Excessive Sweating (Hyperhidrosis): Causes, Treatment Options and When to Be Seen

What it involves

MedlinePlus defines hyperhidrosis as a medical condition in which a person sweats excessively and unpredictably, even in cool temperatures or at rest. It explains that the glands may simply be overactive, or that another medical condition may be driving the sweating.

Who this is for

• Patients whose hands, feet or underarms sweat heavily without heat or exercise as a trigger
• Patients who sweat all over the body and have recently started a new medicine
• Patients whose sweating arrived suddenly or comes with weight loss, fever or a pounding heartbeat
• Patients who have tried store-bought antiperspirants and want to know what else exists

What to expect

• Questions about where the sweating occurs, when it began and whether it happens at night
• A review of medicines, caffeine and alcohol, and other symptoms such as weight loss or a racing pulse
• Blood work if a thyroid or blood sugar problem is suspected, since the practice lists blood work among its services
• A plan that may include antiperspirant strategies, medicine changes or a referral if sweating stays severe

Normal sweat versus too much sweat

Sweating is how the body cools itself, and MedlinePlus says it is perfectly natural in warm weather, during exercise, or when you feel nervous, angry, embarrassed or afraid. The sweat itself is a clear, salty liquid. What marks hyperhidrosis is that the sweating happens without those triggers. The health topic page also notes that sweat mixed with skin bacteria is what causes body odor, which bathing and antiperspirants or deodorants can help control. Sweating a lot because it is hot out is not a medical problem.

Primary and secondary hyperhidrosis

MedlinePlus separates two kinds. Sweating that is not caused by another disease is called primary hyperhidrosis; it usually involves the hands, feet and armpits, often has no findable cause, and seems to run in families. Sweating that comes from another condition is secondary, and it may be all over the body or in one place. The list it gives includes anxiety conditions, diabetes and low blood sugar, an overactive thyroid, menopause, heart or lung disease and certain medicines, among others. The thyroid care page explains how thyroid problems are followed.

The questions a provider will ask

The encyclopedia suggests several details that help narrow the cause. Does the sweating occur on the face, palms or armpits, or all over the body? Does it happen at night, and did it start suddenly? Does it come when something upsets you? And are there other symptoms, such as weight loss, a pounding heartbeat, cold or clammy hands, fever or lack of appetite? Writing those answers down before the visit saves time. Sweating that happens mostly at night has its own page, the night sweats guide.

Tests that may be used

MedlinePlus says visible signs of sweating may be noted during the visit and lists a few tests used to confirm excessive sweating, including a starch-iodine test that darkens wherever sweat collects and a paper test that weighs absorbed sweat. Blood tests may be ordered if a thyroid problem or another medical condition is suspected. Those two sweat tests are specialist tools and are not described here as services of this practice. Blood work is on the practice's list, and the blood sugar and diabetes page covers glucose follow-up.

Treatments MedlinePlus describes

For underarm sweating, MedlinePlus says the first line is a strong antiperspirant with 10 to 20 percent aluminum chloride, with higher strengths sometimes prescribed. Other options it names are medicines that block sweat gland stimulation, iontophoresis for hands and feet, botulinum toxin for severe underarm, hand and foot sweating, and, in severe cases, a minimally invasive nerve surgery or removal of the underarm sweat glands. Most of these need a specialist. A primary care visit is where the cause is sorted out and the right next step chosen.

Signs that call for a visit soon

MedlinePlus says to contact a provider if sweating is prolonged, excessive and unexplained, happens mostly during sleep, or comes with weight loss. It also says sweating with fever, weight loss, chest pain, shortness of breath or a rapid, pounding heartbeat can point to an underlying disease such as an overactive thyroid. Sweating with chest pain or pressure is an emergency, so call 911. A racing heartbeat on its own is covered in the heart palpitations guide.

Sources

• MedlinePlus — Hyperhidrosis
• MedlinePlus — Sweat