Excessive Sweating

1 Excessive Sweating Summary

Excessive sweating, also known as hyperhidrosis, is a common condition in which the person sweats excessively. It is often defined as sweating that disrupts normal activities of a person.

The sweating may be restricted to one particular area or generalized throughout the body. Localized sweating is referred to as focal hyperhidrosis. Areas commonly affected by excessive sweating are armpits, palms, soles of feet, face, chest, and groin.

It may affect the parts on either side of the body, equally. Hyperhidrosis is not a serious condition but may cause considerable embarrassment and distress to the affected person. This condition may be present at birth or develop at a later stage in life. Teenage is the most common phase for the onset of symptoms of excessive sweating.

The most common symptoms of hyperhidrosis are: 

  • Wet palms in hands
  • Wet soles in feet
  • Increased frequency of sweating
  • Sweating that is noticeable

Patients with this condition have increased the risk of bacterial and fungal infections of the skin. They are often self-conscious and are reluctant to have contact with other people.

It often leads to depression as the person remains socially withdrawn due to embarrassment and discomfort. They tend to spend a lot of time in a day to deal with the increased sweating. They also worry about body odor.

Hyperhidrosis is categorized into:

  • Primary idiopathic hyperhidrosis – the actual cause behind this condition remains unknown. Sweating in this type of hyperhidrosis is often localized.
  • Secondary hyperhidrosis – this type is caused by an underlying medical condition like gout, obesity, menopause, or increased secretion of thyroid hormones.

Causes of primary hyperhidrosis are not fully understood. Certain genes may play an important role in the development of the condition. The majority of a patient with this condition seem to have a family history of excessive sweating.

There are multiple causes for secondary hyperhidrosis, this includes: 

  • Spinal cord injury
  • Diabetes
  • Alcohol abuse
  • Obesity
  • Parkinson’s disease
  • Pregnancy
  • Gout
  • Certain infections
  • Certain medications
  • Substance abuse

Some medications like antidepressants, anticholinesterases, and medications used in the treatment of high blood pressure are known to cause excessive sweating.

Blood and urine tests are used to rule out underlying causes like hyperthyroidism and hypoglycemia. Information on the part that is affected by sweating, frequency of sweating episodes, and the onset of the condition may help in providing important clues regarding the possible causes of excessive sweating. The severity of sweating is tested using thermoregulatory sweat test.

Changes in lifestyle may help to improve symptoms of excessive sweating. This includes using loose clothing, shoes made of natural materials, and better absorbing socks. Antiperspirants and armpit shields may help in controlling excessive sweating to some extent.

Dermatologists may recommend iontophoresis, a method in which hands and feet are submerged in a bowl of water and an electric current passed through it. Botox injections, anticholinergic drugs, and endoscopic thoracic sympathectomy are also used in the treatment of this condition.

If left untreated, it may lead to infections in nails, skin infections, warts, and heat rash. Primary focal hyperhidrosis is a completely resolvable condition. If caused by an underlying condition, treating the same would help in reducing sweating.

2 Causes

The most common cause of excessive sweating is primary focal hyperhidrosis. It usually starts during adolescence and persists through a life time. This type of hyperhidrosis does not lead to any illness.

People who have primary focal hyperhidrosis are healthy and may not have any drug interactions or diseases. The actual cause of this type of hyperhidrosis is not clear. A minor abnormality in the nervous system is implicated in this condition.

It is also found to run in families. It interferes with the quality of life. Certain genes are considered to play an important role in the cause of this condition. Thus, primary hyperhidrosis may be an inherited disorder.

Secondary hyperhidrosis results in generalized sweating and is often referred to as secondary general hyperhidrosis. It is a more serious medical condition when compared to primary focal hyperhidrosis. It is caused by an underlying medical condition and hence the name secondary hyperhidrosis.

A number of medical conditions may lead to excessive sweating, this includes: 

  • Menopause – menopause is characterized by many symptoms including irregular periods, hot flashes, excessive sweating, and night sweats.
  • Pregnancy – the body undergoes many changes during pregnancy. Along with the many physical changes, it also causes excessive sweating in pregnant women.
  • Thyroid problems – hyperhidrosis can be a symptom of thyroid problem like hyperthyroidism, where the thyroid gland is overactive and produces an excess amount of thyroid hormones.
  • Diabetes – diabetes is a chronic disease characterized by increased levels of blood sugar. Occasionally people with diabetes experience hypoglycemia, which is characterized by excessive sweating. Patients with diabetic neuropathy may also experience excessive sweating, particularly during the night and while eating.
  • Alcoholism – one of the effects of alcohol is the dilation of blood vessels which increases sweating. Excessive sweating in the night is a symptom of alcohol withdrawal.
  • Infectious diseases – some infections including tuberculosis, HIV, and malaria are characterized by this symptom. Tuberculosis is a bacterial infection that affects different organs, particularly lungs. Infection by this bacteria may cause several symptoms including increased sweating.
  • Parkinson’s disease – this disease affects the nerve cells and causes rigidity of muscles and tremors. Weakness, difficulty in walking and speech, and swallowing problems are also seen in this disease. Some people with this condition are affected by excessive sweating which causes much distress.
  • Rheumatoid arthritis – this condition is caused by an exaggerated immune system which attacks the lining of joints. Rheumatoid arthritis may cause excessive sweating in addition to the many symptoms.
  • Stroke – stroke is caused by a block in the blood vessel or bleeding in a part of the brain. Weakness, numbness, headache and increased sweating are some of the symptoms of the condition.
  • Heart failure – heart failure may be caused by many factors like cardiomyopathy, hypertension, and coronary artery disease. Excessive sweating may be one of the symptoms of the condition.
  • Some cancers – some cancers like leukemia and lymphoma may also result in excessive sweating.
  • Certain medications – certain medications like psychiatric drugs, some drugs used in controlling blood pressure, medicines used for controlling dryness of mouth, some antibiotics, and some supplements may cause excessive sweating.
  • Anxiety – people who have anxiety disorders tend to sweat more than others.

3 Diagnosis and Treatment

Review of medical history, physical examination, and symptoms are the diagnostic methods for hyperhidrosis. The doctor may try to analyze whether it is localized or generalized form of sweating.

Blood and urine tests also are suggested to determine the underlying cause of the condition. Starch-iodine test is a characteristic diagnostic test recommended. In this method, iodine is applied on the affected area.

When the iodine dries up, starch is sprinkled on the same area. The color change of starch to blue indicates increased sweating. Paper test is also sometimes used for analyzing increased sweat.

In this method, a special kind of paper is put on the sweating area. The paper is then weighed after absorption of sweat from the area. Increased weight of the paper indicates excessive sweating.

The thermoregulatory test is similar to starch-iodine test, in which a special powder is applied to the affected area. This powder is sensitive to sweat and moisture and changes color.

The change in color, when applied to the body, indicates increased sweating. Sauna or sweat cabinet is also helpful in detecting hyperhidrosis. In a sweat cabinet, the palm may show more sweat.

The treatment method adopted depends on the severity of sweating and area affected by the condition.

Antiperspirants – specialized antiperspirants containing aluminum chloride is recommended for controlling this symptom. It is usually effective in alleviating mild form of hyperhidrosis and is found to be more effective than the over-the-counter versions of antiperspirants.

Iontophoresis – in this procedure, low-level electric currents are used to block the functioning of sweat glands. The current is applied while the patient is submerged in water. It is usually delivered to the areas that are commonly involved in sweating, like feet, armpits and hands.

Anticholinergic drugs – anticholinergic drugs are recommended to provide relief from generalized sweating in the body. These drugs, as the name suggests, blocks the functioning of acetylcholine the chemical that stimulates the sweat glands in the body.

Botulinum toxin injections – botulinum toxin or botox injections are also used in the treatment of hyperhidrosis. This method is used to block the nerves that stimulate the sweat glands.

Surgery – this is generally suggested when the sweating is restricted to some places like armpits. In this surgical repair method, the sweat glands from the affected region may be removed.

Endoscopic thoracic sympathectomy – this surgical method involves the severing of nerves that triggers the sweat glands. When the trigger is removed, the glands tend to produce lesser amounts of sweat.

Most forms of hyperhidrosis can be controlled by home remedies like:

  • Over-the-counter antiperspirants are found to be useful in alleviating excess sweating
  • Bathing daily helps to remove the bacteria
  • Using clothes made of natural materials
  • Changing socks at least twice a day
  • Using absorbent foot powder
  • Using dress shields like armpit shields
  • Wearing loose clothing
  • Avoid clothes that show sweat marks

4 Related Clinical Trials