Hyperhidrosis

What is hyperhidrosis?

Hyperhidrosis is excessive sweating. This condition happens when you sweat more than what your body needs to regulate your temperature. You may experience sweating when you’re at rest, in cold temperatures or randomly at times when you wouldn’t expect to sweat.

Sweat is an odorless fluid released from your eccrine glands (sweat glands). Sweat’s job is to help regulate your body temperature and prevent overheating. You have eccrine glands in your skin. Sweat moves from your glands through tubes called ducts until it reaches the surface of your skin. Once sweat leaves the ducts, it changes from a liquid to a gas and disappears from your skin (evaporates) to cool down your body.

Hyperhidrosis is the result of your sweat glands overworking.

What are the types of hyperhidrosis?

There are two types of hyperhidrosis:

• Primary focal hyperhidrosis: Focal hyperhidrosis is a chronic skin condition. A genetic change (mutation) causes this condition. You can inherit it from your biological family. This is the most common type of hyperhidrosis. It usually affects your armpits, hands, feet and face. It tends to start before age 25.
• Secondary generalized hyperhidrosis: Generalized hyperhidrosis is excessive sweating caused by an underlying medical condition or it’s a side effect of a medication. Some examples include diabetes and Parkinson’s disease and medications, such as naproxen (Aleve®). Generalized hyperhidrosis may cause you to sweat while sleeping.

How common is hyperhidrosis?

Hyperhidrosis is common. Research suggests that an estimated 3% of adults in the United States between ages 20 and 60 have hyperhidrosis.

What are the symptoms of hyperhidrosis?

The main symptom of hyperhidrosis is sweating. When you sweat, you may feel:

• Wetness on your skin.
• Damp clothing.
• Beads of fluid dripping from your cheeks or forehead.

Over time, hyperhidrosis can lead to the following symptoms:

• Itching and inflammation when sweat irritates your skin.
• Body odor, which occurs when bacteria on your skin mixes with sweat particles.
• Cracked or peeling skin on your feet.

Hyperhidrosis symptoms can range in severity. You may have minor symptoms that come and go or you may have constant symptoms that have an impact on your day-to-day activities.

Hyperhidrosis can also have an emotional impact on your life. Many people who have hyperhidrosis feel embarrassed when they sweat or they might avoid being around other people. If this condition affects your mental health, reach out to a healthcare provider to help you manage your symptoms and a mental health professional to help you manage how you feel about your body.

Where will I have symptoms of hyperhidrosis?

Sweat comes from eccrine glands, which exist in the skin throughout your body. You have the most eccrine glands in your:

• Armpits or underarms (axillary hyperhidrosis).
• Soles of your feet (plantar hyperhidrosis).
• Palms of your hands (palmar hyperhidrosis).
• Forehead and cheeks (craniofacial hyperhidrosis).
• Genitals.
• Lower back.

The most common location on your body to experience excessive sweating is the palms of your hands.

What causes hyperhidrosis?

Overactive sweat glands cause hyperhidrosis. Your eccrine glands (sweat glands) create sweat to cool down your body when you get hot. This process activates when you exercise or if you’re nervous. If you have hyperhidrosis, your eccrine glands activate and produce sweat more often than when your body is too hot. You may experience sweating at random times of the day when there isn’t something like an activity or emotion causing your glands to produce sweat. Research is ongoing to learn more about why your glands make too much sweat.

Triggers that cause sweating

Your body produces sweat to cool it down and prevent overheating. There may be certain triggers in your environment that can cause your sweat glands to produce more sweat including:

• Certain emotions like stress, anxiety, fear or nervousness.
• Warm temperatures or humidity.
• Exercise or physical activity.
• Certain foods and beverages, like spicy foods, fatty foods, sugary and salty foods, and foods with high levels of protein. Beverage examples include caffeinated beverages (coffee) and alcohol.

Medications that cause sweating

Certain medications can cause sweating as a side effect, including but not limited to:

• Albuterol (Proventil®).
• Bupropion (Wellbutrin®).
• Hydrocodone.
• Insulin (Humulin® R, Novolin® R).
• Levothyroxine.
• Lisinopril.
• Naproxen (Aleve®).
• Omeprazole (Prilosec®).
• Sertraline (Zoloft®).

If you take any of these medications and experience symptoms of hyperhidrosis, talk to your healthcare provider. Don’t stop taking a medication unless your provider tells you it’s safe to do so.

Medical conditions that cause sweating

Hyperhidrosis (generalized) could be a sign of an underlying medical condition including but not limited to:

• Acromegaly.
• An infection (tuberculosis).
• Anxiety.
• Cancer.
• Diabetes.
• Heart disease or heart failure.
• Hyperthyroidism.
• Menopause.
• Obesity.
• Parkinson’s disease.

Does hyperhidrosis run in families?

Yes, you may be more at risk of hyperhidrosis, specifically focal hyperhidrosis, if someone in your biological family has the condition. Research indicates that a hereditary genetic mutation or change to your DNA could cause hyperhidrosis.

What are the complications of hyperhidrosis?

Hyperhidrosis can cause complications that include:

• A skin infection.
• Skin changes, such as paleness, discoloration, cracks or wrinkles.
• Maceration, or unusually soft, moist skin.

Hyperhidrosis can also impact your mental health. You may find yourself changing your routine to hide your symptoms from others. Constant sweating may be so severe that you avoid common actions, such as lifting your arms or shaking hands. You may even give up activities you enjoy to avoid problems or embarrassment from excessive sweating. Contact a healthcare provider if hyperhidrosis affects your mental health and social well-being.

How is hyperhidrosis diagnosed?

A healthcare provider will diagnose hyperhidrosis after a physical exam and learning more about your symptoms and medical history. They’ll evaluate your symptoms using diagnostic criteria. If you experienced excessive sweating for at least six months and answered yes to at least two of the following questions, it may lead to a hyperhidrosis diagnosis:

• Sweating occurs on your underarms, palms, soles or face.
• You sweat the same on both sides of your body.
• You don’t sweat at night or sweat less at night.
• An episode of sweating lasts for at least one week.
• You have a history of hyperhidrosis in your biological family.
• Sweating interferes with your ability to do certain activities.
• You’re younger than 25 years old.

What tests diagnose hyperhidrosis?

A healthcare provider may use one of the following tests to determine the cause of hyperhidrosis:

• Starch-iodine test: Your provider applies an iodine solution to the sweaty area and sprinkles starch over the iodine solution. In places where you have excess sweating, the solution turns dark blue.
• Paper test: Your provider places special paper on the affected area to absorb sweat. Later, your provider weighs the paper to determine how much sweat you have.
• Blood or imaging tests: These tests can take a sample of your blood or take pictures underneath your skin to help your healthcare provider learn more about what causes your symptoms.

How is hyperhidrosis treated?

Treatment for hyperhidrosis varies based on the part of the body affected, the severity of your diagnosis and what treatment options work for you. A healthcare provider or a dermatologist can help you find the best treatment options to help you manage your symptoms. There isn’t one form of treatment that works well for everyone.

At-home hyperhidrosis treatment

You can manage your symptoms of hyperhidrosis at home by:

• Using antiperspirants and deodorants. Antiperspirants work by sealing up sweat glands so your body stops producing sweat. A provider may recommend certain over-the-counter (OTC) or prescription-strength varieties. The best deodorant for hyperhidrosis is an aluminum-based product.
• Showering or bathing more often. Changing your routine, such as showering more often, may improve mild symptoms.
• Wearing breathable clothing. Choosing clothing that’s breathable and more absorbent, like cotton, can help you feel more comfortable if you sweat. Avoid blended fabrics and polyester, which can trap heat and make you sweat more.

Hyperhidrosis medications

A healthcare provider or dermatologist may recommend taking medications to reduce your symptoms of hyperhidrosis, including:

• Anticholinergic agents (glycopyrrolate and oxybutynin).
• Antidepressants.
• Beta-blockers.
• Medicated wipes (glycopyrronium tosylate, Qbrexza®).
• Aluminum chloride gel.

Talk to a healthcare provider about the side effects of the medication they prescribe before taking them.

Hyperhidrosis treatment therapies

If your symptoms don’t improve with at-home treatment and/or medications, your healthcare provider may recommend more specialized therapies:

• Iontophoresis: You place your hands or feet in a shallow tub of tap water. A special device emits a low electrical current through the water, blocking sweat glands over time. Each treatment takes 10 to 20 minutes. You may need repeated treatments. Insurance may cover the equipment, enabling you to do the therapy at home.
• Botulinum toxin (Botox®) injections: Injecting botulinum toxin into an overactive nerve can stop sweat production for months at a time. Repeat treatments are necessary.
• Microwave therapy: Your provider places a high-tech device (miraDry®) against the affected area of your skin. The device emits thermal energy (heat), which destroys sweat glands permanently. This is an hour-long procedure that takes place in a healthcare provider’s office.

Hyperhidrosis surgery

When other treatments don’t work well and your symptoms persist, your provider may consider surgery:

• Endoscopic thoracic sympathectomy: ETS is a minimally invasive type of surgery where a surgeon will cut a nerve in your body to turn off the signal that tells your glands to produce sweat.
• Sweat gland removal: A surgeon will remove your sweat glands using a laser, scraping (curettage), cutting (excision) or liposuction.

Surgery has the potential to offer lasting benefits for persistent sweating that doesn’t respond to other therapies. Talk to your surgeon about the possible side effects of surgery to see if it’s right for you.

Are there side effects of the treatment?

Each type of treatment has possible side effects. Side effects of hyperhidrosis treatment could include:

• Skin irritation, cracking or blisters.
• Skin discoloration.
• Pain or discomfort.
• Color changes or damage to your clothing.
• Scarring.

Your healthcare provider will have the most up-to-date information about the possible side effects of the treatment they offer. Make sure you discuss with your provider the possible side effects before starting treatment.

How soon after treatment will I feel better?

You may feel better immediately after you begin treatment, or it may take a few weeks to months before you notice any changes to your symptoms. The timeline for each type of treatment varies. Your provider can let you know what to expect with each type of treatment option.

Can hyperhidrosis be prevented?

Not all cases of hyperhidrosis are preventable. For example, you can’t prevent focal hyperhidrosis since it may have a genetic cause. If you have generalized hyperhidrosis, managing or treating any underlying health conditions can help. You can also work with your healthcare provider to manage the side effects of medications you’re prescribed to reduce the likelihood of hyperhidrosis.

What can I expect if I have hyperhidrosis?

While hyperhidrosis has no cure, there are a variety of treatment options available to help you manage your symptoms. The condition isn’t life-threatening, but it can have a major impact on your life. You may feel embarrassed or sensitive talking about your condition and it might keep you from participating in activities that you regularly enjoy. If hyperhidrosis affects your mental health, talk to a healthcare provider or a mental health professional. They can help you feel better about your body and the effect of overactive sweat glands.

Is there a cure for hyperhidrosis?

There’s no cure for focal hyperhidrosis. Treatments can help you reduce your symptoms and improve your quality of life. Generalized hyperhidrosis can go away if you and your healthcare provider manage or treat the underlying cause, which could be either a side effect of an underlying condition or a medication you take. Not all cases of generalized hyperhidrosis have a cure.

When should I see a healthcare provider?

You should call your healthcare provider if sweating:

• Negatively impacts your life.
• Causes you to avoid activities or people you love.
• Worsens over time.
• Happens overnight while you sleep.

In some cases, extreme sweating may be due to a severe and sometimes life-threatening condition. See a healthcare provider right away if you have chest pain or feel nauseous or dizzy along with sweating symptoms.

What questions should I ask my doctor?

If you have hyperhidrosis, you may want to ask your healthcare provider:

• What caused my sweating symptoms?
• What are my treatment options?
• Which treatments do you recommend I try first?
• Can I do anything else to improve my symptoms or my overall health?
• How long will it take for my symptoms to reduce?
• How can I support my mental health?

Why does sweat smell bad?

Sweat from your eccrine glands is naturally odorless, but it can combine with bacteria and cause an odor. Sweat is made up of mostly water. Your body naturally has small amounts of bacteria on it. When bacteria on your skin combine with sweat droplets, the bacteria break down the tiny molecules that make up sweat. This process of breaking down sweat causes a pungent odor.

Your body has another type of sweat gland called apocrine glands. These glands are in areas of your body where you have hair follicles, like your armpits and genital areas. The fluid that these glands produce is thicker than the fluid from eccrine glands. When this fluid meets bacteria on your skin, it produces body odor.

A note from Cleveland Clinic

Excessive sweating due to hyperhidrosis can be a short- or long-term condition that can be challenging to manage. Concern over how someone may react to your symptoms (like shaking your sweaty hand) may make you want to withdraw from social situations. There’s no cure for hyperhidrosis, but help is available. Your provider may recommend a prescription-strength antiperspirant or medications to lessen your symptoms.