Excessive Sweating (Hyperhidrosis)

Hyperhidrosis is defined by abnormal, excessive sweating that is unrelated to physical activity or temperature. It can occur in otherwise healthy individuals or be a symptom of an underlying health condition. There are two primary types:

• Primary focal hyperhidrosis: This type typically begins in adolescence or early adulthood and affects specific areas of the body such as the underarms, palms, soles, or face. It usually affects both sides of the body equally and occurs without an apparent medical cause.
• Secondary generalized hyperhidrosis: This type results from an underlying condition such as endocrine disorders, infections, neurological diseases, or medication side effects. It tends to affect larger areas of the body and may occur during sleep.

The cause of primary hyperhidrosis is not fully understood, but it is thought to involve overactivity of the sympathetic nervous system, which controls sweat glands. Genetic factors may play a role, as the condition often runs in families.

Secondary hyperhidrosis can be triggered by a variety of medical conditions, including:

• Thyroid disease (hyperthyroidism)
• Diabetes
• Menopause
• Obesity
• Infections, including tuberculosis and HIV
• Certain cancers
• Neurological disorders, such as Parkinson’s disease or spinal cord injuries
• Medications, including some antidepressants, blood pressure medications, and antipyretics

Identifying whether the sweating is primary or secondary is essential for determining the appropriate treatment approach.

The hallmark symptom of hyperhidrosis is visible, uncontrollable sweating that occurs at least once a week and often begins in childhood or adolescence in primary cases. Additional signs and symptoms may include:

• Persistent moisture in affected areas despite being at rest
• Cold, clammy skin
• Difficulty grasping objects or performing tasks due to slippery hands
• Skin irritation or breakdown from prolonged moisture exposure
• Emotional stress, anxiety, or embarrassment due to visible sweating

Diagnosing excessive sweating begins with a detailed medical history and physical examination. Dr. Neely Khan will ask questions about the timing, location, severity, and triggers of sweating episodes. Important diagnostic considerations include:

• Onset and pattern (localized or generalized)
• Frequency and duration of episodes
• Family history of similar symptoms
• Presence of underlying medical conditions

If secondary hyperhidrosis is suspected, blood tests, urine analysis, or imaging studies may be ordered to identify potential underlying causes. In some cases, a starch-iodine test or gravimetric test may be performed to quantify sweat production. These tests help assess the severity of sweating and can be used to monitor treatment effectiveness over time.