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Medical Dermatology Conditions

Hyperhidrosis

Hyperhidrosis is a condition characterized by abnormally excessive sweating which is not a result of heat or exercise. It can affect just one specific area or the whole body in which the sweat may soak through clothes or drip off the hands. Although it is not life-threatening and is tolerable, it can cause discomfort, embarrassment, and anxiety, which can affect everyday activities and social interactions. However, in some cases, hyperhidrosis can become severe and intolerable and can cause serious problems such as difficulties in holding objects such as a pen.

According to studies, it is estimated that several million people have this condition, with most cases starting during the teenage years1. Hyperhidrosis is normally active on body parts that have a relatively high concentration of sweat glands such as the hands, feet, underarms, and the groin area.

Causes of Hyperhidrosis

Sweating is a natural way in which the body cools itself in response to factors such as heat, fever, exercising, or feeling anxious or nervous. Typically the nervous system automatically triggers the sweat glands as part of the body’s self-protection mechanisms; however, in the case of hyperhidrosis, the sweat glands don’t shut off and continue to sweat even if the natural causes that trigger sweating are not present. This type of abnormal response can be categorized as either primary or secondary hyperhidrosis.

Primary Hyperhidrosis, also known as Primary Idiopathic, is diagnosed when sweating has an unknown cause and persists for no apparent reason. Typically this type of sweating is localized.

Secondary Hyperhidrosis occurs when there is an underlying health condition or as a result of certain medications or substances causing excessive sweating.

Primary Hyperhidrosis

In primary hyperhidrosis, initial studies concluded that the cause was linked to the patient’s mental and emotional state. The nerves that trigger the signaling of the sweat glands would become overactive as a result of stress and anxiety. However, recent research reveals that it is the other way around – it is the excessive sweating that affects the mental and emotional health of an individual2. It is also now thought that genetic factors may play a role in developing hyperhidrosis.

Secondary Hyperhidrosis

In secondary hyperhidrosis, the sweating can be triggered by a variety of conditions such as:

  • Stress and anxiety
  • Pregnancy
  • Menopause
  • Spinal cord injury
  • Tumor
  • Obesity
  • Diabetes
  • Gout
  • Heart disease
  • Respiratory failure
  • Hyperthyroidism
  • Parkinson’s disease
  • Hodgkin’s disease
  • Shingles
  • Infections such as HIV, malaria, and tuberculosis
  • Various medication, including some antidepressants, anticholinesterases, pilocarpine, and propranolol
  • Alcohol and substance abuse

Types of Hyperhidrosis

Based on the areas and extent of the body surface affected, hyperhidrosis can be separated into two different categories.

Focal hyperhidrosis occurs when excessive sweating is localized or affects just one specific area of the body. Types include:

  • Palmar hyperhidrosis, which is characterized by excessive sweating of the palms
  • Plantar hyperhidrosis, which is characterized by excessive sweating of the soles
  • Palmoplantar hyperhidrosis, which is characterized by excessive sweating of both the palms and soles
  • Axillary hyperhidrosis, which is characterized by excessive sweating of the underarms
  • Inguinal or Hexel’s hyperhidrosis, which is characterized by excessive sweating of the groin area

Generalized hyperhidrosis is when excessive sweating doesn’t affect only a specific area but rather affects the entire body.

Symptoms

Signs and symptoms include:

  • Frequent sweating
  • Wet palms
  • Wet soles
  • Noticeable sweating wherein the sweat soaks through clothing and can cause stains.

Furthermore, even if the excessive sweating is tolerable, the person may feel or experience:

  • Skin infections that may be fungal or bacterial, which can be irritating and painful
  • Worry more about body odor
  • Self-conscious There is a tendency that a person looks in the mirror from time to time to wipe off sweat in the face as well as in other parts of the body especially the underarms to check for sweat soaking through clothing.
  • Avoiding jobs with physical contact or human interaction
  • Hesitant to make physical contact. Other effects may include wiping the hands first before shaking hands.
  • Socially withdrawn due to being embarrassed. This may lead to depression.

Severity

Complications may arise when hyperhidrosis becomes severe. These can include being prone to skin and bacterial infections and psychological impacts affecting the social and emotional state of an individual. The severity is measured through a 4-point scale called the Hyperhidrosis Disease Severity Scale (HDSS). It is a diagnostic tool that is quick and easily-understood and that is carried out by asking the patient to rate the severity of hyperhidrosis using four statements:

  1. My sweating is never noticeable and never interferes with my daily activities.
  2. My sweating is tolerable but sometimes interferes with my daily activities.
  3. My sweating is barely tolerable and frequently interferes with my daily activities.
  4. My sweating is intolerable and always interferes with my daily activities.

Based on the response of the patient, the severity can be scored. A score of 1 or 2 indicates a mild or moderate condition, while a score of 3 or 4 indicates a severe case.

Treatments

If the diagnostic is secondary hyperhidrosis, the contributing health condition will be treated first; but for primary hyperhidrosis, treatment focuses on controlling excessive sweating. Antiperspirants are usually tried first in treating hyperhidrosis. Over-the-counter antiperspirants are prescribed initially, but if they don’t work, prescription antiperspirants containing aluminum chloride are the next resort. However, irritation is a side effect of prescription antiperspirants.

If antiperspirants don’t work, medical treatment may be recommended. This can include:

  • Submerging of the hands and feet in the water, while a low electrical current passes through. This is done for about 20 to 30 minutes at least a few times a week. Experts believe that this method blocks the sweat from getting to the skin’s surface. However, this is not recommended for pregnant women and those who have pacemakers or metal implants.
  • Botulinum toxin (Botox) injections. These injections block the nerves that trigger the sweat glands to activate. Several injections may be needed for effective results.
  • Anticholinergic drugs. Administered orally, the medication stops the sweat glands from activating. This treatment is not recommended for everyone due to its side effects which can include blurred vision, palpitations, dryness of mouth and eyes, and difficulty urinating.
  • Endoscopic thoracic sympathectomy (ETS). A surgical intervention that cuts the nerves that trigger the sweat glands. This is the last resort of treatment and must be performed in severe cases only. It is performed on the face, hands, and underarms only. Performing ETS on the feet has a risk of permanent sexual dysfunction.

Home remedies may also help. Examples include:

  • Using armpit shields to protect clothing.
  • Avoiding clothing made of certain synthetic fibers such as nylon.
  • Wearing loose clothing or those made of natural breathable fabrics such as cotton and silk.
  • Wearing moisture-absorbing socks.
  • Using antibacterial soap.
  • Drying yourself completely before applying antiperspirants.
  • Limiting eating of spicy foods and intake of alcohol.

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