Excessive sweating - overview

Definition

Excessive sweating is a medical condition in which a person sweats much more than needed. The medical name of this condition is hyperhidrosis.

Alternative Names

Sweating - excessive; Perspiration - excessive; Diaphoresis; Hyperhydrosis

Causes

Sweating helps the body stay cool. Most people may sweat more when:

  • The temperature is warm
  • Exercising
  • Nervous, angry, embarrassed, or afraid
Sweating

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Sweating

Excessive or extreme sweating can occur without triggers or other cause. This is called primary hyperhidrosis.

  • The cause appears to be overactive sweat glands.
  • It seems to run in families and often begins in childhood or adolescence.
  • It most often involves the hands, feet, underarms, and face.

Increased sweating may also be the result of another medical condition. Common conditions include:

Personality problems or phobias do not seem to be a cause of excessive sweating.

Symptoms

Most people with primary hyperhidrosis sweat from only one or two areas of the body:

  • The palms, feet, underarms, or head are the most common areas. Sweating will be on both sides of the body at the same time.
  • The rest of the body remains dry.
  • Sweating is absent during sleep. It occurs at least once a week or more often.
  • Less commonly, excessive sweating may be present in many areas of the body.
  • Sweating occurs even when you are not exerting yourself.

The main symptom of hyperhidrosis is wetness. Sweating can be so heavy that:

  • It is hard to use a keyboard or turn a doorknob.
  • Sweat may soak through clothes.
  • Skin problems may also result from the extreme sweating. These include infections and breakdown of the skin.

Many people with this condition feel embarrassment, stress, and worry, which affect their social and work lives.

Sweating caused by other medical problems:

  • Tends to involve the entire body
  • Often occurs during sleep as well as at other times

Visible signs of sweating may be noted during a doctor's visit. Tests may also be used to diagnose excessive sweating, including:

  • Sweat test: An iodine solution is applied to the sweaty area. After it dries, starch is sprinkled on the area. The starch-iodine combination turns a dark blue color wherever there is excess sweat.
  • Paper test: Special paper is placed on the affected area to absorb the sweat. Then it is weighed. The heavier it weighs, the more sweat the paper has absorbed.

Treatment

SELF-CARE

It may help to avoid certain triggers, such as:

  • Alcohol
  • Caffeine
  • Heat
  • Hot sauce or spices, such as curry or cumin

Antiperspirants: Excessive sweating may be controlled with strong anti-perspirants, which plug the sweat ducts:

  • Antiperspirants are not the same as deodorants. Deodorants do not prevent sweating, but they help to reduce body odor.
  • Products containing 10% to 20% aluminum chloride hexahydrate are used first. Some patients may be prescribed a product with a higher dose of aluminum chloride.
  • Dry the area well before using.
  • Your health care provider may tell you to use them before bed for up to five days in a row, and then once or twice a week.
  • These products can irritate your skin. Large doses can damage clothing.

Wear sandals if you can. When you wear shoes:

  • Choose shoes that allow air to circulate, such as those made from leather or other natural materials.
  • When possible, take your shoes off.
  • Allow your shoes to dry before wearing them again. Try not to wear the same pair of shoes two days in a row.

Choose socks that draw (or wick) moisture away from the skin. Cotton socks do not do this. Often, the packaging will say whether socks wick moisture away skin. Wash and dry your socks before wearing them again.

Antiperspirants can also be used on your feet. Apply before bed and wash it off in the morning. After doing this for three or four nights in a row, use it on your feet one time a week. Sprays may work better on your feet.

TREATMENTS

Medication: Certain medicines may prevent excessive sweating:

  • These are prescribed for certain types of hyperhidrosis, such as excessive sweating of the face.
  • Medicines have side effects and are not right for everyone.

Iontophoresis: This is a simple office procedure that uses electricity to temporarily turn off the sweat gland. It works best for sweating of the hands and feet.

  • The hands or feet are placed into water, and then a gentle current of electricity is passed through it. The electricity is slowly increased until the patient feels a light tingling sensation.
  • The therapy lasts about 10 to 20 minutes. You will have 2 to 3 treatments a week for a while, then every week to month.
  • If this treatment works, you can buy a device and use it at home.
  • Side effects include skin cracking and blisters, although it is rare.

Botox: Botulinum toxin type A (Botox) is used to treat severe underarm sweating.

  • Injections are used for the underarms, feet, hands, or face and head. They temporarily block the nerves that stimulate sweating.
  • Side effects include injection-site pain and flu-like symptoms.
  • Botox used for sweating of the palms can cause mild, but short-term weakness and intense pain.

Endoscopic thoracic sympathectomy (ETS): This is a procedure that is recommended for severe cases when other treatments do not work:

  • During the procedure, a nerve is cut, turning off the signal that tells the body to sweat excessively.
  • It is most often done on people whose palms sweat too much. It may also be used to treat extreme sweating of the face.
  • ETS does not work as well for those with excessive underarm sweating.

Underarm surgery: This is surgery to remove the sweat glands in the armpits. Methods used include laser, curettage (scraping), excision (cutting), or liposuction. These procedures are done using local anesthesia.

Support Groups

International Hyperhidrosis Society | www.sweathelp.org

Outlook (Prognosis)

With treatment, hyperhidrosis can be managed. Your doctor can discuss treatment options with you.

Call your health care provider if you have:

  • Prolonged, excessive, and unexplained sweating
  • Sweating with or followed by chest pain or pressure
  • Sweating with weight loss
  • Sweating that most often occurs during sleep
  • Sweating with fever, weight loss, chest pain, shortness of breath, or a rapid, pounding heartbeat. These symptoms may be a sign of an underlying disease, such as hyperthyroidism.

References

Hamm H. Impact of hyperhidrosis on quality of life and its assessment. Dermatol Clin. 2014;32:467-476. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25152339.

Miller JL. Diseases of the eccrine and apocrine sweat glands. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 39.

Reisfeld R, Berliner KI. Evidence-based review of the nonsurgical management of hyperhidrosis. Thorac Surg Clin. 2008:18:157-66. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18557589.

Review Date: 5/21/2013
Reviewed By: Diane M. Horowitz, MD, North Shore Long Island Jewish Health System, Great Neck, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial Team. Editorial update: 1/22/2015.

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