Hyperhidrosis in Adult
Alerts and Notices
Synopsis
Primary hyperhidrosis is idiopathic focal sweating; triggers may include emotions (eg, anxiety), physical activity, heat, and spicy food. Pathophysiology is not fully understood but is thought to result from neurogenic overactivity of sweat glands involving both the sympathetic and parasympathetic pathways. Secondary hyperhidrosis is usually generalized and is associated with an underlying medical condition (eg, metabolic disorder, neurologic condition, infection, or malignancy) or medication use. Primary hyperhidrosis occurs in both children and adults. It often begins in teenage years. It is less common in elderly individuals. It is estimated to affect between 1% and 3% of the population. A positive family history is common.
The 3 main areas of the body that are affected in primary hyperhidrosis are the palms, feet, and axillae. Prepubescent children with this condition tend to present with palmoplantar hyperhidrosis, since the axillary glands are not fully developed until after puberty. After puberty, axillary hyperhidrosis is the most common presentation. In addition to the palms, feet, and axillae, affected body regions include the scalp, face, and inframammary and inguinal folds.
The following diagnostic criteria have been proposed for primary focal hyperhidrosis: focal, visible, excessive sweating that lasts at least 6 months, has no underlying cause, and matches at least 2 of the following characteristics:
- Involvement is bilateral and symmetric
- Impairs daily activities
- Episodes occur at least once per week
- Onset is before age 25
- The patient has a positive family history
- Symptoms cease during sleep
Concomitant dermatological conditions that may be present include eczematous dermatitis, dermatophytosis, pitted keratolysis, and verrucae.
Codes
ICD10CM:R61 – Generalized hyperhidrosis
SNOMEDCT:
312230002 – Hyperhidrosis
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Differential Diagnosis & Pitfalls
Focal hyperhidrosis:- Frey syndrome (auriculotemporal syndrome, gustatory sweating after parotidectomy)
- Peripheral neuropathy
- Spinal cord injury
- Anxiety disorder
- Obesity
Endocrine:
- Diabetes (type 1, type 2)
- Hyperthyroidism or hyperpituitarism (eg, from pituitary adenoma)
- Pregnancy or menopause
- Carcinoid syndrome
- Pheochromocytoma
- Acromegaly
- Acute bacterial or viral infection
- Tuberculosis
- Brucellosis
- Malaria
Drugs, medications, and other toxicities:
- Alcohol use disorder
- Cocaine use
- Heroin use (including withdrawal)
- Fluoxetine
- Venlafaxine
- Doxepin
- Ciprofloxacin
- Acyclovir
- Esomeprazole
- Sertraline or other antidepressants
- Poisoning (acetaminophen, cyanide, mercury)
- Lymphomas and other myeloproliferative disorders
- Congestive heart failure or other cardiac diseases
- Lung cancer or other respiratory conditions
- Blue rubber bleb nevus syndrome
- POEMS syndrome
- Glomus tumor
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:04/22/2020
Last Updated:01/17/2022
Last Updated:01/17/2022
Patient Information for Hyperhidrosis in Adult
Overview
Hyperhidrosis, the medical name for excessive sweating, involves overactive sweat glands, usually of a defined body part, including the palms, soles, forehead, or underarms. Rarely, hyperhidrosis can be generalized, affecting the majority of the skin. This condition can be quite debilitating, depending on the extent and location of the symptoms. Social and business interactions can be affected, for instance, if hyperhidrosis affects the hands and individuals avoid hand shaking due to sweaty palms. Excessive sweating can cause individuals to avoid public speaking engagements for fear of embarrassment of sweating in front of an audience.Who’s At Risk
Excessive sweating most often presents in childhood or adolescence, although it can be observed in adults as well. In up to half of patients, there may be a family history of this condition.Signs & Symptoms
Excessive sweating can develop during certain emotional states, such as under stressful conditions, or in association with certain medications.Self-Care Guidelines
Treatment progress can be made if inciting factors that lead to hyperhidrosis (certain foods, medications, or stressful situations) are identified and avoided. Use of over-the-counter antiperspirants can be helpful to decrease the amount of sweating. New "clinical strength" antiperspirants are now available (Secret, Dove) over the counter, which have been helpful for self-treatment. Additionally, there are products designed specifically for use on the feet (Certain Dri Feet Moisture Control Pads, Certain Dri Feet Microsponge Powder). Use of antiperspirant/deodorant combinations can help with the prevention of odor. Wearing natural fabrics, like cotton socks, can help to wick away moisture from areas of sweating and allow for faster drying of the skin.When to Seek Medical Care
Consultation with a physician should be sought when over-the-counter antiperspirants/deodorants are not effective in controlling symptoms. If symptoms are debilitating, causing major lifestyle changes to avoid developing symptoms or fear or embarrassment, patients should seek consultation with a dermatologist.Treatments
There are several common treatments that can be tried to effectively reduce the impact of symptoms of excessive sweating, including the following:- Topical aluminum compounds (Drysol, 20% aluminum chloride) – Act by blocking (occluding) the sweat gland.
- Glycopyrrolate – An oral medication that blocks molecules involved in signaling between the nervous system and the sweat glands.
- Oxybutynin – Another oral medication that blocks molecules involved in signaling between the nervous system and the sweat glands.
- Iontophoresis – Involves the passage of electric current into the skin, thereby disrupting the functioning of the sweat glands. This is most easily used for the palms and soles. Home units can be purchased for use within the home.
- Botulinum toxin injection (Botox) – Used to inhibit signaling between the nervous system and the muscle fibers found in the sweat glands.
- Sympathectomy – A surgical procedure used as a last attempt to get control of symptoms. The nerves of the sympathetic nervous system (those that govern the sweating behavior) are cut to reduce symptoms. Unfortunately, side effects such as excessive sweating in previously unaffected areas (known as compensatory hyperhidrosis) can result.
Hyperhidrosis in Adult