Hyperhidrosis (Excessive sweating): Causes, Symptoms, Treatment

Do you feel conscious every time you reach out for a handshake because of constant sweaty hands? Do you get drenched in performing the mild activity?

If yes, then this article is for you. The condition of excessive sweating is known as hyperhidrosis. It affects nearly 4.8% of the US population.

According to the American Academy of Dermatology, Dr Benjamin Barankin, “ It is not always easy for the average person to know the difference”. Hyperhidrosis or sudorrhea has been linked to endocrine disorders as well as diabetes. So what causes the condition? 

What causes Hyperhidrosis?

Why am I sweating excessively for no reason?

Sweating is the process by which our body releases heat. Human beings can sweat up to 1.5 gallons per day.

Our sweat glands are operated by the adrenergic and cholinergic pathways but in case of hyperhidrosis associated with conditions like pheochromocytoma, hypoglycemia, and hypotension it’s been noted to be governed by the catecholamines that prevent evaporation of sweat from the skin surface.

Most people sweat excessively on some occasions. Usually, it is not medically concerning.

Hyperhidrosis is classified as primary and secondary depending upon its aetiology and localised or generalised depending upon its extent. 

Primary Focal Hyperhidrosis  

If you suffer from sweaty palms or feet, you might be suffering from primary focal hyperhidrosis.

It usually doesn’t have a secondary cause and is thought to be triggered by nervous system disorders like anxiety, stress or fear. It may have a familial origin. 

• Hereditary- It may be familial. Usually, the primary localised type falls under this category. 
• Frey’s Syndrome- It happens due to accidental damage to the auriculotemporal nerve that passes near the parotid resulting in localised sweating on nerve stimulation.

Generalised Secondary Hyperhidrosis

It is usually caused by a secondary factor like disease or medications and the symptoms are not localised to a particular spot. Here are a few causes for this type of hyperhidrosis.

• Diabetes- It may overstimulate the sweat glands leading to impaired homeostasis and excessive sweating along with loss of water and electrolytes.
• Menopause- ( hot flashes)- Unpredictable fluctuations of hormones may lead to hot flashes and generalised excessive sweating in females.
• Low blood sugar- In the case of hypoglycemia, the low glucose levels stimulate adrenaline secretion which leads to excessive sweating. 
• Thyroid problems- Thyroid hormone increases metabolic rate and thereby sweating. It might be due to thyroid overactivity as in the case of goitre or thyroid cancer.
• Heart attack- palpitations, restlessness, chest tightness and profuse sweating are indicative of a heart attack. It must be treated as an emergency and the patient must be admitted immediately. 
• Side effects of medication- This type is usually caused by medication like antidepressants, pain relievers and diabetes or hormonal medication like pilocarpine, propranolol and anticholinesterase. 
• Infections- Certain infections like HIV, malaria and TB may trigger the condition.
• Malignancy- Excessive sweating may also be seen in certain types of cancer like Hodgkin’s disease
• Spinal cord injury- As a part of post-traumatic syringomyelia (PTS) patients may sometimes develop hyperhidrosis as a result of hyperreflexia syndrome
• Alcohol abuse- Alcohol intake increases peripheral blood supply leading to excessive sweating
• Anxiety- According to the International Hyperhidrosis Society, up to 32 per cent of people with social anxiety experience hyperhidrosis.
• Gout- High levels of uric acid may lead to excessive sweating.
• Obesity- In the case of obese subjects, the subcutaneous fat layer prevents heat loss leading to compensatory hyperhidrosis.

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Complications

So what if you are sweating just a little more than usual?

Studies show that subjects suffer from the physiological as well as the psychological impacts of the condition. It may manifest as skin infection and irritation, sweat patches, body odour as well as sweaty palms. 

1. Socio-emotional impact- Hyperhidrosis causes subjects to avoid social and pubic interactions which may hamper their professional as well as personal life and self-image. It may also lead to a lack of physical contact and depression among adolescents.
2. Maceration- Constantly wet surfaces may lead to secondary infections and disruption of the epithelial layer also known as maceration.
3. Others- Other infections like jock itch, athlete’s foot and bacterial infections are also some of the common complications of this condition. 

Also Read: Cold Sweats: Causes, Symptoms, and Treatment

Symptoms

What is excessive sweating a symptom of?

Hyperhidrosis is a clinical symptom of a wide range of conditions like pheochromocytoma and medication side effects. It usually manifests as 

• wet palms of the hands
• Clammy soles of the feet
• Frequent sweating
• Sweat Patches on clothes
• Body odour

Treatments

How can I stop excessive sweating?

Treatment of hyperhidrosis starts with a diagnosis of the cause. In the case of secondary hyperhidrosis, the elimination of the root cause may provide relief from the symptom.

The treatment options extend from therapy to pharmacological/ medicinal management. Here are a few ways the condition is managed. It is usually the domain of a skin specialist aka a dermatologist. 

• Iontophoresis– This therapy involves passing a painless current through a medium( usually water) where one is required to submerge their hands and feet. Usually, patients need 2- 4 sessions of 20-30 min for each.
• Botulinum toxin (Botox)– This method is used to block the nerves that stimulate sweat secretion. The main downside is that subjects may need several sessions before they get successful results.
• Anticholinergic drugs– These medications inhibit the parasympathetic nerve impulse conduction thereby reducing perspiration rate. Patients usually need about 2 weeks of treatment to get results.
• ETS (Endoscopic thoracic sympathectomy)– This may be considered as the last resort. In this mode of treatment, the sweat glands are surgically removed by liposuction, curettage or excision to cure the condition. It must not be used for the feet because of the chances of permanent sexual dysfunction. 
• Topical medicines- For adults and children 9 and older with primary hyperhidrosis of the underarms, the Food and Drug Administration approved Qbrexza (glycopyrronium) in 2018.

Also Read: Sweating out a fever: Is it good or bad for you?

Prevention

Some alterations in daily activity and lifestyle may help improve symptoms:

• Antiperspirants –The aluminium chloride in antiperspirants clogs the pores and prevent excessive sweating.
• Armpit shields – These are special pads for the armpit. They may protect you from embarrassing sweat patches
• Clothing – Loose cotton garments may help you stay cool.
• Shoes – Those with palmer hyperhidrosis should wear leather shoes. 
• Socks – Socks made of natural fibres have been shown to provide better management than those made of synthetic fibre. 

Conclusion

Hyperhidrosis is a fairly common condition that may indicate a plethora of pathologies. It is usually not something to be concerned about. So when should I be worried about excessive sweating?

When the condition affects your daily life, you should seek expert advice. Physicians usually diagnose it by eliminating conditions like diabetes or hyperthyroidism.

If the cause is known to be primary in origin, it may be managed by medicinal, surgical and psychological therapy. It must however be considered that often any one mode of treatment isn’t enough and you might need to have a combination therapy for better results. 

Hyperhidrosis Related FAQs