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Hyperhidrosis (excessive sweating)By Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/hyperhidrosis/DS01082
Hyperhidrosis (hi-pur-hi-DROE-sis) is excessive sweating that occurs even when the temperature isn't hot and you're not exercising. In some people who have hyperhidrosis, the sweat literally drips off their hands.
Hyperhidrosis usually affects the palms of the hands, soles of the feet and underarms. Besides disrupting normal daily activities, hyperhidrosis can cause social anxiety or embarrassment.
One of the first options for treatment involves using prescription-strength antiperspirants on the affected areas. In severe cases, your doctor may suggest surgery either to remove the sweat glands or to disconnect the nerves responsible for the overproduction of sweat.
Most people sweat when they exercise or exert themselves, are in a hot environment, or are nervous, anxious or under stress. The excessive sweating experienced with hyperhidrosis far exceeds such normal sweating.
Hyperhidrosis usually affects the hands, feet, underarms and sometimes the face. Rarely, the entire body is affected. The excessive sweat may soak through clothes or drip off your hands. Episodes usually occur at least once a week without an obvious reason.
When to see a doctor
See your doctor if:
- Sweating disrupts your daily routine
- You suddenly begin to sweat more than usual
- You experience night sweats for no apparent reason
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Sweating is your body's mechanism to cool itself. Your nervous system automatically triggers your sweat glands when your body temperature rises. Sweating also normally occurs, especially on your palms, when you're nervous.
In hyperhidrosis, the nerves responsible for triggering your sweat glands become overactive and call for more perspiration even when it's not needed. The problem worsens if you're under stress or nervous.
The type of hyperhidrosis that occurs primarily in your palms and soles may have a genetic component, because it sometimes clusters in families. If you have excessive sweating all over your body, it may be caused by an underlying health factor, such as:
- Certain medications
- Menopause hot flashes
- Low blood sugar
- Overactive thyroid gland
- Some types of cancer
- Heart attack
- Infectious disease
Complications of hyperhidrosis include:
- Infections. People who sweat profusely are more prone to skin infections. These infections can range from ringworm to warts.
- Other skin conditions. Certain skin conditions, such as eczema and skin rashes, occur more frequently in people with hyperhidrosis. Excessive sweating may worsen skin inflammation.
- Social and emotional effects. Having clammy or dripping hands and perspiration-soaked clothes can be embarrassing. Palm sweat can soak into paperwork, affecting occupational and educational pursuits.
Preparing for your appointment
You're likely to start by seeing your family doctor. He or she may refer you to a specialist in skin diseases (dermatologist). In some cases, doctors specializing in the treatment of conditions affecting the nervous system (neurologist) may be consulted.
What you can do
Before your appointment, you might want to write a list that answers the following questions:
- Has anyone in your immediate family ever had similar symptoms?
- Does your sweating stop when you're asleep?
- What medications and supplements do you take regularly?
What to expect from your doctor
Your doctor may ask some of the following questions:
- When did you begin experiencing symptoms?
- How often do you experience these symptoms?
- Have your symptoms been continuous or occasional?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
Tests and diagnosis
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|Thermoregulatory sweat test|
During your appointment, your doctor will ask about your medical history and conduct a physical exam. If your symptoms are obvious, it may be relatively easy for your doctor to diagnose hyperhidrosis.
Your doctor may order blood or urine tests to determine if the excessive sweating is caused by another medical condition, such as an overactive thyroid (hyperthyroidism) or low blood sugar (hypoglycemia).
Thermoregulatory sweat test
During this test, your skin is coated with a powder that changes color when it gets wet. The test begins in a room heated to a comfortable temperature, and then you enter a heating cabinet that brings your core temperature up to 100.4 F (38 C). Most people who have hyperhidrosis sweat enough to make the powder turn purple before they go into the heating cabinet.
Treatments and drugs
Hyperhidrosis treatment varies, depending on the severity of the problem. In most cases, your doctor will want to try conservative treatments before suggesting more-invasive options such as surgery.
Drugs used to treat hyperhidrosis may include:
- Prescription antiperspirant. If over-the-counter antiperspirants don't help, your doctor may prescribe stronger products to apply at bedtime. Prescription-strength antiperspirants can cause skin irritation, so wash the product off your body in the morning. If your skin becomes irritated, hydrocortisone cream might help.
- Pills that block nerve communication. Some oral medications block the chemicals that permit certain nerves to communicate with each other. This can reduce sweating in some people, but can also cause dry mouth, blurred vision and bladder problems.
- Botulinum toxin injections. Commonly used to help smooth facial wrinkles, botulinum toxin (Botox, Myobloc, others) can also block the nerves that trigger sweat glands. However, each affected area of your body will need several injections, which are painful and expensive. And the effects may last for only a few months.
Surgical and other procedures
Other types of hyperhidrosis treatments may include:
- Iontophoresis. In this procedure, a dermatologist uses a device to deliver a low level of electrical current to the hands or feet, and sometimes the armpits, while that part of the body is immersed in water. Treatments are often performed once a day for several weeks, followed by less frequent maintenance therapy.
- Sweat gland removal. If excessive sweating occurs just in your armpits, removing the sweat glands there may help. This can be accomplished via liposuction through very small incisions.
- Nerve surgery. In severe cases of hyperhidrosis, your doctor might suggest a procedure that cuts, burns or clamps the spinal nerves that control sweating in your hands. In some cases, this procedure triggers excessive sweating in other areas of your body.
Lifestyle and home remedies
In addition to over-the-counter antiperspirants, the following suggestions may help you reduce sweating and the associated body odor:
- Bathe daily. Regular bathing helps keep the number of bacteria on your skin in check.
- Dry your feet thoroughly after you bathe. Microorganisms thrive in the damp spaces between your toes. Use over-the-counter foot powders to help absorb sweat.
- Choose shoes and socks made of natural materials. Shoes made of natural materials, such as leather, can help prevent sweaty feet by allowing your feet to breathe.
- Rotate your shoes. Shoes won't completely dry overnight, so try not to wear the same pair two days in a row.
- Wear the right socks. Cotton and wool socks help keep your feet dry because they absorb moisture. When you're active, moisture-wicking athletic socks are a good choice.
- Change your socks often. Change socks or hose once or twice a day, drying your feet thoroughly each time. Women may prefer pantyhose with cotton soles.
- Air your feet. Go barefoot when you can, or at least slip out of your shoes now and then.
- Choose natural-fiber clothing. Wear natural fabrics, such as cotton, wool and silk, which allow your skin to breathe. When you exercise, you might prefer high-tech fabrics that wick moisture away from your skin.
- Try relaxation techniques. Consider relaxation techniques such as yoga, meditation or biofeedback. These can help you learn to control the stress that triggers perspiration.
Coping and support
Hyperhidrosis can be distressing. You may have trouble working or enjoying recreational activities because of wet hands or feet or wet stains on clothing. You might feel embarrassed or anxious about your symptoms and become withdrawn or self-consciousness. You may be frustrated or upset by other people's reactions.
Besides talking to your doctor, you may want to talk to a counselor or medical social worker. Or you may find it helpful to talk to other people with hyperhidrosis. Go online to connect with other people living with the condition.
- Kliegman RM, et al. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/das/book/body/208746819-6/0/1608/0.html. Accessed July 18, 2012.
- Smith CC, et al. Primary focal hyperhidrosis. http://www.uptodate.com/index. Accessed July 18, 2012.
- Cerfolio RJ, et al. The Society of Thoracic Surgeons expert consensus for the surgical treatment of hyperhidrosis. Annals of Thoracic Surgery. 2011;91:1642.
- Bradley WG, et al. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa.: Butterworth-Heinemann Elsevier; 2008. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-0-7506-7525-3..X5001-8--TOP&isbn=978-0-7506-7525-3&uniqId=230100505-57. Accessed July 18, 2012.
- Solish N, et al. Evaluating the patient presenting with hyperhidrosis. Thoracic Surgical Clinics. 2008;18:133.
- Eisenach JH, et al. Hyperhidrosis: Evolving therapies for a well-established phenomenon. Mayo Clinic Proceedings. 2005;80:657.
- Barbara Woodward Lips Patient Education Center. Hyperhidrosis (Excessive sweating). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2011.