Hyperhidrosis: Symptoms, Causes, and Treatments
Understand hyperhidrosis, or diagnosed excessive sweating, and learn more about why it happens and how to manage it.
Sweating is normal—it’s the body’s natural way of cooling itself. But over 16 million Americans live with something called hyperhidrosis, or excessive sweating for no apparent reason. The effects of living with hyperhidrosis can cause embarrassment and interfere with daily activities, from sweating through clothes (no matter how cold the weather), to hesitating before a handshake because of sweaty hands.
But many of those living with hyperhidrosis are both surprised and relieved to discover that there are effective treatments available. If you think you may be living with this condition, understanding how it's managed can be your first step towards symptom relief.
What is hyperhidrosis?
Hyperhidrosis is a medical condition that causes your body to sweat more than it needs to, regardless of body temperature or exercise. In people with hyperhidrosis, the body’s 2 to 4 million sweat glands are overactive, causing profuse perspiration at times when others would sweat lightly, if at all.
Who does hyperhidrosis affect?
Hyperhidrosis is most common in people between 20 and 60 years of age, while men and women are equally likely to be diagnosed. People from all races can have this condition, but studies show that people from Japan are more likely to have it than other groups. While hyperhidrosis can affect any part of the body, the palms of the hands are the most commonly affected area. This is known as palmar hyperhidrosis.
Symptoms of hyperhidrosis
The main symptom of hyperhidrosis is uncontrollable sweating. When you sweat, you may feel:
Moisture on your skin
Wet clothing
Beads of fluid running down your cheeks or forehead
With time, hyperhidrosis can cause the following issues:
Itching and inflammation caused by sweat irritating your skin
Body odor, which happens when hyperhidrosis sweat mixes with bacteria on your skin
Dry, cracked, or peeling skin on your feet
Most people with hyperhidrosis experience extreme sweating on the palms of the hands, known as palmar hyperhidrosis, or on the soles of the feet and palms, known as palmoplantar hyperhidrosis. But you may also experience symptoms in the following areas:
Armpits or underarms (axillary hyperhidrosis)
Forehead and cheeks
Genitals
Lower back
Symptoms of hyperhidrosis can range in severity. You might experience occasional mild symptoms, or you could have ongoing symptoms that affect your daily life.
Complications of hyperhidrosis
In addition to causing physical symptoms, hyperhidrosis can also have a big impact on your overall mental and physical health. If left untreated, hyperhidrosis can interfere with your well being, resulting in dehydration and skin infections, or damaging self-esteem and relationships. In fact, 48% of those living with unmanaged hyperhidrosis report poor or very poor quality of life.
Dehydration
In severe cases, hyperhidrosis can cause dehydration. When you sweat excessively, your body loses both water and electrolytes, like sodium and potassium, which are important for normal body function. If you don’t drink enough fluids to replace what you lose, you can become dehydrated. If someone with hyperhidrosis does not replace the fluids lost through sweating, they may experience symptoms like dry mouth, dizziness, fatigue, and confusion. Severe dehydration can lead to more serious issues like heat stroke, kidney problems, or even fainting.
Skin infections
Exposure to constant moisture from hyperhidrosis sweat can lead to something called skin maceration, which is the process of skin softening and breaking down due to prolonged exposure to moisture. Those with hyperhidrosis have a nearly 30% greater risk of skin infections, such as athlete's foot and more severe conditions such as bacterial infections or pitted keratolysis.
Anxiety and depression
People with hyperhidrosis may feel self-conscious about their sweating, which can lead to social anxiety and depression; people living with hyperhidrosis are more likely to experience anxiety and depression than the general population. In fact, a 2020 study found that patients with hyperhidrosis were significantly more anxious and depressed than any other group of dermatology patients.
Odor
People with hyperhidrosis generally don’t have body odor because the apocrine sweat glands responsible for body odor are usually not affected. However, sweat can begin to smell if sweat produced by the affected eccrine glands mixes with the different bacteria on your skin and begins to break down.
Types of hyperhidrosis
There are two types of hyperhidrosis:
Primary focal hyperhidrosis: Primary hyperhidrosis, also known as focal hyperhidrosis, is usually inherited and has no obvious cause. This type of hyperhidrosis causes extreme sweating in only specific areas of the body, not all over, with the most commonly affected body parts being the armpits, hands, feet, and face. It tends to start before age 25. Compared with secondary generalized hyperhidrosis, focal hyperhidrosis is more common.
Secondary generalized hyperhidrosis: Secondary generalized hyperhidrosis, also known as generalized hyperhidrosis, is the less common form of the condition. With secondary hyperhidrosis, sweating can happen in one or two locations on the body, or it can affect the entire body, and is caused by some medications or from an underlying medical condition. Some conditions commonly associated with secondary hyperhidrosis include:
Overactive thyroid
Diabetes
Menopause
Head injuries
Spinal cord injuries
Obesity
Tumors
How is hyperhidrosis diagnosed?
A healthcare provider can diagnose hyperhidrosis after conducting a full physical exam, learning more about your symptoms, and taking a full medical history. In order to get a hyperhidrosis diagnosis, you must meet most of the diagnostic criteria which include:
Extreme sweating for at least six months
Sweat appears on your underarms, hands, feet, or face
Sweat affects both sides of your body equally
You sweat less or not at all while sleeping
Each sweating episode lasts for a minimum of one week
Hyperhidrosis runs in your family
Sweating interferes with your ability to do certain activities
Sweating begins before the age of twenty-five
What tests diagnose hyperhidrosis?
Here are a few tests that can be used to determine the presence of hyperhidrosis:
Starch-iodine test: An iodine solution is applied to the sweaty area and starch is sprinkled over the iodine solution. The solution will turn dark blue where sweating occurs.
Paper test: A special paper will be applied to the affected area to absorb sweat. Later, the paper can be weighed to determine how much you sweat.
Blood or imaging tests: These tests can take a sample of your blood or take pictures underneath your skin to help your healthcare provider see if your sweating is caused by another underlying medical condition, such as an overactive thyroid (hyperthyroidism) or low blood sugar (hypoglycemia).
Vapometer: This device measures the amount of sweat that the hands, underarms, feet and scalp make, giving your doctor an objective way to compare the amount of sweat before and after treatment.
What causes hyperhidrosis?
Primary hyperhidrosis has no obvious cause, while secondary hyperhidrosis can be caused by a number of different triggers.
Causes of primary hyperhidrosis
The cause of primary hyperhidrosis is not well understood. However, a part of the nervous system called the sympathetic nervous system is thought to be involved, and genes may also play a role.
The sympathetic nervous system
Your sympathetic nerves are responsible for your “fight or flight” response. It’s activated when your brain senses that you’re in a stressful situation. It also acts like your body’s thermostat, sending a signal from your brain to the millions of sweat glands in your body if it senses your body temperature is rising, during exercise, or if you’re nervous. This produces sweat, cooling your skin and reducing the temperature of your body. In primary hyperhidrosis, it is thought that the brain sends signals to sweat glands—usually the sweat glands known as eccrine glands—even when there is no need to cool the body, resulting in overactive sweat glands.
Genes
Studies suggest that primary hyperhidrosis is inherited, as the condition has been known to run in families. This suggests the presence of a genetic mutation—a change in the DNA sequence of a gene—that is passed down from parents to their children.
Causes of secondary hyperhidrosis
Secondary hyperhidrosis can have a number of different triggers, such as medications and medical conditions. Common triggers include:
Pregnancy
Menopause
Anxiety
Low blood sugar
Hyperthyroidism
Obesity
Certain medications, including some antidepressants, propranolol, pilocarpine, and bethanechol
Infections such as tuberculosis or HIV
Parkinson’s disease
Disorders of the blood cells or bone marrow, such as Hodgkin lymphoma
Hyperhidrosis treatment options
Treatment for hyperhidrosis will depend on the severity of the condition, the part of the body affected, and what treatment options work best for you.
Antiperspirants
Most antiperspirants can be obtained over the counter, without a prescription, and are often the first treatment many people who sweat excessively will try. Antiperspirants generally contain an aluminum compound to combat sweat. Stronger antiperspirants may require a prescription—in these cases, the active ingredient is usually aluminum chloride hexahydrate.
Other Medications
After antiperspirants, other oral and topical medications are usually suggested to treat hyperhidrosis symptoms:
Topical medications: Topical medications are applied directly to the skin—in the case of hyperhidrosis, the area of excessive sweating. Most are applied daily, usually at night, and then covered to encourage absorption. While these can be very effective, some people find that they have uncomfortable side effects. Topical treatments for hyperhidrosis include prescription-strength antiperspirants and anticholinergic agents like glycopyrrolate.
Oral medications: Oral medications, unlike topicals, are ingested via the mouth and affect the entire body. For example, anticholinergics like glycopyrrolate cause a drying reaction in the body, and can be a good option for patients who sweat in multiple locations. Other oral medications that can help with excessive sweating include clonidine and beta blockers, though beta blockers are best used for short-term episodic hyperhidrosis related to anxiety.
Therapies
If your symptoms don’t improve with oral or topical medications like aluminum chloride, there are a number of specialized therapies available:
Botulinum toxin injection: Injecting botulinum toxin, or Botox, into affected areas can temporarily stop sweat production, typically for about three to six months at a time. Repeat treatments are necessary.
Iontophoresis: If you have uncontrollable sweating that affects your hands and feet, iontophoresis is a treatment that involves sending a weak electric current through water or a wet pad to the skin. This is thought to help block the sweat glands. Depending on the severity of your condition, you may require frequent treatments.
Microwave therapy: Microwave therapy uses a handheld device to deliver microwave energy to permanently destroy overactive sweat glands in the affected area.
Surgical treatment
If symptoms persist and other treatments fail to bring you symptom relief, you may consider surgical treatment:
ETS: ETS, or endoscopic thoracic sympathectomy, is a minimally invasive type of surgery where small incisions are made and the nerves that control sweating in the affected area are cut or clipped. This means signals can no longer pass along them to the sweat glands. The operation is carried out under general anesthesia and is done on both sides of the body.
Sweat gland removal: It’s possible to remove or destroy the overactive sweat glands in the armpits via surgery using a laser, scraping (curettage), cutting (excision) or liposuction.
While surgery is an effective option for some, it's worth taking a close look at all the risks involved and trying less serious treatments first.
Lifestyle and at-home remedies
Beyond medication and surgery, there are a number of lifestyle changes and at-home remedies that you can use to help manage your hyperhidrosis symptoms:
Diet: Research shows that certain foods, such as spicy foods, alcohol, and caffeine, may make hyperhidrosis symptoms worse. Adopting a vegetarian diet, taking dietary supplements, and reducing your intake of certain foods may help with excessive sweating.
Clothing: Wearing clothing that is breathable and absorbent, like cotton, can help you stay comfortable. Try to avoid blended fabric and polyester, which can trap heat and increase symptoms.
Staying hydrated: Since excessive sweating can result in dehydration, it’s important to make sure you drink enough water throughout the day, especially in hot weather.
Summary
If you are living with excessive sweating, you’re not alone. Hyperhidrosis is estimated to affect approximately 15.8 million Americans, many of whom don’t realize that there are a wide variety of treatments available. In fact, managing hyperhidrosis can significantly improve your quality of life, with many treatment options available to help alleviate symptoms. These options include medications, therapies like Botox or iontophoresis, surgical treatment, and lifestyle changes.
Not sure where to start? Visit SweatRx to speak with a licensed dermatologist who can help you decide how to start managing your symptoms today.
References
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Fujimoto, T., Inose, Y., Nakamura, H. et al. Questionnaire-based epidemiological survey of primary focal hyperhidrosis and survey on current medical management of primary axillary hyperhidrosis in Japan. Arch Dermatol Res 315, 409–417 (2023). https://doi.org/10.1007/s00403-022-02365-9.
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