What is hyperhidrosis?
In hyperhidrosis, your body’s sweat glands overact. This overactivity causes you to sweat a lot, at times and places where other people wouldn’t.
Sometimes, a medical condition or emotion (like anxiety) triggers excessive sweating. For many people with hyperhidrosis, controlling symptoms can be a constant challenge.
What is focal hyperhidrosis?
Focal hyperhidrosis is a chronic skin disorder that you can inherit from your family. It results from a mutation (change) in your genes. It is also called primary hyperhidrosis. Most people who sweat excessively have focal hyperhidrosis.
Focal hyperhidrosis usually affects only the armpits, hands and feet, and head. It tends to start early in life, before age 25.
What is generalized hyperhidrosis?
Generalized hyperhidrosis is excessive sweating that happens due to another medical problem. Many medical conditions (like diabetes and Parkinson’s disease) can cause your body to sweat more than usual. Some medications, such as naproxen (Aleve®) and zinc supplements (Cold-Eeze®), cause extra sweating as a side effect.
Generalized hyperhidrosis, also called secondary hyperhidrosis, tends to occur in adults.
How common is hyperhidrosis?
Estimates suggest between 2% and 5% of people in the U.S. have hyperhidrosis. However, that number may be higher. Many people who sweat excessively don’t talk about their symptoms and never tell their healthcare provider. That makes it hard to gauge how many people hyperhidrosis affects.
Symptoms and Causes
What causes hyperhidrosis?
Sweating is how your body cools itself when it gets too hot (when you’re exercising, sick or really nervous). Nerves tell your sweat glands to start working. In hyperhidrosis, certain sweat glands work overtime for no apparent reason, producing sweat that you don’t need.
Focal hyperhidrosis commonly results from:
- Certain odors and foods, including citric acid, coffee, chocolate, peanut butter and spices.
- Emotional stress, especially anxiety.
- Spinal cord injury.
Generalized or secondary hyperhidrosis can result from:
- Dysautonomia (autonomic dysfunction).
- Heat, humidity and exercise.
- Infections, such as tuberculosis.
- Malignancies, such as Hodgkin disease (cancer of the lymphatic system).
- Metabolic diseases and disorders, including hyperthyroidism, diabetes, hypoglycemia (low blood sugar), pheochromocytoma (a benign tumor in the adrenal glands), gout and pituitary disease.
- Severe psychological stress.
- Some prescription drugs, including certain antidepressants (buproprion or Wellbutrin®) and insulins (Humulin® R).
In secondary hyperhidrosis, a medical condition or medication causes you to sweat more than usual. Medical experts haven’t uncovered what causes the body to produce extra sweat in focal hyperhidrosis.
Can hyperhidrosis be passed down in families?
Focal hyperhidrosis runs in families, which suggests a genetic link. While it’s common for multiple members of one family to have hyperhidrosis, you may not know it. That’s because lots of people with hyperhidrosis don’t feel comfortable talking about their symptoms.
What symptoms does hyperhidrosis cause?
Hyperhidrosis symptoms can range widely in their severity and impact on your life. Minor symptoms may ebb and flow over a long time. Or excessive sweating may be an everyday challenge, a constant source of frustration and insecurity.
Hyperhidrosis affects people differently. Sweat may:
- Pool under your arms or around your back.
- Soak your shirt to the point that you need to change clothes to feel comfortable.
- Bead on your cheeks or forehead.
- Dampen or drip down your hands or soak your socks.
Excessive sweating may also lead to:
- Itching and inflammation when sweat irritates the affected area.
- Body odor, when bacteria on the skin mix with sweat particles.
- Residue from combinations of sweat, bacteria and chemicals (deodorants), leaving noticeable marks on clothing.
- Skin changes, such as paleness or other discoloration, cracks or wrinkles.
- Maceration (unusually soft or disintegrating skin) on the soles of your feet.
Your symptoms may offer clues to the type of hyperhidrosis you have. Excessive sweating due to focal hyperhidrosis usually affects both sides of the body (both hands or feet). Focal hyperhidrosis doesn’t cause night sweats and doesn’t go away without treatment. People with generalized hyperhidrosis may sweat while sleeping.
What parts of the body does hyperhidrosis affect?
Generalized hyperhidrosis makes you sweat all over. Focal hyperhidrosis mostly affects the:
- Armpits (axillary hyperhidrosis).
- Bottoms (soles) of the feet (plantar hyperhidrosis).
- Face, including the cheeks and forehead.
- Lower back.
- Undersides (palms) of the hands (palmar hyperhidrosis).
Does sweat smell bad?
Sweat by itself is odorless, made up of mostly water. However, sweat can cause a noticeable body odor when bacteria on the skin come into contact with sweat droplets. Bacteria break down the molecules that make up sweat. The bacteria at work cause a pungent smell.
Diagnosis and Tests
How is hyperhidrosis diagnosed?
Excessive sweating can be embarrassing and uncomfortable. Many people never bring up the problem with their healthcare provider. By talking to a provider about their symptoms, many people find relief.
Your provider will review your health history and thoroughly evaluate your symptoms. Your provider may ask about how often or when you have symptoms.
Do I need testing to confirm hyperhidrosis?
You may need one or more tests to help pinpoint what’s causing your body to sweat too much. Blood or urine tests may confirm or rule out an underlying medical condition.
Your provider also may recommend a test to measure how much sweat your body produces. These tests include:
- Starch-iodine test: Your provider applies an iodine solution to the sweaty area and sprinkles starch over the iodine solution. 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 you sweated.
Management and Treatment
Can hyperhidrosis be cured?
There is no cure for focal hyperhidrosis. Treatments focus on reducing your symptoms and improving your quality of life.
How your healthcare provider treats secondary hyperhidrosis will depend on the underlying problem. When you can identify and treat the cause of excessive sweating, excessive sweating typically stops.
How is hyperhidrosis treated?
Your primary care provider may refer you to a dermatologist (skin specialist) for hyperhidrosis treatment. Your provider will ask about your symptoms (where and how often you sweat) and overall health. The provider may start by recommending lifestyle changes or medications.
- Lifestyle changes: Changing your routine (such as showering more often or wearing breathable fabrics) may improve minor hyperhidrosis symptoms. Your provider will discuss all your treatment options and help you decide what’s right for you.
- Aluminum-based antiperspirants: Antiperspirants work by sealing up sweat glands so your body stops producing sweat. Your provider may recommend over-the-counter or prescription-strength varieties. Stronger antiperspirants may help more. But they are also more likely to cause side effects, such as skin irritation.
- Oral medications: Anticholinergic drugs (glycopyrrolate and oxybutynin) can make aluminum-based antiperspirants work better. Potential side effects include blurred vision and problems peeing. Your provider may recommend an antidepressant, which may lessen sweating while also calming anxieties. Beta blockers may also be recommended by your provider.
- Clinical-grade cloth wipes: Prescription-strength cloth wipes containing glycopyrronium tosylate (Qbrexza®) may reduce armpit sweating. Each single-use cloth comes in its own package. You should use the wipes daily for continued benefits.
What if medications or lifestyle changes don’t improve my symptoms?
If your symptoms don’t improve, 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.
- Botox® injections: Injecting botulinum toxin (Botox®) into an overactive nerve can stop sweat production for months at a time. Treatments must be repeated and can be costly.
- Microwave therapy: Your provider places a high-tech device (called MiraDry®) against the affected area. The device emits thermal energy (heat), which destroys sweat glands permanently. Providers perform this hour-long procedure in their office. It can significantly reduce underarm sweating for good.
Who has hyperhidrosis surgery?
When other treatments don’t work and your symptoms persist, your provider may consider surgery.
Surgeons treat some cases of excessive armpit sweating by removing sweat glands in the underarm. Carefully disconnecting the nerves responsible for symptoms (called a sympathectomy) may also provide relief for some people with hyperhidrosis.
Surgery has the potential to offer lasting benefits for persistent sweating that doesn’t respond to other therapies. But every procedure has risks. Many people have postsurgical side effects like sweating in other areas that surgery didn’t treat (compensatory hyperhidrosis). Discuss a procedure’s advantages and potential drawbacks with a provider you trust.
What are the complications of hyperhidrosis?
Over time, excessive sweating could put you at an increased risk of developing a skin infection. Hyperhidrosis can also impact your mental health.
You may find yourself changing how you act to hide your symptoms from others. Constant sweating may be so severe that you avoid routine 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.
In some cases, extreme sweating may be due to a severe and life-threatening problem. See a healthcare provider right away if you ever have chest pain or feel queasy or dizzy along with sweating symptoms.
Can I prevent hyperhidrosis?
Focal hyperhidrosis cannot be prevented. You may be able to prevent some cases of generalized hyperhidrosis. The key is getting a precise diagnosis and treatment for an underlying condition that is causing symptoms.
Outlook / Prognosis
What is the prognosis (outlook) for people with hyperhidrosis?
While hyperhidrosis has no cure, you have options for controlling your symptoms. And treatments today are varied and evolving.
Still, while hyperhidrosis isn’t life-threatening, it can seriously disrupt how you live. Worrying about excessive sweating can affect your relationships, social life and career. Reaching out to a mental health provider may provide valuable support. A hyperhidrosis support group can connect you with people who have faced similar challenges. The support can help you embrace what makes you unique.
When should I call the doctor?
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.
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 symptoms or my overall health?
- How can I support my mental health?
A note from Cleveland Clinic
Excessive sweating due to hyperhidrosis can be a short- or long-term problem. It affects some people for most of their lives. Concern over how someone may react to your symptoms (like shaking your sweaty hand) may make you want to withdraw. There is no cure for hyperhidrosis, but help is available. Your provider may recommend a prescription-strength antiperspirant. Newer therapies offer you even more ways to lessen symptoms.
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