Sweating is necessary; it serves to prevent the body from overheating. In hyperhidrosis, however, sweat still occurs even when the body is not in need of cooling. This excessive sweating can become a real nuisance and interfere with daily activities
Hyperhidrosis can be localised or generalised.
Localized hyperhidrosis: affects armpits, palms, soles, face or other sites
Generalized hyperhidrosis: affects most or all of the body
It can be primary or secondary.
Onset is in childhood or adolescence; improvement may or may not happen with age
There may be a family history
Usually involves armpits, palms and or soles in a symmetric distribution
Sweating usually decreases at night, and disappears during sleep
Less common than primary hyperhidrosis
More likely to be unilateral and asymmetrical, or generalized
Can occur at night or during sleep.
Results from endocrine or neurological conditions
Examples of localized hyperhidrosis include axillary hyperhidrosis, palmar hyperhidrosis, and plantar hyperhidrosis.
Primary hyperhidrosis has been linked to overactivity of the hypothalamic thermoregulatory center, a zone in the brain that is responsible for maintaining a stable core body temperature; this affects the function of the sweat glands.
Attacks of excessive sweating may be triggered by: hot weather, exercise, anxiety, fever, and spicy food
Secondary localized hyperhidrosis is usually associated with neurologic disorders such as stroke, nerve damage, neuropathy, and chronic anxiety.
Secondary generalized hyperhidrosis is precipitated by obesity, diabetes, hyperthyroidism (over active thyroid gland), and drugs like caffeine, steroids, and some antidepressants.
If secondary generalized hyperhidrosis is suspected, screening tests, including fasting blood sugar (to rule out diabetes) and thyroid function tests (to rule out hyperthyroidism) may be recommended.
How to manage hyperhidrosis?
Choose loose-fitting clothes made with sweat-proof fabrics; change clothing when damp
Use absorbent insoles in shoes and replace them frequently.
Use a non-soap cleanser
Apply talcum powder or corn starch powder after bathing
Avoid caffeinated food and drink
Check if you are taking any drug that may be causing hyperhidrosis; if so, discuss alternatives with your doctor
Apply antiperspirants that contain 10–25% aluminium salts to reduce sweating in the affected areas
Iontophoresis: this process helps in cases of hyperhidrosis of palms, soles and armpits. The affected area is immersed in water, an electrolyte solution or glycopyrronium solution, and a mild electrical current is passed across the skin surface for 10–20 minutes. The process is repeated daily for a few weeks, then less frequently as required. It may or may not produce the desirable effects.
Oral anticholinergic drugs, beta blockers, calcium channel blockers, nonsteroidal anti-inflammatory drugs and anxiolytics may be useful for some patients.
Botulinum toxin injections: used for armpit hyperhidrosis off-label for localized hyperhidrosis in other sites. They reduce or stop sweating for three to six months.
Surgical removal of axillary sweat glands
Overactive sweat glands in the armpits may be removed by several methods, usually under local anesthetia.
In order to deactivate the nervous stimulation of sweat glands, this procedure is reserved for the most severely affected individuals due to potential risks and complications. Recurrence rate is up to 15%, in addition to the potential for undesirable skin warmth and dryness, and new-onset hyperhidrosis of other sites in 50% of patients treated with this method.