What is hyperhidrosis?

Causes and Symptoms

The purpose of perspiration is to keep the body at an ideal temperature. The sweat glands

are affected by the sympathetic branch of the autonomic nervous system. Two types of sympathetic nerve fibers affect sweat glands: the noradrenergic, which respond to emotional stimuli, and the cholinergic, which respond to temperature. Hyperhidrosis refers to sweating that is greater than is needed to keep the body at a normal temperature.

Hyperhidrosis may be due to a secondary cause, such as hyperthyroidism, hormonal treatments, obesity, menopause, or severe psychiatric disorders. The immediate cause of primary hyperhidrosis (not attributable to another disorder or condition) is dysfunction of the sympathetic branch of the autonomic nervous system; however, the underlying cause of the dysfunction is not clear.

Hyperhidrosis may affect the entire body (general), or it may affect only specific areas, such as the armpits (axillary), palms of the hands (palmar), soles of the feet (plantar), or face (facial). General hyperhidrosis may be a variation on normal sweating. Paroxysmal localized hyperhidrosis, periodic excessive perspiration in a particular area of the body, may also occur. A genetic predisposition may be present. Persons who are obese are more likely to be affected, as are people with certain forms of eczema. Hyperhidrosis can also occur following frostbite.

Hyperhidrosis can vary in severity from being merely embarrassing to quite disabling. It tends to begin in adolescence and gradually increase with age.

Treatment and Therapy

Topical prescription antiperspirants applied to the affected areas may control the symptoms. Drugs that block the sympathetic portion of the autonomic nervous system may also be used. Some people with localized sweating respond to iontophoresis, a technique in which the affected area is placed in an electrolyte solution and stimulated with low-level electrical current. Some success has been shown with injections of botulinum toxin (Botox) into the affected areas. This technique has considerable disadvantages, however. Repeated injections are needed, and they are both painful and costly. Furthermore, the injections may cause temporary weakness of the hand muscles. Surgery to the affected areas of the nervous system has a 90 percent success rate for excessive sweating of the palms but is accompanied by numerous complications, including wound infection, sweating with eating (gustatory sweating), and recurrent hyperhidrosis. Little evidence exists for the effectiveness of psychotherapy, hypnosis, acupuncture, and herbal or homeopathic remedies.

Bibliography:

American Medical Association. American Medical Association Family Medical Guide. 4th rev. ed. Hoboken, N.J.: John Wiley & Sons, 2004.

Carruthers, Jean, and Alastair Carruthers, eds. Botulinum Toxin: Procedures in Cosmetic Dermatology. 3d ed. London: Saunders/Elsevier, 2013.

Carson-DeWitt, Rosalyn. "Hyperhidrosis." Health Library, September 30, 2012.

Haider, Aamir. “Hyperhidrosis: An Approach to Diagnosis and Management.” Dermatology Nursing 16, 6 (December 1, 2004): 515–518.

"Hyperhidrosis (Excessive Sweating)." Mayo Clinic, September 21, 2012.

Komaroff, Anthony, ed. Harvard Medical School Family Health Guide. New York: Free Press, 2005.

Kreyden, O. P., R. Böni, and G. Burg, eds. Hyperhidrosis and Botulinum Toxin in Dermatology. New York: S. Karger, 2002.

Stoppard, Miriam. Family Health Guide. London: DK, 2006.