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Hyperhidrosis
Last reviewed: 05.07.2025
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Hyperhidrosis is excessive sweating, which can be localized or widespread and has multiple causes.
Sweating of the armpits, palms and feet is most often caused by stress. Widespread sweating usually has an idiopathic basis, but the development of malignant neoplasms, infections and endocrine diseases is possible. The diagnosis is obvious, but it is necessary to conduct an examination for possible causes. In the treatment of hyperhidrosis, aluminum chloride, water iontophoresis, botulinum toxin are used, in extreme cases, surgical intervention is possible.
[ What causes hyperhidrosis?
Hyperhidrosis can be localized or general.
Localized hyperhidrosis
Often sweating of the palms, soles, armpits, forehead is caused by emotions, anxiety, worry, anger or fear. Although this is a normal reaction of the body, patients with hyperhidrosis sweat even in situations in which most people do not have this reaction.
Increased sweating around the lips and mouth is observed when eating foods and drinks that are spicy or hot. No specific cause has been identified, but this type of sweating can occur with diabetic neuropathy, herpes zoster faciale, CNS disease, or damage to the parotid salivary gland. Frey's syndrome may develop, infection or injury can disrupt the innervation of the parotid gland and lead to increased parasympathetic influences, causing increased function of the sweat glands.
Other causes: follicular mucinosis of the skin, hypertrophic osteoarthropathy, blue nevus, cavernous tumor. Compensatory increase in sweating is observed after sympathectomy.
General hyperhidrosis
Although most cases are idiopathic, numerous conditions may be present, including endocrine disorders (especially hyperthyroidism, hypoglycemia, hyperpituitarism), pregnancy and menopause, drugs (especially antidepressants of all types, aspirin, nonsteroidal anti-inflammatory drugs, hypoglycemic agents, caffeine, and theophylline), carcinoid syndrome, autonomic neuropathy, and CNS disease. If profuse night sweats are present, investigations for malignancy (especially lymphoma and leukemia), infection (especially tuberculosis, endocarditis, or systemic fungal disease) should be considered, although anxiety and tension may often be responsible.
Symptoms of hyperhidrosis
Sweating is often present during the examination and is sometimes very profuse, clothing may be soaked with sweat, and the skin of the palms and soles may become loose and white. Hyperhidrosis can cause emotional distress and lead to limited interpersonal communication.
What's bothering you?
Diagnosis of hyperhidrosis
The diagnosis is made clinically and anamnestically, and can be confirmed by a test using an iodine solution (apply iodine, let it dry - sweaty areas will darken).
Tests used to determine the causes of hyperhidrosis include a clinical blood test to detect leukemia, blood sugar, and thyroid hormones to detect thyroid dysfunction.
What do need to examine?
How to examine?
Who to contact?
Treatment of hyperhidrosis
Initially, the treatment for any type of hyperhidrosis is the same.
Aluminum chloride hexahydrate solution 6-20% is used for the topical treatment of axillary, palmar and plantar sweating, this medicine requires a prescription. The solution blocks sweat ducts and is most effective when applied at night, under occlusion. In the morning, the solution should be washed off. Sometimes it is necessary to use anticholinergic drugs to prevent the leaching of aluminum chloride. Initially, it is necessary to apply the solution several times a week until certain results are achieved, then 1-2 times a week is enough. If occlusive dressings cause irritation, they can be discontinued. The solution should not be applied to inflamed, damaged, wet or recently shaved skin. In moderate cases, a highly concentrated aqueous solution of aluminum chloride can provide adequate help. Alternatives to the use of aluminum chloride are formaldehyde, glutaraldehyde, tannin, but contact dermatitis and skin discoloration may develop.
Plain water iontophoresis is a possible treatment for patients who do not respond to topical treatments. The affected areas (typically the palms or soles) are placed in tubs of tap water, each containing a 15-25 milliamp electrode, for 10-20 minutes. The procedure is performed daily for a week, then weekly or twice a month. Although the treatment is usually effective, it is time-consuming and somewhat cumbersome, making it tiring for patients.
Botulinum toxin A is a neurotoxin that reduces the release of acetylcholine by sympathetic nerves. Injected directly into the armpits, palms, or forehead, botulinum blocks sweating for about 5 months, depending on the dosage. Complications include muscle pain and headaches. The injections are effective, but painful and expensive.
Surgery is necessary if other treatments have failed. In patients with excessive axillary sweating, removal of the sweat glands may be considered. The most painful part of the surgery is considered to be sympathectomy. Potential complications include phantom sweating, oral sweating, neuralgia, and Horner syndrome.