Excessive Sweating (Hyperhidrosis)

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Hyperhidrosis is excessive sweating. It can be an embarrassing and serious problem that affects social, professional and intimate relationships.

You can have one of two types of hyperhidrosis:

  • Primary hyperhidrosis:
    • Usually affects specific areas
    • Has no known cause
  • Secondary hyperhidrosis:
    • Usually affects the entire body
    • Caused by an underlying condition

What Triggers Hyperhidrosis?

Triggers of primary hyperhidrosis include:

  • High emotional states, such as intense sadness, fear, anger or stress
  • Spicy foods
  • Hot climates
  • Certain medications

Triggers of secondary hyperhidrosis include:

  • Menopause
  • Fever
  • Infection
  • Cancer, such as lymphoma
  • Thyroid disease
  • Hypothalamic disorders
  • Adrenal tumor
  • Nervous system disorders
  • Diabetes
  • Tuberculosis
  • Drug withdrawal
  • Certain medications

Hyperhidrosis Symptoms

The sweating occurs most commonly in the palms of the hands, soles of the feet and/or armpits. In some cases, the sweating can also affect the entire body. Symptoms include:

  • Excessive sweating of palms of the hands and/or soles of the feet
  • Excessive sweating of the armpits, head and/or face
  • Increased amount of sweating
  • Change in pattern of sweating
  • Change in the odor associated with sweating
  • Stained clothing

Tests & Treatments

A starch-iodine test is often used on the armpits to determine the areas with the most active sweat glands. Once diagnosed, several treatment options exist.

Lifestyle Changes

To help decrease the uncomfortable feeling and odor associated with sweating, try:

  • Frequent clothing changes
  • Careful washing

Topical Treatments

You can use a number of topical creams to decrease sweating in a particular area. These include:

  • Aluminum chloride hexahydrate
  • Aluminum tetrachloride
  • Formalin compresses
  • Glutaraldehyde compresses
  • Iontophoresis (stimulation with electrical current)—needs to be repeated on a daily or weekly basis, eventually tapering off to every 1-2 weeks; may be used if prescription antiperspirants fail

Medications for Secondary Hyperhidrosis 

While rarely used due to their side effects, medication options include:

  • Amitriptyline
  • Clonazepam
  • Beta blockers
  • Calcium channel blockers
  • Gabapentin
  • Oxybutynin
  • Indomethacin

Botulinum A Neurotoxin

This is the toxin produced by the bacteria that causes botulism. Injections of this toxin can decrease sweating in certain areas. It is often used on the palms of the hands and armpits. The effect of one cycle of injections may last for 6-8 months for most patients.

Surgery for Hyperhidrosis

  • Endoscopic thoracic or lumbar sympathectomy, the destruction of nerves that stimulate sweating
  • Curettage, the local removal of sweat glands via surgical scraping
  • Ultrasound
  • Liposuction techniques