What Is Hyperhidrosis?

Hyperhidrosis is a medical condition that causes excessive sweating beyond what’s necessary to regulate body temperature. While it can be triggered by heat, stress, or exercise, people with hyperhidrosis may sweat excessively even at rest or in cool environments. The condition can affect quality of life, leading to embarrassment, discomfort, and even social withdrawal.

Hyperhidrosis may begin in childhood or adulthood and can be either a standalone issue or secondary to another medical condition. Although not life-threatening, the impact on daily living is often significant.

Types of Hyperhidrosis

Hyperhidrosis is generally classified into two categories:

  • Primary focal hyperhidrosis: This type occurs without any identifiable medical cause. It typically affects specific areas like the hands, feet, underarms, or face. Sweating usually appears symmetrically and starts early in life.

  • Secondary generalized hyperhidrosis: This form results from an underlying medical condition or as a side effect of certain medications. It often affects larger areas of the body and may include nighttime sweating.

Recognizing Symptoms

The hallmark symptom of hyperhidrosis is persistent, excessive sweating. Other signs may include:

  • Noticeable sweat marks on clothing

  • Slippery hands interfering with typing or shaking hands

  • Wet feet that leave prints on the floor

  • Skin irritation, peeling, or rashes in moist areas

  • Increased risk of bacterial or fungal infections like athlete’s foot

People with hyperhidrosis often feel anxious about sweating, which can make symptoms worse.

Common Causes

The underlying causes differ between the two types:

Primary hyperhidrosis:

  • Thought to be genetic; tends to run in families

  • May involve overactivity of the sympathetic nervous system

Secondary hyperhidrosis may be caused by:

  • Diabetes

  • Hyperthyroidism

  • Menopause

  • Infections

  • Certain cancers

  • Neurological disorders

  • Medications such as antidepressants, insulin, or opioids

Diagnostic Process

To diagnose hyperhidrosis, a healthcare provider will evaluate:

  • Medical history

  • Symptom onset and severity

  • Patterns of sweating

  • Current medications

They may perform specific tests to support the diagnosis:

  • Starch-iodine test: A powder and iodine solution identify sweaty regions by turning blue-black

  • Paper test: Special paper is used to measure sweat absorption

  • Blood tests: Evaluate conditions like thyroid dysfunction or infections

  • Imaging: In rare cases, scans may be used to identify tumors or abnormalities

Treatment Options

Managing hyperhidrosis involves addressing the type and severity. Treatment options include:

Topical Treatments

  • Antiperspirants (over-the-counter or prescription-strength): Contain aluminum chloride to block sweat glands; best applied at night

  • Glycopyrronium wipes (Qbrexza): Prescription wipes for underarm sweating with localized effect

Devices and Therapies

  • Iontophoresis: Delivers a mild electric current through water to temporarily block sweat glands on hands and feet

  • Botox (onabotulinumtoxinA): Injections block nerves that activate sweat glands, effective for several months

Medications

  • Anticholinergics: Reduce overall sweating but may cause dry mouth, blurry vision, or urinary retention

  • Beta-blockers or benzodiazepines: Sometimes prescribed for stress-related sweating

Surgical Interventions

  • Sweat gland removal: Particularly for underarm sweating, includes liposuction or curettage

  • Endoscopic thoracic sympathectomy (ETS): Surgical nerve disruption; may lead to compensatory sweating in other areas

Managing at Home

Daily strategies can help control symptoms:

  • Bathe with antibacterial soap to reduce odor

  • Apply antiperspirants on dry skin at night

  • Wear breathable, moisture-wicking clothing

  • Use dress shields or armpit pads

  • Avoid known food triggers like caffeine and spicy foods

  • Keep feet dry and rotate shoes

Preventive Strategies

While primary hyperhidrosis can’t be prevented, flare-ups can often be reduced by:

  • Managing stress through mindfulness, yoga, or breathing exercises

  • Staying cool in warm weather

  • Avoiding tight, synthetic clothing

  • Skipping foods and drinks that provoke sweating

  • Keeping a symptom journal to track personal triggers

Potential Complications

Although hyperhidrosis isn’t dangerous, it can lead to:

  • Frequent skin infections (fungal, bacterial)

  • Social anxiety and emotional distress

  • Occupational or academic limitations

  • Disruption of daily routines

Mental health support is often necessary to cope with emotional effects.

Living With Hyperhidrosis

Many people with hyperhidrosis feel self-conscious and modify their behavior to hide their symptoms. However, with treatment, symptom tracking, and support, most can manage the condition effectively.

Tips for daily life include:

  • Keeping a spare outfit or towel with you

  • Practicing confidence-boosting affirmations

  • Joining support communities online or in person

  • Speaking with a mental health professional if needed

No one should feel isolated because of sweating—hyperhidrosis is a common and treatable condition.