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Hyperhidrosis

(Excessive Sweating)

Definition

Hyperhidrosis is excessive sweating. It can be an embarrassing and serious problem. It can affect social, professional, and intimate relationships.
The sweating may be in just one area. It is most common in the palms of the hands, soles of the feet, and/or armpits. In some cases the sweating can also affect the entire body. Hyperhidrosis is divided into two categories:
  • Primary hyperhidrosis
    • usually affects specific areas
    • has no known cause
  • Secondary hyperhidrosis
    • usually the entire body
    • caused by an underlying condition
Sweat Gland
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Causes

Primary hyperhidrosis may be triggered by:
  • High emotional states (such as intense sadness, fear, anger, or stress)
  • Spicy foods
  • Hot climates
  • Certain medicines:
    • Fever-lowering medicines
    • Insulin
    • Meperidine
    • Emetics (vomit-inducing medicines)
    • Alcohol
    • Pilocarpine
Secondary hyperhidrosis may be caused by conditions such as:
  • Menopause
  • Fever
  • Infection
  • Cancer, such as lymphoma
  • Thyroid disease
  • Acromegaly or anterior pituitary tumor
  • Hypothalamic disorders
  • Adrenal tumor
  • Parkinsons disease
  • Nervous system disorders
  • Diabetes
  • Tuberculosis
  • Drug withdrawal
  • Certain medicines:
    • Fever-lowering medicines
    • Insulin
    • Antidepressants
    • Meperidine
    • Emetics (vomit-inducing medicines)
    • Alcohol
    • Pilocarpine

Risk Factors

Factors that increase your chance of secondary hyperhidrosis are the conditions that cause it (listed above).

Symptoms

Symptoms include:
  • Excessive sweating of palms of the hands and/or soles of the feet
  • Excessive sweating of armpits
  • Increased amount of sweating
  • Change in pattern of sweating
  • Change in the odor associated with sweating
  • Stained clothing

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done.
A starch-iodine test is often used on armpits. It may be used to determine the areas with the most active sweat glands.
Tests may be done if your doctor is concerned that you may have a specific medical condition.

Treatment

Treatment includes:

Lifestyle Changes

To help decrease the uncomfortable feeling and odor associated with sweating, try:
  • Frequent clothing changes
  • Careful washing

Topical Treatments

A number of treatments can be applied to decrease sweating in a particular area. These include:
  • Aluminum chloride hexahydrate
  • Aluminum tetrachloride
  • Formalin compresses
  • Glutaraldehyde compresses
  • Iontophoresis (stimulation with electrical current)—needs to be repeated on a daily or weekly basis, eventually tapering off to every 1-2 weeks; may be used if prescription antiperspirants fail

Medications

These are usually used for secondary hyperhidrosis. They are very rarely used due to their side effects, but may include:
  • amitriptyline
  • clonazepam
  • beta blockers
  • calcium channel blockers
  • gabapentin
  • oxybutynin
  • indomethacin

Botulinum A Neurotoxin

This is the toxin produced by the bacteria that cause botulism. Injections of this toxin can decrease sweating in certain areas. It is often used on the palms of the hands and armpits. The effect of one cycle of injections may last for 6-8 months for most patients.

Surgery

  • Endoscopic thoracic or lumbar sympathectomy—the destruction of nerves that stimulate sweating
  • Curettage—local removal of sweat glands via surgical scraping
  • Ultrasound
  • Liposuction techniques

Prevention

There are no known ways to prevent hyperhidrosis.

RESOURCES

Hyperhidrosis http://www.hyperhidrosis.ca

International Hyperhidrosis Society http://www.sweathelp.org

CANADIAN RESOURCES

Canadian Institute for Health Information http://www.cihi.ca

Health Canada http://www.hc-sc.gc.ca

References

Baumgartner FJ. Surgical approaches and techniques in the management of severe hyperhidrosis. Thorac Surg Clin . 2008;18(2):167-181.

Cecil Textbook of Medicine . 22nd ed. WB Saunders Company; 2004.

Commons GW, Lim AF. Treatment of Axillary Hyperhidrosis/Bromidrosis Using VASER Ultrasound. Aesthetic Plast Surg . 2009 Jan 3.

Kasper DL, et al. Harrison's Principles of Internal Medicine . 16th ed. McGraw-Hill Professional; 2004.

Local injection of botulinum toxin A for palmar hyperhidrosis: usefulness and efficacy in relation to severity. Yamashita N, Shimizu H, Kawada M, Yanagishita T, Watanabe D, Tamada Y, Matsumoto Y. J Dermatol . 2008;35(6):325-329.

Primary Care Medicine . 4th ed. Lippincott Williams & Wilkins; 2000.

Saenz JW, Sams RW 2nd, et al. FPIN's clinical inquiries. Treatment of hyperhidrosis. Am Fam Physician . 2011;83(4):465-466.

Solish N, Bertucci V, et al. A comprehensive approach to the recognition, diagnosis, and severity-based treatment of focal hyperhidrosis: recommendations of the Canadian Hyperhidrosis Advisory Committee. Dermatol Surg . 2007;33(8):908–923.

Treatment of hyperhidrosis. Dermatologic Clinics . 1998 Oct.

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