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Hyperhidrosis in Adult
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Hyperhidrosis in Adult

Contributors: Vivian Wong MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Hyperhidrosis is increased perspiration in excess of the body's need for thermoregulation. It may or may not be associated with bromhidrosis. Hyperhidrosis may be primary or secondary.

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:
  1. Involvement is bilateral and symmetric
  2. Impairs daily activities
  3. Episodes occur at least once per week
  4. Onset is before age 25
  5. The patient has a positive family history
  6. Symptoms cease during sleep
Hyperhidrosis can cause significant anxiety and embarrassment and disrupt social and professional activities, especially those that require a dry grip.

Concomitant dermatological conditions that may be present include eczematous dermatitis, dermatophytosis, pitted keratolysis, and verrucae.

For more information, see OMIM.

Codes

ICD10CM:
R61 – Generalized hyperhidrosis

SNOMEDCT:
312230002 – Hyperhidrosis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Focal hyperhidrosis:
Generalized hyperhidrosis may be associated with metabolic diseases and other endocrine-related conditions, neurologic conditions, infections, malignancies, medications, and alcohol use disorder or substance abuse.

Endocrine:
Infection:
Neurologic:
Drugs, medications, and other toxicities:
Other conditions:

Best Tests

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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.

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References

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Last Reviewed:04/23/2020
Last Updated:05/05/2020
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Hyperhidrosis in Adult
Hyperhidrosis : Axilla, Plantar feet, Palms, Excessive sweating
Clinical image of Hyperhidrosis
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