ask you questions about your medical and family history. You can expect them to ask about:

• Family history of hyperhidrosis.
• How long symptoms have been presenting and how often they show up.
• How this condition is affecting your life.
• Other noticeable symptoms (i.e. heart pounding or weight loss).
• Prescription medications you are taking.
• Triggers (i.e. thought process when sweating occurs).
• Where on the body you experience excessive sweating.

Tests to diagnose hyperhidrosis

You can also expect your doctor to perform a physical exam and order some tests. They may want to examine the areas of your body that are sweating more than normal and check the rest of your body for any abnormalities.

Some sweat tests that help determine hyperhidrosis include:

• Gravimetry — This test includes weighing a piece of filter paper before and after it touches an area of the body that produces excessive sweat for a determined amount of time.
• Minor’s starch iodine test — Helps determine primary hyperhidrosis. An iodine solution and starch paper are applied to the skin and the appearance of a violet color may indicate hyperhidrosis.
• The Quantitative Sudomotor Axion Reflex Test (QSART) — Measures nerves that cause sweating by using an electrical stimulation machine.

Your doctor may also order blood or urine tests to determine hyperhidrosis.

Hyperhidrosis prognosis

While there currently is no cure for hyperhidrosis, there are many treatment options available that can help stop or significantly reduce the amount of excessive sweating. Many people can live full, healthy lives managing their hyperhidrosis and going out into the world with confidence.

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How Do You Treat Hyperhidrosis?

Experts in UPMC's Division of Thoracic and Foregut Surgery offer surgical and non-surgical treatment options for hyperhidrosis.

Nonsurgical treatments for hyperhidrosis

Non-surgical treatments for hyperhidrosis represent a way to temporarily reduce and manage excessive sweating and don’t work as a permanent cure.

Topical agents

Topical agents to manage sweating associated with hyperhidrosis include:

• Anesthetic agents.
• Astringents.
• Prescription-strength aluminum chloride antiperspirant.

These agents are applied before bed once or twice a week and are used until the sweating is manageable. 

Disadvantages of these treatments are:

• Possible skin irritation, causing discomfort leading to discontinuation of use.
• They don't last long.

Anticholinergic drugs

Anticholinergic agents, such as glycopyrrolate:

• Are applied as a damp medicated cloth that is wiped on the underarms once a day.
• Help prevent the stimulation of sweat glands.
• Seem effective for some people, but researchers haven’t studied their long-term effects or implications as well as they have for other nonsurgical therapies.

Possible risks from this treatment method are:

• Dilated pupils.
• Dry mouth.
• Irritation or blurry vision if cloth gets in eyes.
• Irritation on the face.
• Irritation of the underarms.
• Sore throat.

Sofprionium gels

This gel prescription reduces how much sweat the body produces. The medication is applied to the underarms every night before bed. Once applied, do not touch the skin where you applied the gel, as this can irritate your skin.

The disadvantages of gel medication include:

• Dilated pupils.
• Dry mouth.
• Irritated underarm skin.

Procedures and energy-based treatment methods for hyperhidrosis

Iontophoresis machine

Also called a “portable antisweat machine,” iontophoresis:

• Involves temporarily deactivating the sweat gland by passing an electrical current through intact skin while submerged in water.
• Takes about 10 to 20 minutes per session and requires several sessions, either daily or every few days.
• Works best for those with hyperhidrosis of the hands or feet.

Side effects of iontophoresis include:

• Mild burning or tingling in the hands or feet.

Botox® injections

This treatment:

• Uses Botox brand botulinum toxin injections to temporarily reduce the amount of sweat produced.
• Is FDA-approved for treating axillary (armpit) hyperhidrosis, but is also used on the hands, feet, and face.
• Seems effective as a temporary hyperhidrosis management protocol.
• Takes about a week to notice improvement.

Disadvantages of Botox injections include:

• Bruising or weakness in injection site.
• High cost.
• Mild itching.
• Need for repeated treatments, as results tend to only last three to 10 months.
• Pain of injections

Surgical treatments for hyperhidrosis

If nonsurgical options are not working, your doctor may recommend surgery for your hyperhidrosis. These surgeries have a high success rate in stopping excessive sweating in the affected area.

Thoracoscopic sympathectomy

Thoracoscopic sympathectomy is the preferred surgical treatment for correcting hyperhidrosis. This operation gives the best results for those with palmar (palms of hands) hyperhidrosis but also works well for people with axillary (armpit) and facial hyperhidrosis.

Advances in surgical techniques and instrumentation have simplified the operation. It's now done as an outpatient procedure, using minimally invasive methods with high success.

You will receive general anesthesia for the thoracoscopic sympathectomy and be asleep for the duration of the surgery. Once asleep, the surgeon will make two tiny incisions in the area being treated. Using video technology to look inside the body, they will cut the nerves that connect to the area they are treating, cutting off the signal from the nerves that produce sweat in the area.

Typically, you will be able to go home the same day, with dry hands and armpits for the first time since the onset of the disorder.

Side effects from thoracoscopic sympathectomy include:

• Compensatory sweating, usually in the abdomen, back, or legs. This sweating is not as severe as the excessive sweating from hyperhidrosis.
• Excessive dryness in the area.
• Rarely, a return of excessive sweating.

Sweat gland removal surgery

If you are dealing with primary hyperhidrosis in the armpits, sweat gland removal surgery may be beneficial.

In this surgery, you may be given local anesthesia or general anesthesia, depending on the area being treated. Your surgeon will make small incisions in the armpits and remove the sweat glands either through scraping, suctioning, lasers, microwave energies, or a combination of methods.

Sweat gland removal surgery permanently removes the sweat glands in the affected area to end excessive sweating. The most common side effect is compensatory sweating, where sweat glands will compensate in other areas, and you may sweat more than usual in those places.

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