What is Hyperhidrosis?
Hyperhidrosis is a condition where a person sweats excessively due to overactivity of certain sweat glands. These sweat glands, known as eccrine glands, are in areas like the armpits, face, palms and soles. They are activated by certain chemicals in the body called cholinergic receptors. People with hyperhidrosis sweat more than their body needs to control heat, often for no clear reason.
This excessive sweating condition affects about 3% people in the United States. It can result in emotional, psychological, social, and job-related issues. Hyperhidrosis is divided into two types; primary and secondary. The treatment can vary greatly between these two types. Primary hyperhidrosis usually starts earlier in life with more localized symptoms. Secondary hyperhidrosis usually starts because of side effects of medications or disorders affected the nervous system.
Diagnosis is usually made through a doctor’s examination, and various scales and tests help determine how severe and widespread the sweating is. If secondary hyperhidrosis is suspected, blood tests may be necessary, to rule out issues like infections, overactive thyroid, diabetes, nervous system disorders, or side effects of medications.
The treatment options for hyperhidrosis can depend on the severity of the condition. Mild to moderate cases may be treated with topical solutions containing aluminum chloride or oral medications that block the sweat gland stimulating chemicals. Other treatments like injections of a drug called Botulinum toxin A, surgical removal of sweat glands, or nerve surgery (sympathectomy) are also effective, but are usually reserved for patients who aren’t responding to other, less invasive treatments.
What Causes Hyperhidrosis?
Hyperhidrosis, which is excessive sweating, can be split into two categories: primary or secondary. Why this is crucial is because the treatment for each category can significantly vary. As of now, we don’t completely understand why primary hyperhidrosis occurs, though genetic factors contributing to overactive nerves might have something to do with it.
Secondary causes are usually noticeable because they’re connected to certain medications or diseases. These medications can include dopamine stimulants, SSRIs (these are a type of antidepressants), antipsychotics, and insulin. The diseases can be diabetes, hyperthyroidism, Parkinson’s disease, and other neurological conditions; as well as tumors.
Fevers can often lead to hyperhidrosis. Excessive regular alcohol consumption and tuberculosis, a bacterial infection that mainly affects the lungs, are also related to hyperhidrosis. It’s rare, but some people get a type of hyperhidrosis that just affects one part of their body. It could show up on an adult’s forehead, underarm, palm, foot, or forearm. Some women who have gone through menopause might get moderate to severe hyperhidrosis on their face and scalp. Its more common for hyperhidrosis to occur on the right side of the face or arm, with a loss of sweating on the left side.
Risk Factors and Frequency for Hyperhidrosis
Hyperhidrosis, also known as excessive sweating, affects about 3% of people in the United States. It is most common in individuals aged between 20 and 60. This condition does not favor any gender, meaning both men and women are equally likely to experience it.
- The palms of the hands are the areas most commonly affected by hyperhidrosis.
- All racial and ethnic groups can experience hyperhidrosis, but it has been found to be more common in Japanese people compared to other groups.
Signs and Symptoms of Hyperhidrosis
Hyperhidrosis is a condition in which a person experiences excessive sweating, usually in parts of the body that have a high number of sweat glands. These areas can include the palms, soles, face, head, or underarms. Hyperhidrosis typically affects younger people and is often seen in those who’ve had symptoms for over 6 months, those with a family history of the condition, and those where the symptoms are present on both sides of the body. If someone starts to experience this excessive sweating later in life, they should be checked for potential secondary causes such as medication side effects or underlying diseases. Diagnosis is typically based on a visual check of the common areas where the condition appears. To judge the severity, doctors use visual scales mostly for palm sweat. A test which uses iodine and starch can also help pinpoint the exact areas if the locations are uncertain, and this can assist in the treatment.
The following are the criteria used to diagnose primary hyperhidrosis:
- Excessive sweating for 6 or more months
- Sweating involves the underarms, palms, soles, and/or face
- Sweating is equally present on both sides of the body
- No or little sweating during night
- Sweating episodes last at least one week
- The person is 25 years old or younger
- There is a family history of excessive sweating
- Sweating severely affects daily activities
Testing for Hyperhidrosis
If you’re dealing with excessive sweating, also known as hyperhidrosis, it’s crucial for your doctor to figure out whether it’s a primary issue, meaning the sweating is the main problem, or a secondary one, where it’s a symptom of another health issue. A thorough chat with your doctor about your health history can help determine this.
If your doctor believes your excessive sweating might be a symptom of another condition (a.k.a. a secondary cause), they might order several tests. These could include a complete blood count, basic metabolic panel, thyroid-stimulating hormone test, sedimentation rate, antinuclear antibody test, hemoglobin A1C, and chest x-ray. These tests can help rule out other health problems that might be associated with excessive sweating such as infection, kidney issues, cancer, diabetes, thyroid disease, an inflammatory disorder, or a connective tissue disease.
Your doctor might also measure the severity of your excessive sweating. To do this, they could use a scale to measure the amount of sweat on your palms, or a starch-iodine test to figure out the pattern of your sweating. However, these tests aren’t used often, as usually, a visual check by the doctor is enough to diagnose the condition.
Treatment Options for Hyperhidrosis
Hyperhidrosis, a condition causing excessive sweating, has become easier to treat with more options now available. Doctors often use a step-by-step approach, and there are many skin applied and oral medications at their disposal.
Initially, hyperhidrosis is usually treated with over-the-counter treatments like aluminum chloride. These are used for a few days and then nightly as needed. However, these treatments can irritate the skin and therefore may not be the best long-term solution. Another newly approved option is a pre-moistened cloth with a solution of glycopyrronium tosylate, specifically designed for treating excessive sweating. Aluminum chloride gel may also help. However, this could be a potent irritant.
All topical treatments have the potential to sensitize the skin. Some, like tannic acid and potassium permanganate, can cause skin discoloration. However, these treatments work by changing the structure of keratin, a protein in your skin, hence blocking the sweat glands temporarily. If these treatments don’t work or if the sweating is more widespread, oral medications that inhibit nerve signals to sweat glands are considered. Side effects may include dry eyes, dry mouth, difficulty urinating, and constipation.
When these treatments fail, other options include iontophoresis, which involves passing a weak electric current through the skin, multiple times a week, or injections of botulinum toxin A every few weeks. Iontophoresis usually only has mild effectiveness and it is often not used consistently. Botulinum toxin is more effective, although it can be expensive and needs to be repeatedly administered. However, it can last between 6 to 24 months and it can be useful for treating excessive sweating in hands, feet, and underarms.
If the above treatments are unsuccessful, more invasive procedures may be considered as a last option. Surgery, for example, can involve removing sweat glands in the affected areas or even cutting nerve pathways. However, these procedures can have serious complications and are usually only considered after other treatments have failed.
If an underlying condition or medication is causing the hyperhidrosis, treating the condition or stopping the medication, in addition to the regular treatment, is recommended.
What else can Hyperhidrosis be?
When someone experiences too much sweating, which is called hyperhidrosis, doctors might consider the possibility of various conditions that could be causing this. These include:
- Thyrotoxicosis (an overactive thyroid)
- Neuropathy (damage to nerves)
- Hypoglycemia (low blood sugar)
- Pheochromocytoma (a rare tumor that affects heart rate and blood pressure)
- Menopause
- Lymphoma (a group of blood cell tumors)
- Tuberculosis (a serious infection affecting the lungs)
- Alcohol use disorder
What to expect with Hyperhidrosis
The outlook for hyperhidrosis or excessive sweating can be challenging. While it’s not a threat to life, hyperhidrosis can cause significant personal discomfort because of its effects on one’s appearance, and may even interfere with work. It can greatly affect the quality of life, especially for individuals suffering from the severe form of the condition.
Currently, there is no full-proof treatment for hyperhidrosis as it’s often difficult to manage and there’s a high chance of it reoccurring. Despite the availability of various treatment options, none of them ensure a complete and reliable cure. This often leads to recurring symptoms. The good news is that there are some promising new surgical treatments, however, they’re not guaranteed to provide a permanent solution.
Possible Complications When Diagnosed with Hyperhidrosis
Excessive sweating, or hyperhidrosis, can lead to several problems. These include:
- Feeling embarrassed in social situations
- Emotional upset
- Mental stress
- Difficulties at work or school
