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Causes and Symptoms of Hyperhidrosis

by | May 25, 2024 | Info | 0 comments

Hyperhidrosis Overview

Hyperhidrosis is a condition characterized by excessive sweating. Signs of hyperhidrosis include visible sweating and sweating interfering with everyday activities. It may affect one area or the whole body.

Polyhidrosis or sudorrhea is also known as hyperhidrosis. Although not life-threatening, it can be uncomfortable and cause embarrassment and psychological trauma.

What is Hyperhidrosis?

The excessive sweating associated with hyperhidrosis is normally most active in the hands, feet, armpits, and the groin because of their relatively high concentration of sweat glands.

  • Focal hyperhidrosis: When the excessive sweating is localized. For example, palmoplantar hyperhidrosis is excessive sweating of the palms and soles.
  • Generalized hyperhidrosis: Excessive sweating affects the entire body.

Hyperhidrosis may be present from birth or might develop later in life. However, most cases of excessive sweating tend to start during a person’s teenage years.

The condition can be due to an underlying health condition, or have no apparent cause:

  • Primary idiopathic hyperhidrosis: “Idiopathic” means “of unknown cause.” In the majority of cases, the hyperhidrosis is localized.
  • Secondary hyperhidrosis: The person sweats too much because of an underlying health condition, such as obesity, gout, menopause, a tumor, mercury poisoning, diabetes mellitus, or hyperthyroidism  (overactive thyroid gland).

According to the International Hyperhidrosis Association, approximately 2.8 percent of Americans are affected by hyperhidrosis; that’s around 7.8 million people.

For some, hyperhidrosis symptoms are so severe that it becomes embarrassing, causing discomfort and anxiety. The patient’s career choices, free time activities, personal relationships, self-image, and emotional well-being may be affected.

Fortunately, there are several options which can treat symptoms effectively. The biggest challenge in treating hyperhidrosis is the significant number of people who do not seek medical advice, either due to embarrassment or because they do not know that effective treatment exists.

Signs and Symptoms of Hyperhidrosis

Hyperhidrosis is defined as sweating that disrupts normal activities. Episodes of excessive sweating occur at least once a week for no clear reason and have an effect on social life or daily activities.

Signs and symptoms of hyperhidrosis may include the following:

  • Clammy or wet palms of the hands 
  • Frequent sweating
  • Clammy or wet soles of the feet
  • Noticeable sweating that soaks through clothing

People with hyperhidrosis might experience the following:

  • Socially withdrawn, sometimes leading to depression
  • Irritating and painful skin problems, such as fungal or bacterial infections
  • Worry more than other people about body odor
  • Reluctant to make physical contact
  • Self-conscious
  • Select employment where physical contact or human interaction is not a job requirement
  • Spend a large amount of time each day dealing with sweat, such as changing clothes, wiping, placing napkins or pads under the arms, washing, wearing bulky, or dark clothes 
  • Worrying about having stained clothing

Experts are not certain why, but excessive sweating during sleep is not common for people with primary hyperhidrosis (the type not linked to any underlying medical condition).

Causes of Hyperhidrosis

The causes of primary hyperhidrosis are not well-understood; on the other hand, secondary hyperhidrosis has a long list of known causes.

Causes of Primary Hyperhidrosis

People used to think that primary hyperhidrosis was linked to the patient’s mental and emotional state, that the condition was psychological and only affected stressed, anxious, or nervous individuals.

However, recent research has demonstrated that individuals with primary hyperhidrosis are no more prone to feelings of anxiety, nervousness, or emotional stress than the rest of the population when exposed to the same triggers.

In fact, it is the other way round – the emotional and mental feelings experienced by many patients with hyperhidrosis are because of the excessive sweating.

Studies have also shown that certain genes play a role in hyperhidrosis, making it look more likely that it could be inherited. The majority of patients with primary hyperhidrosis have a sibling or parent with the condition.

Causes of Secondary Hyperhidrosis

Diagnosis of Hyperhidrosis

Initially, a doctor may try to rule out any underlying conditions, such as an overactive thyroid (hyperthyroidism) or low blood sugar ( hypoglycemia) by ordering blood and urine tests.

Patients will be asked about the patterns of their sweating – which parts of the body are affected, how often sweating episodes occur, and whether sweating occurs during sleep.

The patient may be asked a series of questions, or have to fill in a questionnaire about the impact of excessive sweating; questions may include:

  • How often do you change your clothing?
  • Do you carry anything around to deal with episodes of excessive sweating, such as napkins, antiperspirants, towels, or pads? 
  • How often do you think about excessive sweating?
  • Does hyperhidrosis affect your behavior or mental state when you are in public?
  • Has hyperhidrosis had any effect on your employment?
  • Have you ever lost a friend due to hyperhidrosis? 
  • How often do you wash or have a shower/bath?

Thermoregulatory sweat test: a powder which is sensitive to moisture is applied to the skin. When excessive sweating occurs at room temperature, the powder changes color. The patient is then exposed to high heat and humidity in a sweat cabinet, which triggers sweating throughout the whole body.

When exposed to heat, people who do not have hyperhidrosis tend not to sweat excessively in the palms of their hands, but patients with hyperhidrosis do. This test also helps the doctor determine the severity of the condition.

Lab Tests

Your health care provider may recommend blood, urine or other lab tests to see if your sweating is caused by another medical condition, such as an overactive thyroid (hyperthyroidism) or low blood sugar (hypoglycemia).

Sweat Tests

Or you may need a test that pinpoints the areas of sweating and evaluates how severe your condition is. Two such tests are an iodine-starch test and a sweat test.

Treatment of Hyperhidrosis

A doctor may refer the person to a skin specialist, or dermatologist.

They may recommend the following:

Iontophoresis – the hands and feet are submerged in a bowl of water. A painless electric current is passed through the water. Most patients need two to four 20-30 minute treatments.

Botulinum toxin (Botox injections) – Botox injections block the nerves that trigger the sweat glands. Patients with hyperhidrosis may need several injections for effective results.

Anticholinergic drugs – these medications inhibit the transmission of parasympathetic nerve impulses. Patients generally notice an improvement in symptoms within about 2 weeks.

ETS (Endoscopic thoracic sympathectomy) – this surgical intervention is only recommended in severe cases which have not responded to other treatments. The nerves that carry messages to the sweat glands are cut.

ETS may be used to treat hyperhidrosis of the face, hands or armpits. ETS is not recommended for treating hyperhidrosis of the feet because of the risk of permanent sexual dysfunction.

Medications

Drugs used to treat hyperhidrosis include:

  • Prescription antiperspirant. Your health care provider may prescribe an antiperspirant with aluminum chloride (Drysol, Xerac AC). Apply it to dry skin before going to bed. Then wash the product off when you get up, taking care to not get any in your eyes. Once you start seeing results from using it daily for a few days, you can scale back to once or twice a week to maintain the effect.

    This product can cause skin and eye irritation. Talk with your health care provider about ways to reduce side effects.

  • Prescription creams and wipes. Prescription creams that contain glycopyrrolate may help hyperhidrosis that affects the face and head. Wipes soaked in glycopyrronium tosylate (Qbrexza) may ease symptoms of the hands, feet and underarms. Possible side effects of these products include mild skin irritation and dry mouth.
  • Nerve-blocking medications. Some pills (oral medications) block the nerves that trigger sweat glands. This can reduce sweating in some people. Possible side effects include dry mouth, blurred vision and bladder problems.
  • Antidepressants. Some medications used for depression can also decrease sweating. They may also help decrease anxiety.
  • Botulinum toxin injections. Treatment with botulinum toxin (Botox) blocks the nerves that trigger the sweat glands. Most people don’t feel much pain during the procedure. But you may want your skin numbed beforehand. Your health care provider might offer one or more of the methods used to numb skin. These include topical anesthesia, ice and massage (vibration anesthesia).

    Each affected area of your body will need several injections. It may take a few days to notice results. To retain the effect, you’ll likely need repeat treatments about every six months. A possible side effect is short-term muscle weakness in the treated area.

Surgical and Other Procedures

Your health care provider might suggest other treatments:

  • Iontophoresis. With this home treatment, you soak your hands or feet in a pan of water while a device passes mild electric current through the water. The current blocks the nerves that trigger sweating. You can buy the device if you have a prescription from your health care provider.

    You’ll need to soak the affected areas for 20 to 40 minutes. Repeat the treatment 2 to 3 times a week until your symptoms improve. After you get results, you can reduce treatments to once a week or once a month to maintain the effect. Talk with your health care provider if you experience side effects.

  • Microwave therapy. With this therapy, a handheld device (miraDry) delivers microwave energy to destroy sweat glands in the armpits. Treatments involve two 20- to 30-minute sessions, three months apart. Possible side effects are a change in skin sensation and some discomfort. Long-term side effects are unknown.
  • Sweat gland removal. If you sweat heavily only in your armpits, your health care provider may suggest removing those sweat glands. This may be done through scraping them away (curettage), suctioning them out (liposuction) or using a combination of the two (suction curettage).
  • Nerve surgery (sympathectomy). During this procedure, the surgeon removes a small section of the spinal nerves that control sweating in your hands. A possible side effect is permanent heavy sweating in other areas of your body (compensatory sweating). Surgery is generally not an option for isolated head and neck sweating. A variation on this procedure treats the palms. It interrupts the nerve signals without removing the sympathetic nerve (sympathotomy), which reduces the risk of compensatory sweating.

    Because nerve surgery has a risk of side effects and complications, it is usually only considered for people who have tried many other treatments without good results.

Each of these procedures may be done with general anesthesia or with local anesthesia and sedation.

Natural Remedies

Some alterations in daily activity and lifestyle may help improve symptoms:

  • Antiperspirants – deodorants do not stop sweating, but antiperspirants sprays do. Some prescription antiperspirants include aluminum chloride, which plugs the sweat glands. 
  • Clothing – certain synthetic fibers, such as nylon, may worsen symptoms. Loose clothing is better.
  • Armpit shields – pads worn in the armpit to protect a garment from perspiration.
  • Socks – some socks are better at absorbing moisture, such as thick, soft ones made of natural fibers.
  • Shoes – synthetic materials are more likely to worsen symptoms. Natural materials, such as leather, are recommended.

If these measures are not effective, medical treatment may help.

Complications of Hyperhidrosis

If hyperhidrosis is not treated, it can lead to complications.

  • Bacterial Infections: Especially around hair follicles and between the toes.
  • Heat rash (prickly heat, miliaria): An itchy, red skin rash that often causes a stinging or prickling sensation. Heat rash develops when sweat ducts become blocked and perspiration is trapped under the skin. 
  • Nail infections: Especially toenail infections.
  • Psychological impact: Excessive sweating can affect the patient’s self-confidence, job, and relationships. Some individuals may become anxious, emotionally stressed, socially withdrawn, and even depressed. 
  • Warts: Skin growths caused by the human papillomavirus (HPV).

On average, a person with hyperhidrosis seeks medical help after living with the condition for 9 years. It is important to spread the word that the symptoms of excessive sweating can be effectively treated.

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