Excessive Sweating (Hyperhidrosis)

Sweating is your body's natural cooling system. When body temperature rises, the nervous system triggers sweat glands to release moisture that evaporates and cools the skin. Normal sweating occurs with heat, physical activity, stress, or spicy foods. However, excessive sweating happens when this system overreacts or when underlying conditions trigger abnormal perspiration.

Hyperhidrosis can be primary (no underlying cause) or secondary (due to medical conditions or medications). Primary hyperhidrosis typically affects specific areas like palms, soles, underarms, or face, often starting in childhood or adolescence. Secondary hyperhidrosis usually causes generalized sweating and begins in adulthood.

The impact extends beyond physical discomfort. Excessive sweating can cause social anxiety, limit career choices, affect relationships, and lead to skin problems. Understanding whether your sweating is normal variation or requires medical evaluation is important for proper management.

Medical Conditions

• Hyperthyroidism: Overactive thyroid increases metabolism
• Diabetes: Low blood sugar (hypoglycemia) triggers sweating
• Menopause: Hot flashes with sweating
• Infections: Tuberculosis, HIV, endocarditis
• Cancers: Lymphoma, leukemia
• Heart disease: Heart attack, heart failure
• Neurological: Parkinson's, stroke, neuropathy
• Anxiety disorders: Panic attacks, social anxiety
• Obesity: Increased body mass
• Pregnancy: Hormonal changes

Medications

• Antidepressants: SSRIs, tricyclics
• Pain medications: Opioids, NSAIDs
• Diabetes medications: Insulin, sulfonylureas
• Hormone therapy: Thyroid, testosterone
• Blood pressure meds: Beta blockers
• Psychiatric drugs: Various types
• Antibiotics: Some types

Lifestyle Factors

• Alcohol: Causes vasodilation
• Caffeine: Stimulant effect
• Spicy foods: Gustatory sweating
• Hot beverages: Raise body temperature
• Stress: Emotional triggers
• Withdrawal: Alcohol, drugs

Primary Hyperhidrosis Triggers

• Heat and humidity
• Emotional stress
• Public speaking
• Social situations
• Exercise
• No apparent trigger

Excessive sweating often occurs with other symptoms that help identify the cause:

• Weight loss: Hyperthyroidism, cancer, infections
• Fever: Infections, inflammatory conditions
• Palpitations: Thyroid, heart conditions, anxiety
• Fatigue: Chronic conditions
• Flushing: Menopause, carcinoid syndrome
• Tremor: Hyperthyroidism, anxiety
• Chest pain: Heart conditions
• Headaches: Pheochromocytoma
• Skin changes: Rashes, maceration
• Odor: Bromhidrosis
• Anxiety: Both cause and effect
• Sleep disturbance: Night sweats

Physical Complications

• Skin maceration and breakdown
• Fungal infections (athlete's foot)
• Bacterial infections
• Warts (from moisture)
• Contact dermatitis
• Dehydration risk
• Body odor

Social and Emotional Impact

• Social anxiety and isolation
• Embarrassment in public
• Avoiding physical contact
• Career limitations
• Relationship difficulties
• Low self-esteem
• Depression risk

Practical Challenges

• Frequent clothing changes
• Damaged electronics/papers
• Difficulty with manual tasks
• Slippery hands/feet
• Stained clothing
• Extra laundry
• Financial burden

Medical History

• Pattern and distribution of sweating
• Age of onset
• Family history
• Triggers and timing
• Associated symptoms
• Medications
• Impact on life

Diagnostic Tests

• Starch-iodine test: Maps sweating areas
• Paper test: Measures sweat production
• Thermoregulatory test: Whole body assessment
• Blood tests: Thyroid, glucose, hormones
• Imaging: If tumor suspected

Criteria for Diagnosis

• Excessive sweating for 6+ months
• Bilateral and symmetric pattern
• Impairs daily activities
• At least weekly episodes
• Onset before age 25
• Positive family history
• Stops during sleep

Daily Management

• Use clinical-strength antiperspirants
• Apply at night to dry skin
• Wear breathable fabrics
• Layer clothing
• Keep spare clothes
• Use absorbent powders
• Carry towels/wipes
• Stay hydrated

Lifestyle Modifications

• Identify and avoid triggers
• Manage stress levels
• Maintain healthy weight
• Limit spicy foods
• Reduce caffeine/alcohol
• Keep cool environment
• Use fans
• Take cool showers

Skin Care

• Keep skin clean and dry
• Change wet clothing promptly
• Use antifungal powder
• Wear moisture-wicking socks
• Air-dry shoes
• Trim nails to prevent injury
• Moisturize dry areas

Schedule an Appointment For:

• Sweating interfering with daily activities
• Night sweats lasting more than few weeks
• Sudden change in sweating patterns
• Sweating with unexplained weight loss
• One-sided or asymmetric sweating
• Sweating with other concerning symptoms
• Skin infections from moisture
• Emotional distress from sweating
• Failed over-the-counter treatments

Red Flags Requiring Evaluation:

• New onset generalized sweating
• Night sweats with fever
• Sweating with chest pain
• Associated weight loss
• Sweating with palpitations
• Color changes in sweat

• Clothing choices: Natural fibers, loose fit
• Footwear: Breathable shoes, moisture-wicking socks
• Environment: Air conditioning, fans
• Stress management: Relaxation techniques
• Diet: Avoid trigger foods
• Hygiene: Regular bathing, antibacterial soap
• Products: Sweat shields, dress shields
• Planning: Extra time for cooling
• Support: Join support groups
• Professional help: Don't delay treatment