When I created this blog, one of my main goals was to build an accessible resource that helps patients learn more about medical conditions without feeling overwhelmed. With that in mind, I’ve been encouraging those around me to research conditions they find interesting, so that we can all expand our understanding of the human body together.
This article is the first contributed by a relative who has no medical background. He was intrigued by hyperhidrosis and took the time to explore what it is and how it affects patients. I hope you enjoy reading it as much as I did!
Hyperhidrosis is a condition characterised by excessive sweating beyond what is needed to regulate body temperature. Sweating is normal when we are hot, exercising, stressed, or anxious, but in hyperhidrosis, the sweating occurs excessively and unpredictably. It can affect specific areas (hands, feet, underarms, face) or the entire body. Importantly, primary hyperhidrosis, which is one of the two types of Hyperhidrosis, as we will see later in this article, does not occur during sleep, which helps distinguish it from secondary hyperhidrosis.
Types
- Primary Hyperhidrosis
Primary hyperhidrosis, also known as essential or idiopathic hyperhidrosis, has no identifiable underlying medical cause. Research suggests it arises from overactivity of the sympathetic nervous system, particularly affecting the sweat glands in the skin.
This type of sweating occurs on very specific areas of the body (described as focal areas, such as sweaty hands, sweaty feet, sweaty underarms, and sweaty face or head) and is usually relatively “symmetrical” meaning that both the left and right sides of the body are affected similarly and it also happens in more than one place at a time.
- Secondary Hyperhidrosis
Secondary hyperhidrosis occurs as a result of an underlying medical condition or medication. This means that it has been caused by something else that is also going on in the body.
Common medical causes include:
- Hyperthyroidism – this is a condition caused by making too much thyroid hormone. This can lead to abnormal metabolism, abnormal body heat control, irritability, irregular periods (in women) and excessive sweating.
- Other hormone disorders like those caused by adrenal tumours can similarly disrupt temperature control
- Menopause – this affects women in their late 40s to mid-50s when dropping hormone levels confuse the brain’s temperature control, causing hot flashes and night sweats in up to 8 out of 10 women
- Diabetes – this causes excessive sweating in two ways: high blood sugar damages nerves controlling sweat glands, and low blood sugar episodes trigger panic sweating as a warning sign
- Serious infections – this includes infections like sepsis, which forces your body to work overtime fighting germs, creating internal heat and severe night sweats that can completely soak bed sheets
Other underlying causes include cancer, brain/nerve disorders, heart problems and obesity.
Who’s at Risk?
- Individuals with family history of hyperhidrosis.
- Those with underlying health conditions that cause secondary sweating.
- People taking medications that list sweating as a side effect.
- Young people, as primary hyperhidrosis often begins early in life.
Signs and Symptoms
- Visible, excessive sweating beyond what’s expected for temperature/exercise input
- Sweating that occurs daily for at least 6 months in primary cases (often used as a diagnostic clue), or that is localized and symmetrical (e.g., both palms)
- Interference with daily tasks: wet/soiled clothing, difficulty holding tools/paper, visible sweat patches, difficulty with handshakes or physical contact, and more
- Skin complications such as fungal infections like athlete’s foot and sore rashes in skin folds may develop due to persistent moisture
- Emotional and social effects: avoidance of activities, anxiety, reduced quality of life.
Diagnosis
Diagnosis is primarily clinical, based on history and examination:
- History: age of onset, areas affected, presence during sleep, family history, impact on daily life.
- Physical examination: symmetrical sweating, areas affected.
- Tests for secondary causes: blood tests for thyroid function, glucose levels, infection markers, and if generalised sweating starts later in life.
- Specialised tests (if needed)
Treatment
There is no permanent cure for primary hyperhidrosis, but many treatments can help reduce symptoms. These treatments fall into three main groups:
- Self-help and Lifestyle Changes: Simple changes to your daily routine can make a big difference. Wear lightweight, breathable clothes made from natural fibres like cotton that allow air to flow through. Choose moisture-wicking socks that pull sweat away from your feet and use absorbent shoe insoles to keep your feet dry. You can also use sweat shields or clothing protectors that stick inside your clothes to prevent sweat stains on your shirts.
- Medical and Procedural Treatments:
- Strong prescription antiperspirants containing aluminium chloride work much better than regular deodorants and are often the first treatment doctors recommend.
- Iontophoresis is a safe treatment where you put your hands or feet in water whilst a gentle electric current passes through – this can be done at home and works well for many people.
- Botulinum toxin injections (similar to Botox) are very effective for underarm sweating and sometimes work for sweaty palms or face, with effects lasting several months.
- Doctors can prescribe special wipes containing glycopyrronium that you apply to sweaty areas, or tablets like oxybutynin for severe cases, though these tablets can cause side effects like dry mouth.
- MiraDry is a newer treatment that uses microwave energy to destroy sweat glands in the underarms permanently.
- Surgery called endoscopic thoracic sympathectomy is only considered for very severe cases that don’t respond to other treatments, as it carries the risk of causing excessive sweating in other parts of the body.
References
- American Academy of Dermatology (n.d.) Hyperhidrosis: Diagnosis & Treatment. Available at: https://www.aad.org (Accessed: 12 September 2025).
- Hyperhidrosis UK (2025) Home — Hyperhidrosis UK. Available at: https://hyperhidrosisuk.org (Accessed: 12 September 2025).
- International Hyperhidrosis Society (n.d.) Types, Treatments, Research. Available at: https://www.sweathelp.org(Accessed: 12 September 2025).
- Mayo Clinic (2025) Hyperhidrosis — Symptoms and Causes. Available at: https://www.mayoclinic.org(Accessed: 12 September 2025).
- Merck Manual (2025) Hyperhidrosis Overview and Differential Diagnosis. Available at: https://www.merckmanuals.com (Accessed: 12 September 2025).
- NHS (2025) Excessive Sweating (Hyperhidrosis). Available at: https://www.nhs.uk (Accessed: 12 September 2025).
