Hyperhidrosis (Excessive Sweating)
Symptoms
Hyperhidrosis is characterized by excessive sweating beyond what is needed to regulate body temperature. It most commonly affects the palms, soles, underarms, and face. Sweating can occur even in cool environments and often interferes with daily activities. Patients may avoid handshakes, develop skin irritation or maceration, or need frequent clothing changes. In severe cases, the sweating can be socially and emotionally distressing. Episodes may be triggered by stress or occur spontaneously. It may begin in childhood or adolescence and persist lifelong. Symptoms can be focal or generalized.
Cause
Primary hyperhidrosis is thought to be due to overactivity of the sympathetic nerves that control sweat glands. It has no known underlying disease and often runs in families. Secondary hyperhidrosis results from medical conditions such as hyperthyroidism, diabetes, infections, or medication side effects. Primary hyperhidrosis typically affects specific areas (e.g., hands, feet), while secondary tends to be more generalized. Triggers can include heat, anxiety, or exertion. Diagnosis is clinical but may involve testing for underlying conditions if generalized.
Treatment
First-line treatment includes clinical-strength antiperspirants containing aluminum chloride. Prescription options may be stronger than over-the-counter versions. Other therapies include oral anticholinergics, Botox injections (FDA-approved for axillary hyperhidrosis), or iontophoresis for palms and soles. Microwave thermolysis (e.g., miraDry) can permanently destroy sweat glands in the underarms. For severe cases, surgery (e.g., sympathectomy) may be considered. Lifestyle tips such as breathable fabrics and moisture-wicking clothing may help. A dermatologist can tailor treatment based on the severity and area affected.
Dr. Beth Schulz-Butulis
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