We all get sweaty from time to time. But profusely sweating after a hard workout is much different than sweating all day long without reason. If you’re experiencing the latter, you may have focal hyperhidrosis—especially if that sweating occurs in one or a few concentrated body parts.
Focal hyperhidrosis is when someone experiences excessive sweating in one or a couple parts of the body (mainly the soles of the feet, armpits, palms, scalp, and/or face). This condition is often underdiagnosed and misunderstood, which is why it’s worth taking a deep dive into its causes, symptoms, and treatments.
What is Focal Hyperhidrosis?
Before we get ahead of ourselves, let’s run through a quick refresher of what hyperhidrosis is. In short, hyperhidrosis is a medical condition where receptors on the eccrine glands, glands on the skin that produce sweat, are overstimulated. The body begins to sweat excessively and unpredictably, often without a trigger, like hot weather or vigorous exercise.
There are many types and subtypes of hyperhidrosis. To accurately identify the type, the sweating location is key. If someone sweats everywhere, they may be diagnosed with general hyperhidrosis. But if that sweating is concentrated?
Enter: Focal hyperhidrosis. Medically, it’s referred to as “primary focal hyperhidrosis,” or “primary idiopathic hyperhidrosis.” This condition occurs when sweating is centralized in one area of the body or a few parts, and 93% of people with hyperhidrosis have this type.
Typically, focal hyperhidrosis impacts the hands, feet, face or scalp, or the armpits. All these body parts have high concentrations of eccrine glands, and that isn’t a coincidence. It’s the reason focal hyperhidrosis tends to happen there.
In the medical terms for this condition, you may have noticed the word primary. Primary vs. secondary hyperhidrosis is another important distinction. The latter is when hyperhidrosis is due to another medical condition, like menopause or hyperthyroidism. Primary hyperhidrosis occurs when excessive sweating is a standalone act. When we add the word focal (i.e. primary focal hyperhidrosis), there isn't generalized sweating or an underlying medical condition.
Symptoms of Focal Hyperhidrosis
Hyperhidrosis symptoms can be summarized with one word: sweating. Hyperhidrosis sweating occurs constantly, even when there isn’t an external trigger, though it’s more common during the day, decreasing or disappearing when someone sleeps.
Unlike with general hyperhidrosis, focal hyperhidrosis sweating is concentrated. It might occur under the armpits, for example. And we’re using armpits (plural) and not armpit (singular) for a reason. Focal hyperhidrosis is symmetrical, meaning it affects both sides of the body, such as. both the right and left hand or both armpits.
While this sweating is constant and symmetrical, it impacts everyone’s lives in different ways. A 2022 study polled individuals with hyperhidrosis about how sweat showed up on their day-to-day. The most common answers were:
Sweat stains on clothing or objects they touched
Visible sweat on face
Wet handshakes
Strong body odor
At best, this excessive sweating leads to some awkward moments and more laundry. At worst, it can take a toll on your mental and social health. Common mental health complications include an inability to work or attend school, embarrassment in social situations, and stress, depression, or anxiety.
What Causes Focal Hyperhidrosis?
The exact cause of primary hyperhidrosis is a giant question mark, though it does seem to run in families. When there is no known cause, other than a possible genetic component, hyperhidrosis is labeled as “primary.”
Secondary hyperhidrosis is another story. The number of potential causes is longer than most of our to-do lists. The most common medical conditions associated with secondary hyperhidrosis include:
Acromegaly, a rare condition where there’s too much growth hormone in the body
Anxiety and other mental health conditions that deregulate the nervous system
Cancer
Certain medications, including antipsychotics, dopamine agonists, and selective serotonin reuptake inhibitors (SSRIs)
Glucose control disorders, like hypoglycemia or diabetes
Hyperthyroidism
Infections, including tuberculosis and the flu
Lung conditions
Menopause
Parkinson’s disease
Spinal cord injuries
Stroke
Various cardiovascular conditions
While it is possible to have secondary focal hyperhidrosis, most with this condition fall into the first camp (primary, with an unknown cause).
Who does Focal Hyperhidrosis Affect?
Focal hyperhidrosis can affect anyone. That said, there does seem to be a genetic component. 30-50% of patients have a family history of this condition. But researchers still don’t understand how big of a role genetics play or what specific genes are responsible for primary hyperhidrosis.
What we do know is that both men and women are diagnosed with hyperhidrosis, typically between the ages of 20 and 60. All ethnicities experience focal hyperhidrosis, though individuals of Japanese descent are diagnosed at a higher rate.
How is Focal Hyperhidrosis Diagnosed?
Getting a focal hyperhidrosis diagnosis should be straightforward. There are clear criteria a doctor can look out for, such as:
Six or more months of excessive, visible sweating
Sweaty hands, armpits, feet, and/or face
Bilateral and symmetric sweating (meaning if one armpit is sweating excessively, the other is too)
No sweating or less sweating at night
Episodes of sweating that last longer than seven days
Sweating that impairs daily activities
To determine if these criteria are met, a doctor makes a clinical assessment in either an annual check-up or an appointment scheduled specifically for excessive sweating concerns. They will also ask you about your medical history, if hyperhidrosis runs in the family, and your age, as most people are diagnosed with focal hyperhidrosis before they are 25 years old.
Seeing a doctor is also crucial to determine if you’re experiencing primary or secondary hyperhidrosis. Secondary often requires a more in-depth assessment and medical screening process. Treatment options look different too, since the underlying cause needs to be addressed alongside the excessive sweating.
On paper, this diagnosis process sounds easy. In reality, it’s trickier, since there is a tendency to dismiss focal hyperhidrosis symptoms. Because hyperhidrosis is underdiagnosed, it’s important to consult with a doctor who is aware of this condition and has experience treating hyperhidrosis in other patients. Finding one of these healthcare providers can be tricky, but getting matched with a qualified dermatologist on SweatRx, takes the search out of your hands.
What Areas are Usually Affected?
Focal hyperhidrosis is centralized in one or a few parts of the body. The most commonly affected areas include:
Armpits: the axillary sweat glands, located in the armpits, are often impacted by focal hyperhidrosis. 50% of primary focal hyperhidrosis occur in the armpits, making this the most common type. It is referred to as axillary hyperhidrosis.
Hands: About 25% of those with focal hyperhidrosis experience sweating in their palms, and this is diagnosed as palmar hyperhidrosis.
Feet: 30% of cases occur in the feet. If sweating is exclusive to the feet, it’s referred to as plantar hyperhidrosis.
Face: If excessive sweating occurs in the head, face, or scalp, it’s referred to as craniofacial hyperhidrosis. 20% of cases occur in the face.
If you add up those percentages, you’ll get 120% because it’s possible to have focal hyperhidrosis in multiple locations. Someone, for example, may be diagnosed with primary palmar hyperhidrosis and primary axillary hyperhidrosis. The most common combo, however, is in the soles of the feet and palms of the hand, which is referred to as palmoplantar hyperhidrosis.
No matter where sweating occurs, it can take a toll on your mental health. Sweating is a touchy subject. In excess, it’s visible to others and may influence how often someone socializes or how comfortable they feel at work or in public. As a result, a hyperhidrosis diagnosis increases your risk for anxiety and depression.
Managing Focal Hyperhidrosis
For some, hyperhidrosis limits their ability to participate at work. For others, it hinders their social life or makes it hard to show up at the gym. It also affects different parts of the body. Since this condition is so individualized, your treatment plan should be as well. Palmoplantar hyperhidrosis, for example, often requires a different treatment plan than axillary hyperhidrosis.
Below, we’ve listed different treatment options to mix and match—under the supervision of a healthcare provider, of course.
Medicines and Botox
Medical treatments fall into three buckets: pharmacological, surgical procedures, and non-surgical medical procedures. Each option has its pros and cons, and some work well together or alongside lifestyle changes. To start, let’s look at the first line of defense, pharmacological interventions. This is a fancy way to say over-the-counter (OTC) and prescription medications that treat excessive sweating.
When first diagnosed with focal hyperhidrosis, there’s a good chance a doctor will prescribe an antiperspirant. Antiperspirants are a medication class that contain 5% to 25% aluminum salts which hinder mild or moderate sweat production. The most prescribed is aluminum chloride antiperspirants.
Often, they come in a topical gel or spray. The exact concentration of these salts depends on if it’s an OTC or prescription medication. When effective, individuals start to experience less sweat after one to two weeks of regular use. This treatment tends to work best on primary axillary hyperhidrosis.
Another class of medications are anticholinergics, which can come as an oral pill, topical spray, or a wipe. There are a few popular options in this group:
Glycopyrrolate: often effective for craniofacial hyperhidrosis.
Glycopyrronium tosylate: an option which was most effective for axillary hyperhidrosis clinical trials.
Oxybutynin gel: has also been effective for focal hyperhidrosis in limited trials.
Sofpironium bromide: a newer anticholinergic that is designed for axillary hyperhidrosis.
Botulinum toxin injections (botox for short) is another option. While known for its anti-aging effects, botox can treat sweat glands at a deeper level than topical treatments. In one 2023 study, individuals with hyperhidrosis saw a benefit from botox within one week of getting this procedure, and the benefits lasted over six months.
Non-surgical medical procedures
When pharmacological solutions don’t work, a doctor may prescribe a non-surgical medical procedure. The most common include iontophoresis, microwave thermolysis radiofrequency therapy, laser treatment, and ultrasounds.
Iontophoresis has been around since the 1940s, though it looks a bit different today than it did back then. This procedure involves a medical device where an electrical current is passed through water. Traditionally, someone put the soles of their feet or hands in a pad with the water and electrical current to decrease sweating. There’s also pads that can be hooked up to other body parts, such as the armpits.
According to the International Hyperhidrosis Society, one iontophoresis session lasts 15 to 40 minutes, depending on the device, and three sessions a week is ideal when first starting. Over time, someone may be able to scale back to weekly maintenance sessions.
Another option is microwave thermolysis, which isn't as crazy as it sounds and doesn’t involve microwaves. Instead, someone uses thermal energy on the armpits to reduce sweat and body odor. Within three months of treatments, patients in one small-scale study experienced a better quality of life, less sweating, and less body odor. Laser therapy and ultrasounds also harness thermal energy to decrease sweating, but they are less common than microwave thermolysis.
Surgeries for Focal Hyperhidrosis
If you’ve tried medications and non-surgical procedures, but haven’t had luck, a doctor may recommend surgery. The most common surgeries for focal hyperhidrosis are local skin excision, liposuction, and endoscopic thoracic sympathectomy (ETS).
Local skin excision is when a surgeon cuts into the skin and removes the sweat glands, permanently, eliminating the ability to sweat. Usually, a patient is under local anesthesia (meaning the anesthesia is administered to the area where the surgery takes place, not the entire body), and this procedure is usually recommended for the armpits.
Liposuction is the least invasive of the bunch, but it still involves local anesthesia. For this procedure, a surgeon makes a suction cannula incision and then removes subcutaneous fat which contains eccrine sweat glands. Liposuction leads to less scarring than local skin excision, but has a greater chance of a hyperhidrosis relapse.
The final surgery option, ETS, is typically for plantar or palmar hyperhidrosis. Before performing ETS, a surgeon will administer general anesthesia (meaning it impacts the entire body, and the patient is unconscious for the procedure). After, a surgeon makes a few incisions at the excessive sweating site and cuts or clips the nerves causing the excessive sweating.
All three surgeries do have some risk, and the most common complication is compensatory sweating, when an unrelated part of the body starts sweating to “make up” for the newfound lack of sweating in the area where surgery took place. If an individual undergoes ETS for primary palmar hyperhidrosis, for example, their body may sweat in an unrelated location after. Compensatory sweating often requires its own solution, such as a topical medication or botulinum toxin treatment.
Lifestyle Options
Hyperhidrosis typically requires medical treatment, but that doesn’t mean there aren’t steps you can take to control excessive sweating. The most effective lifestyle option is to identify and avoid triggers.
Triggers differ from person to person and may take some time to identify. That said, there are some commonly reported triggers to avoid:
Tight fitting clothing
Spicy food
High alcohol consumption
Tight shoes
Therapy or techniques to boost mental health can also be useful to manage mental health symptoms. Avoiding triggers and mental health options, however, don’t treat excessive sweating. Medications, surgery, or non-surgical medical interventions are required to address the root cause, excessive sweating.
Key Takeaways
Focal hyperhidrosis is when excessive sweating occurs in one spot or a few areas. A diagnosis from a doctor is required to confirm if focal hyperhidrosis is causing your symptoms. In the meantime, remember:
Focal hyperhidrosis usually occurs on the head, face, or scalp, the armpits, the palms, and/or the soles of the feet. It’s always symmetrical and the majority of the sweating occurs during the day.
Hyperhidrosis sweat is more than just perspiration. It impacts physical and mental health, as well as work performance, mental health, and someone’s social life.
There are many treatment options for focal hyperhidrosis, and your treatment plan should be personalized.
For customized treatment options, sign up for SweatRx. On our platform, you can access customized hyperhidrosis treatment prescribed by a dermatologist and delivered to your doorstep.
