What is Hyperhidrosis?
Hyperhidrosis is a medical condition characterized by excessive sweating. It is generally categorized into primary and secondary forms. Primary focal hyperhidrosis is characterized by increased amounts of sweating in the palms, soles, and armpits. Affected individuals often suffer from psychological, social, and occupational consequences. These cases of hyperhidrosis have no underlying systemic cause.
Secondary hyperhidrosis is excessive sweating caused by a systemic medical condition or side effect of a medication. Individuals usually have generalized sweating that is not limited the palms and soles. This may occur with conditions such as hyperthyroidism, tuberculosis, and lymphoma.
What Causes Hyperhidrosis?
Primary focal hyperhidrosis is likely caused by an exaggerated response of the brain by normal emotional stress. Sweat glands and structurally and functionally normal?. There appears to be a genetic basis to the disease as most individuals report a family history of the condition.
Secondary hyperhidrosis is excessive sweating due to an underlying systemic condition or medication. This most often leads to generalized sweating instead of focal sweating of the palms or feet. Sweating also tends to occur during day and nighttime. The most common cause of secondary hyperhidrosis is excessive heat. Other potential etiologies include:
- HIV infection – AIDS
- Endocarditis – heart valve infection
- Cancer such as lymphoma or leukemia
- Carcinoid syndrome – serotonin producing tumor
- Pheochromocytoma – catecholamine producing tumor
- Hyperthyroidism – thyroid hormone overproduction
Occasionally, spinal cord injury can result in a condition called autonomic dysreflexia, which results in excessive sweating. Medications such as selective serotonin reuptake inhibitors (SSRIs), bupropion, and aromatase inhibitors (e.g., anastrazole), and estrogen receptor modulators (e.g., tamoxifen) are also implicated.
How Common is Hyperhidrosis?
Hyperhidrosis is a relatively common disorder that is often initially evaluated in the primary care clinic. The prevalence of hyperhidrosis is approximately 1%-3% of the population worldwide. In the United States, the prevalence of hyperhidrosis is about 2.9%. An estimated half of the individuals primarily have armpit symptoms. Advanced or severe cases often requires referral to a dermatology specialist, especially if first-line and conservative measures are unsuccessful.
Signs and Symptoms
Symptoms of primary focal hyperhidrosis typically include excessive sweating in the palms, soles, and armpits. The scalp and face may also occasionally be involved. Symptoms are usually worse with heat or stress. Individuals with axillary (armpit) disease often have soaking of the armpits and stained clothing. Those with palmar involvement frequent have fear of shaking hands or drenching paperwork, which leads to difficulty in social and occupational settings.
Patients with hyperhidrosis frequently have coexisting skin disorders such as fungal infections and cutaneous warts, and eczema in the regions affected by the condition.
Doctor diagnose individuals with primary hyperhidrosis if you meet most of the following criteria:
- Excessive sweating for >6 months without an apparent cause
- One or more episodes per week
- Symptom onset before age 25
- Symptoms involve both hands symmetrically
- Symptoms impair daily activities
- Family history of the disorder
- Symptoms stop during sleep
If you have generalized sweating that occurs during the day and night, your doctor will perform a detailed medication check to ensure your symptoms are not related to drugs. Antidepressants such as SSRIs (eg, Prozac) and Wellbutrin (buproprion) are frequently associated with generalized sweating.
Your doctor will also usually evaluate for an underlying systemic illness. Commonly ordered blood tests include a CMP (comprehensive metabolic panel), CBC (complete blood cell count), and thyroid function studies (TSH, free T4). If you doctor suspects pheochromocytoma, they will usually obtain serum and urine metanephrine levels. HIV is usually diagnosed with serum antigen and antibody assays. Those with suspected tuberculosis typically receive a tuberculin skin test (PPD), serum quantiferon level, and chest x-ray.
Hyperhidrosis Medication and Treatment
The first-line treatment for primary hyperhidrosis includes topical antiperspirants such as Drysol containing aluminum chloride hexahydrate in alcohol. Aluminum reduces sweating by plugging up sweat ducts. Individuals may also benefit from iontophoresis – a treatment that uses electric currents to inhibit sweating.
Those with axillary hyperhidrosis that is not responsive to the aforementioned measures may respond to Botox (botulinum toxin) injection. Microwave thermolysis is an alternative option that may not be available in some dermatology centers. Individuals with refractory axillary hyperhidrosis may benefit from a local surgery called suction curettage, a local surgical intervention.
Occasionally, severe cases are treated with systemic anticholinergic medications such as Cuvposa (oral glycopyrrolate) and Ditropan (oral oxybutynin). Acetylcholine is an important neurotransmitter that stimulates sweat glands to produce sweat. Systemic anticholinergic medications work by reducing acetylcholine levels, thereby removing the stimulus of sweat production. Endoscopic thoracic sympathectomy is an invasive surgery that is typically a last resort treatment for refractory patients.
- Hornberger J, Grimes K, Naumann M, et al. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. J Am Acad Dermatol 2004; 51:274. - https://www.sweathelp.org/pdf/Hornberger_2004.pdf
- Strutton DR, Kowalski JW, Glaser DA, Stang PE. US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: results from a national survey. J Am Acad Dermatol 2004; 51:241. - https://www.sweathelp.org/pdf/Strutton_2004.pdf
- Leung AK, Chan PY, Choi MC. Hyperhidrosis. Int J Dermatol 1999; 38:561. - https://www.ncbi.nlm.nih.gov/pubmed/10487442
The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.