Hyperhidrosis or excessive sweating

Sweating is your body’s mechanism to cool itself. In most circumstances, it’s both natural and healthy. But some people experience frequent or constant excessive sweating — called hyperhidrosis

Hyperhidrosis is the secretion of sweat in amounts greater than needed to cool the body. 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. Fortunately, several options are available to treat hyperhidrosis. In severe cases, surgical procedures can be very effective at stopping sweat.

Although when, where and how much you sweat varies widely, 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.

Signs and symptoms of hyperhidrosis include:

  • Frequent, noticeable, excessive sweating that can soak through clothing
  • Abnormally excessive and bothersome perspiration on your feet, underarms, head or face
  • Clamminess or dripping of sweat droplets on the palms of the hands or the soles of your feet

Hyperhidrosis is defined as sweating that disrupts your normal activities. Episodes usually occur at least once a week without an obvious reason.

For some people, hyperhidrosis interferes with their social life. People may have trouble working or enjoying recreational activities with constantly wet hands — or become withdrawn due to self-consciousness about shaking hands with others, having stained shirts or potential body odor.

See your doctor if:

  • You suddenly begin to sweat more than usual.
  • Sweating disrupts your daily routine.
  • You experience night sweats for no apparent reason.

Seek immediate medical attention for a cold sweat, especially if you have symptoms of lightheadedness or chest and stomach pains. A cold sweat is usually your body’s response to a serious illness, including cardiac disease, anxiety or severe pain.

The cause of hyperhidrosis stems from your body’s temperature regulation system, specifically your sweat glands.

Your skin has two types of sweat glands: eccrine glands and apocrine glands. Eccrine glands occur over most of your body and open directly onto the surface of the skin. Apocrine glands develop in areas abundant in hair follicles, such as on your scalp, armpits and groin.

When your body temperature rises, your autonomic nervous system stimulates these glands to secrete fluid onto the surface of your skin, where it cools your body as it evaporates. This fluid (perspiration) is composed mainly of water and salt (sodium chloride) and contains trace amounts of other electrolytes — substances that help regulate the balance of fluids in your body — as well as substances such as urea.
Sweat glands
The cause of hyperhidrosis depends on the type:

  • Focal hyperhidrosis. This most commonly involves excessive daytime sweating of your palms and soles, and sometimes the underarms for no apparent reason. It occurs equally on both sides — for example, both palms. The sweating typically stops when sleeping. Focal hyperhidrosis usually begins before age 20 and isn’t associated with an underlying condition. The exact cause of focal hyperhidrosis is unknown, but it may have a genetic component as it often runs in families.
  • Generalized hyperhidrosis. This type of hyperhidrosis affects large areas of the body. If it begins suddenly, it typically has an underlying cause, such as being a side effect of a drug or a sign of a disease or condition, such as menopause hot flashes, low blood sugar, overactive thyroid, leukemia, lymphoma, heart attack or possibly an infectious disease. Adjusting your medications or treating an underlying disease often solves this problem.

Complications of hyperhidrosis include:

  • Fungal nail infections. People who sweat profusely are prone to many types of fungal infections. That’s because fungi thrive in warm, moist environments such as sweaty shoes. That’s also why you’re more likely to get an infection in your toenail than in your fingernail. A nail infection usually begins as a white or yellow spot under the tip of your nail. As the fungal infection spreads deeper, your nail may discolor, thicken and develop crumbling edges. Sometimes your nail may separate from the nail bed, and the skin around it may become red and swollen. You may even detect a slight odor.
  • Bacterial infections and warts. Hyperhidrosis can contribute to bacterial infections, especially around hair follicles or between your toes. It can also lead to warts — skin growths caused by the human papillomavirus (HPV) — and delayed resolution of warts after treatment.
  • Heat rash or prickly heat. This rash occurs when the pores around the sweat glands become blocked. As a result, sweat becomes trapped under your skin, causing fine red spots or bumps — usually on your upper back, chest or arms. It most often occurs in hot, humid weather and generally affects babies and young children.
  • Social and emotional consequences. People with hyperhidrosis typically have excessive sweating of the soles and palms, which may produce clammy hands and unpleasant foot odor. As a result, they can experience significant psychological, social, educational and occupational consequences.

During your appointment, your doctor asks about your medical history and conducts a physical exam. He or she 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).

Your doctor may also conduct a thermoregulatory sweat test. During this test, a moisture-sensitive indicator powder is applied to your skin. The powder changes color from yellow-green to dark purple in areas where excessive sweating occurs at room temperature. A digital photo documents this. Then, you are exposed to high heat and humidity in a sweat cabinet that causes sweating over the entire body.

People who have hyperhidrosis tend to sweat even more in the palms in a warm environment, whereas normal individuals tend not to sweat from the palms. The findings from the thermoregulatory sweat test help your doctor accurately make a diagnosis and define the severity of the condition to determine the most appropriate treatment.

Your doctor may recommend one of the following treatments for hyperhidrosis:

  • Prescription antiperspirant. If over-the-counter antiperspirants don’t help, your doctor may prescribe aluminum chloride (Drysol, Xerac). This prescription antiperspirant is used to treat light to moderate hyperhidrosis. For best results, apply the antiperspirant at night to the areas most prone to sweating. Prescription antiperspirants are strong solutions that can cause red, swollen and itchy skin. To prevent irritation, wash the medication off in the morning.
  • Anticholinergic drugs. If you have generalized sweating, your doctor may prescribe an anticholinergic drug, such as glycopyrrolate (Robinul, Robinul Forte). Anticholinergics work by blocking the actions of acetylcholine, a chemical messenger in your body that helps to stimulate your sweat glands. Signs and symptoms generally improve in about two weeks. But because acetylcholine acts on several structures in your body, not just your sweat glands, it can have various side effects. While generally mild, they may include dry mouth, constipation, blurry vision, urinary retention, loss of taste, dizziness and confusion. If you experience diarrhea, rash or hives, or difficulty breathing or swallowing, seek prompt medical help, as these may signal a more serious problem.
  • Iontophoresis. In this procedure, a dermatologist uses a battery-powered device to deliver a low level of electrical current to the hands or feet, and sometimes the armpits, while the patient’s body is immersed in water. This is thought to temporarily block sweat glands. Treatments last about 15 to 30 minutes and are often performed once a day for a couple of weeks, followed by less frequent maintenance therapy. Iontophoresis is generally safe and can be done at home.
  • Botulinum toxin (Botox). This is the same product that helps smooth facial wrinkles by paralyzing certain muscles. Researchers have discovered that Botox injections are also an effective way to treat severe hyperhidrosis by blocking the nerves that trigger the sweat glands. Botox isn’t a cure-all, however. It may take several injections to achieve the desired results, the treatment can be painful, and the results last only about four months. Side effects are possible but uncommon.
  • Surgery. In rare cases, surgery may be an option. If excessive sweating occurs just in your armpits, removing the sweat glands may help. Another procedure involves cutting the nerves that carry the messages from the sympathetic nerves to the sweat glands. The surgery can be performed using a procedure known as endoscopic thoracic sympathectomy. It requires just three small incisions for a video camera and small surgical instruments. Although the operation is delicate, it typically requires only a day in the hospital and produces minimal scarring. After the surgery, sweating on the hands permanently stops. But increased sweating can occur elsewhere on your body, such as your back or the back of your legs.

Hyperhidrosis can be distressing. You may have trouble working or enjoying recreational activities because of wet hands or feet or wet stains on clothing. You might feel embarrassed or anxious about your symptoms and become withdrawn or self-consciousness. You may be frustrated or upset by other people’s reactions.

If you’re having difficulty coping, you may find some of the following suggestions helpful:

  • Educate yourself about hyperhidrosis. The more you know, the better prepared you’ll be to deal with complications or recurrences. Besides talking to your doctor, you may want to talk to a counselor or medical social worker. Or you may find it helpful to talk to other people with hyperhidrosis.
  • Follow your doctor’s recommendations. If your doctor recommends certain treatments or lifestyle changes, be sure to follow them. Ask questions if anything is unclear.
  • Maintain a strong support system. Family and friends can help you tremendously as you go through this difficult time. Sometimes, though, you may find the concern and understanding of other people with hyperhidrosis especially comforting. Go online to connect with other people living with the condition.