Hyperhidrosis is a term for excessive sweating, more than what is required to maintain body temperature.

Why do we sweat?

The main function of sweating is to help maintain core body temperature around 37^oC or 98.6^oF. Sweating and its subsequent evaporation help to lower body temperature.

 

What happens if a person sweats too much or not at all?

Too much sweating can either be embarrassing or, in some situations, may lead to dehydration. Not able to sweat may lead to the danger of overheating, and “heat stroke” in warm climate.  

 

What are different types of conditions causing excessive sweating?

There are numerous conditions causing excessive sweating. One way to look at this subject is to divide it two ways:

1. Generalized excessive sweating: Numerous conditions can cause generalized excessive sweating. Some are listed as follows:
2. Hyperhidrosis of unknown cause
3. Parkinson disease
4. Familial dysautonomia
5. Infections
6. Some cancers
7. Diabetes
8. Thyroid disease
9. Menopause
10. Alcohol or opioid withdrawal
11. Obstructive sleep apnea

 

1. Localized excessive sweating: This category also has numerous conditions, some as follows:
2. Primary focal hyperhidrosis affecting hands, feet, or axillae.
3. Harlequin syndrome
4. Focal or local autonomic dysfunction, such spinal cord injury

 

1. Unique conditions:
2. Gustatory or olfactory sweating, e.g., by eating hot and spicy food, usually affecting the face.
3. Cold induced sweating. These patients sweat with exposure to cold and less or not while in hot climate.
4. Harlequin syndrome

 

What causes excessive sweating?

1. Abnormality of central autonomic nervous system, such as Shapiro syndrome
2. Abnormality of peripheral autonomic nervous system, such as dysautonomia
3. Stroke
4. Hormonal & metabolic reasons, such as menopause or thyroid disorders
5. Infections, such as TB
6. Gustatory stimulation
7. Spinal cord injury
8. Malignancy, such as lymphoma
9. Iatrogenic, caused by meds such as SSRIs, proton pump inhibitors, etc.
10. Alcoholism
11. Porphyria

 

What tests are required to investigate hyperhidrosis?

Depending upon a particular patient, following tests may help:

• Thyroid function test
• Blood glucose
• Catecholamine levels
• Uric acid level
• TB skin test
• Chest x-ray

 

How is hyperhidrosis treated?

Local skin applications:

1. Glycopyrronium tosylate topical cloth (Qbrexza): Local anticholinergic pads for axillary sweating.
2. Boric acid
3. Tannic acid
4. Glutaraldehyde
5. Aluminum chloride hexahydrate (Drysol)

 

Systemic or oral medicines:

1. Anticholinergic medicines such as propantheline bromide, glycopyrrolate, oxybutynin, and benztropine
2. Sedatives
3. Calcium channel blockers

 

Others:

1. Microwave treatment
2. Iontophoresis
3. Botox
4. Surgeries, such as sympathectomy, radiofrequency ablation, liposuction, and removal of the affected area

 

Where can I get more information on hyperhidrosis?

American Academy of Neurology