Hyperhidrosis: definition, causes, symptoms, diagnosis and treatment

By Cristiano Antonino On May 28, 2023

Hyperhidrosis can be defined as an excessive production of sweat. This very copious sweating cannot be considered a true pathology but is rather a symptom of other diseases or particular organic conditions

In fact, although the diagnosis of this disorder may be simple, this condition may be linked to endocrine diseases or promote infections.

For this reason, additional tests by the treating physician may be required.

The causes of Hyperhidrosis are many and can vary greatly from patient to patient.

The condition can affect the whole body or only certain parts, such as the hands, armpits, feet and groin.

Moreover, this condition affects men and women equally and is not affected by gender or age.

Among the consequences of Hyperhidrosis are certainly psychological discomfort and difficulties adapting within society.

Symptoms of Hyperhidrosis

The symptoms of Hyperhidrosis can be translated into two simple words: excessive sweating.

Sweating in itself is a physiological condition in humans and animals.

The amount of sweat produced can change considerably depending on different factors, first and foremost the outside temperature.

Under normal conditions, an adult can produce about half a litre of sweat, which can increase in hot weather or high temperatures to two litres per hour.

However, hyperhidrosis presents itself as excessive sweating in relation to normal over the whole body or in specific areas.

It is most common, for example, on the palms of the hands and feet, but other affected areas can also be armpits, groin, neck, folds of the arms and legs.

The symptoms of hyperhidrosis are thus summarised in excessive sweating, which can also lead to odours and psychological discomfort due to the social embarrassment of this condition.

Finally, excessive sweating can also lead to skin irritation and inflammation, which can become chronic over time and lead to the formation of blisters and a strong sense of itching and burning.

Causes

Although this condition is quite common, the causes of hyperhidrosis can be very different and change from patient to patient.

Primary hyperhidrosis is a dysfunction of the sympathetic system that innervates the sweat glands and thus controls their function.

Very often, however, this pathology has specific causes, which can be linked to pre-existing diseases in the subject.

In this case it is called secondary hyperhidrosis.

Causes of secondary hyperhidrosis include

hyperthyroidism
obesity
hormonal diseases
conditions such as menopause
psychiatric pathologies
endocrine-related diseases
Momentary hyperhidrosis is that caused by temporary conditions, such as strong emotions.

In this case, sweating is often localised, e.g. in the palms of the hands, on the forehead and under the armpits.

For example, when one is very nervous and has a sudden fright, overproduction of sweat is common.

Diagnosis

Making a diagnosis of primary or secondary hyperhidrosis may not be easy.

The first step in diagnosing this condition is certainly to visit the general practitioner and describe the different symptoms, as well as the areas affected and when they occur.

Following a careful anamnesis, which also investigates any cases in the family, an iodine-starch test may be requested.

This test consists of applying an iodine solution to the affected area, e.g. the armpits.

After allowing this solution to dry, corn starch is then applied to darken the areas where sweat is secreted.

In this way, it is possible to see which areas are affected by the overproduction of sweat.

This information can be important as, in the case of asymmetry for example, a neurological factor could be at the root.

In addition, further specific tests may be required.

Some examples are blood glucose or the dosage of thyroid hormones to exclude the presence of underlying diseases such as diabetes and hyperthyroidism, diseases responsible for excessive sweating.

How to combat hyperhidrosis?

The treatment to combat hyperhidrosis varies depending on whether it is of primary or secondary origin.

In fact, if hyperhidrosis is recognised as a symptom of a primary disease, it will be the treatment of the latter that will also remedy this symptom.

If, on the other hand, we are faced with primary hyperhidrosis we will have to treat the symptom directly using one of these remedies:

the use of specific clothing and deodorants. Clothing that is too tight-fitting should be avoided and more breathable materials that allow the skin to breathe are recommended instead. When buying deodorant, it is advisable to opt for products with aluminium chloride, and neutral products recommended by pharmacists are more reliable;
the use of ionophoresis, which exploits the temporary inability to produce sweat, which can be achieved through a current generator and two basins of water. In this way, the sweat glands are inhibited for a certain time;
the injection of botulinum toxin A, which inhibits sweat secretion and is very effective. However, the treatment is also quite painful and expensive and must be repeated every six months or so.
Iontophoresis is one of the alternatives most frequently chosen by patients. Usually this practice carried out in an outpatient clinic uses water and electricity: feet or hands are placed in basins of water or alternatively pads are used to be applied to the skin, such as armpits and forehead.

Pharmacological remedies

In the panorama of drugs that can alleviate hyperhidrosis, we find anxiolytics used in cases where hyperhidrosis is linked to excessive stress or emotional swings, remembering however that they are drugs to be taken under strict medical supervision and not without side effects.

They are usually prescribed as a basic treatment for an anxiety-related condition that in turn leads to hyperhidrosis and not as a treatment for hyperhidrosis per se.

Hyperhidrosis and surgery

An alternative treatment for hyperhidrosis is a surgical procedure called Endoscopic Thoracic Sympathectomy (ETS).

The nerve fibres of the sympathetic system are interrupted: the operation is performed under general anaesthesia and with a thoracoscopic access of about 1 cm.

The surgery is usually only performed on patients with a major indication.

Sympacectomy can have side effects such as bradycardia, Horner’s syndrome and compensatory hyperhidrosis in other parts of the body.

However, it is not a particularly invasive operation and guarantees an optimal result in more than 95 per cent of the cases treated.

The psychological consequences of hyperhidrosis

Hyperhidrosis as anticipated can be a symptom of other diseases and/or pathologies.

However, this condition can lead to severe psychological embarrassment and discomfort such as the feeling of always being wet and being judged by others.

In addition, always having sweaty hands, face, armpits and feet can also lead to the appearance of unsightly stains on clothes or unpleasant odours, or encourage fungal infections.

These discomforts lead to consequences that should not be underestimated and a compromised lifestyle.

To avoid embarrassment, many people always carry a change of clothes and perfume with them.

This condition can lead to deep depression, which affects personal relationships, self-esteem and career.

The unpleasant consequences of hyperhidrosis can then turn into real phobias, such as the fear of shaking hands with a stranger for fear that one’s hand is sweaty.

Another example is the embarrassment of speaking in public for fear of sweating.

These behaviours can then also lead to cases of self-harm, which is why it is essential to have a discussion with your doctor on the best measures to contain this condition.

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