Hyperhidrosis (excessive sweating) By Mayo Clinic staff

Definition

Hyperhidrosis (hi-pur-hi-DRO-sis) is frequent or constant excessive sweating. Sweating is your body's mechanism to cool itself. In most circumstances, it's both natural and healthy. But some people sweat in amounts greater than needed to cool the body, a condition called hyperhidrosis.
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.

Symptoms

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 People may have trouble working or enjoying recreational activities with constantly wet hands — or become withdrawn due to self-consciousness about shaking hands with others, having stained shirts or potential body odor.
When to see a doctor
See your doctor if:

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

Seek immediate medical attention for a cold sweat, especially if it's accompanied by symptoms of lightheadedness or chest and stomach pains. A cold sweat is usually your body's response to an underlying problem, such as a heart attack, anxiety or trauma.

Causes

Sweat glands

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 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.
There are two types of hyperhidrosis. The cause depends on the type.
Focal hyperhidrosis
Focal hyperhidrosis affects your palms, soles and sometimes underarms, usually while you're awake. Episodes often start before age 20. Sweating on your palms and soles is usually due to emotional stress, and it may be that focal hyperhidrosis occurs as an exaggerated response to emotional stimuli. But doctors don't consider it to be a psychological disorder. In fact, focal hyperhidrosis isn't usually associated with any underlying condition. It may have a genetic component, as it often runs in families.
Generalized hyperhidrosis
This type of hyperhidrosis affects large areas of the body. It can occur for no apparent reason but also may have an underlying cause, such as:

• Medication
• Menopause hot flashes
• Low blood sugar
• Overactive thyroid
• Leukemia
• Lymphoma
• Heart attack
• Infectious disease

Adjusting your medications or treating an underlying disease may help resolve generalized sweating.

Complications

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's also associated with warts. When you have hyperhidrosis, warts may take a while to go away after treatment and they have a tendency to recur.
• 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.
• Other skin conditions. Certain skin conditions, such as eczema and skin rashes, occur more frequently in people with hyperhidrosis. It may be that excessive sweating exacerbates skin inflammation.

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a specialist in skin diseases (dermatologist).
Because appointments can be brief, and because there's often a lot to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your appointment. List your questions from most important to least important in case time runs out. For hyperhidrosis, some basic questions to ask your doctor include:

• What is likely causing my symptoms?
• What are other possible causes for my symptoms?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• Is there a generic alternative to the medicine you're prescribing me?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you several questions. Being ready to answer them may reserve time to go over any points you want to discuss more. Your doctor may ask:

• When did you begin experiencing symptoms?
• How often do you experience these symptoms?
• Have your symptoms been continuous or occasional?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

Tests and diagnosis

Thermoregulatory sweat test

Some of the tests your doctor may perform to investigate the causes of your symptoms include:
Medical history and physical exam
During your appointment, your doctor asks about your medical history and conducts 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
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 individuals who don't have hyperhidrosis 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.

Treatments and drugs

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; make sure the areas are completely dry before applying. You may notice symptoms improve within a week. Prescription antiperspirants are strong solutions that can cause red, swollen and itchy skin. To prevent irritation, wash the medication off in the morning. To ease skin irritation, your doctor may recommend a hydrocortisone cream.
• 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 person'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 eventually maintenance therapy can be done at home.
• OnabotulinumtoxinA (Botox). Researchers have discovered that Botox injections, also used to help smooth facial wrinkles, are 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, such as hand muscle weakness, when injected into the palms, and headache, 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 (ETS). 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 sometimes after ETS, increased compensatory sweating can occur elsewhere on your body, such as your back or the back of your legs.

Lifestyle and home remedies

For some people who sweat excessively, the answer may be simple: an over-the-counter antiperspirant used on the hands and feet as well as the underarms. Antiperspirants work by inhibiting the action of your sweat ducts with aluminum salts, thereby reducing the amount of perspiration that reaches your skin. Keep in mind, antiperspirants inhibit sweating; deodorants only mask odor.
For best results, apply an antiperspirant nightly to palms or soles of the feet. Be sure your skin is completely dry before applying the antiperspirant; using a blow drier on the cool setting may help. Try perfume-free antiperspirants to reduce the chance of irritation. Wait 24 to 48 hours after shaving before applying antiperspirant. Once sweating is reduced, you can repeat the process less often.
In addition to antiperspirants, the following suggestions may help you reduce sweating and the associated body odor:

• Bathe daily. Regular bathing helps keep the number of bacteria on your skin in check.
• Dry your feet thoroughly after you bathe. Microorganisms thrive in the damp spaces between your toes. Use over-the-counter foot powders to help absorb sweat.
• 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.
• Rotate your shoes. Shoes won't completely dry overnight, so try not to wear the same pair two days in a row if you have trouble with sweaty feet.
• Wear the right socks. Cotton and wool socks help keep your feet dry because they absorb moisture. 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. Women may prefer pantyhose with cotton soles.
• Air your feet. Go barefoot when you can, or at least slip out of your shoes now and then.
• Choose natural-fiber clothing. Wear natural fabrics, such as cotton, wool and silk, which allow your skin to breathe. When you exercise, you might prefer high-tech fabrics that wick moisture away from your skin.
• Try relaxation techniques. Consider relaxation techniques such as yoga, meditation or biofeedback. These can help you learn to control the stress that triggers perspiration.

Coping and support

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, consider the following suggestions:

• 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 be a tremendous support. 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.