Medscape is available in 5 Language Editions – Choose your Edition here.


Hyperhidrosis Clinical Presentation

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
Updated: Jun 06, 2016


Essential hyperhidrosis is a dermatologic and neurologic disorder characterized by excessive sweating of the eccrine sweat glands.[9]

Patients note excessive sweating in affected areas, which ultimately prompts them to seek medical attention.

Palmoplantar hyperhidrosis (excessive sweating of the palms and soles) is observed in persons with chronic alcoholism.[10]

Localized hyperhidrosis, unlike generalized hyperhidrosis, usually begins in childhood or adolescence.

Hyperhidrosis beginning later in life should prompt a search for secondary causes such as systemic diseases, adverse effects of medication use, or metabolic disorders. Harlequin syndrome is characterized by unilateral hyperhidrosis and flushing, predominantly induced by heat or exercise.[11] The sympathetic deficits are usually limited to the face.

An echo-Doppler study found impaired left ventricular filling in patients with essential hyperhidrosis, which is associated with cardiac autonomic dysfunction because sympathetic fibers to eccrine glands of the palms of the hand arise from stellate and upper thoracic ganglia, which also innervate the heart.[9] This study indicated that hyperactivity of the sympathetic nervous system in patients with hyperhidrosis may alter cardiac function in the long term.

The temperament and character profile for patients with essential hyperhidrosis has stimulated interest,[12] but data suggest that hyperhidrosis is not related to social phobia or personality disorder.

Excessive sweating may be primary (idiopathic) or secondary to medication or disease. Secondary causes include endocrine diseases such as diabetes mellitus, hyperthyroidism, and hyperpituitarism. In one series, one third of cases were neurologic in origin, including peripheral nerve injury, Parkinson disease, reflex sympathetic dystrophy, spinal injury, and Arnold-Chiari malformation. Additional causes to consider include pheochromocytoma, respiratory disease, and psychiatric disease. Asymmetric hyperhidrosis may suggest neurologic disease.[13]

Diagnostic criteria favoring primary hyperhidrosis include excessive sweating of 6 months or more in duration, with 4 or more of the following: primarily involving eccrine-dense (axillae/palms/soles/craniofacial) sites; bilateral and symmetric; absent nocturnally; episodes at least weekly; onset at age 25 years or younger; positive family history; and impairment of daily activities.[13]



Visible signs of hyperhidrosis are clearly evident. If direct visualization of the affected areas by hyperhidrosis is desired, the iodine starch test may be used. This test requires spraying of the affected area with a mixture of 0.5-1 g of iodine crystals and 500 g of soluble starch. Areas that produce sweat turn black.



Hyperhidrosis may be idiopathic or secondary to other diseases, metabolic disorders, febrile illnesses, or medication use.

Generalized hyperhidrosis may be secondary to numerous conditions including the following:

  • Neurologic or neoplastic diseases
  • Spontaneous periodic hypothermia and hyperhidrosis: This is postulated to be a rare cerebral neurotransmitter disorder. [14, 15]
  • Metabolic disorders or processes (eg, thyrotoxicosis, diabetes mellitus, hypoglycemia, gout, pheochromocytoma, menopause)
  • Febrile illnesses
  • Medications: Use of medications may affect one or more components of human thermoregulation and induce hyperhidrosis. Agents such as propranolol, physostigmine, pilocarpine, tricyclic antidepressants, and serotonin reuptake inhibitors have been implicated. Efavirenz was recently described to induce excessive nocturnal sweating that resolved after dose reduction. [16]
  • Hodgkin disease or tuberculosis (in nocturnal hyperhidrosis)

Localized unilateral or segmental hyperhidrosis is rare and of unknown origin. The condition usually presents on the forearm or forehead in otherwise healthy individuals, without evidence of the typical triggering factors found in essential hyperhidrosis. Unilateral hyperhidrosis with accompanying contralateral anhidrosis is also rare.[17] Unilateral hyperhidrosis has been described on the right sides of the forehead, the nose, and the palmar surface of the right hand, with anhidrosis on the left hand.

Localized hyperhidrosis may also be associated with the following:

  • Gustatory stimuli (associated with Frey syndrome, encephalitis, syringomyelia, diabetic neuropathies, herpes zoster parotitis, and parotid abscess)
  • Eccrine nevus: This may be associated with severe localized hyperhidrosis. [18]
  • Eccrine angiomatous hamartoma: This is a rare, benign malformation characterized by both eccrine and vascular components. [19, 20] It is usually first evident at birth or during early infancy and childhood as a nodule or a plaque, usually solitary, involving acral skin. Although often asymptomatic, it may be associated with focal hyperhidrosis, hypertrichosis, and pain.
  • Peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasma-proliferative disorder, and skin changes (POEMS) syndrome
  • Burning feet syndrome
Contributor Information and Disclosures

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.


Rachel Altman, MD Staff Physician, Department of Dermatology, UMDNJ-New Jersey Medical School

Rachel Altman, MD is a member of the following medical societies: Alpha Omega Alpha, Sigma Xi

Disclosure: Nothing to disclose.

George Kihiczak, MD Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital

George Kihiczak, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Medical Society of New Jersey

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Catharine Lisa Kauffman, MD, FACP Georgetown Dermatology and Georgetown Dermpath

Catharine Lisa Kauffman, MD, FACP is a member of the following medical societies: American Academy of Dermatology, Royal Society of Medicine, Women's Dermatologic Society, American Medical Association, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

  1. Altman RS, Schwartz RA. Emotionally induced hyperhidrosis. Cutis. 2002 May. 69(5):336-8. [Medline].

  2. Ruchinskas R. Hyperhidrosis and anxiety: chicken or egg?. Dermatology. 2007. 214(3):195-6. [Medline].

  3. Esen AM, Barutcu I, Karaca S, et al. Peripheral vascular endothelial function in essential hyperhidrosis. Circ J. 2005 Jun. 69(6):707-10. [Medline].

  4. Yamashita N, Tamada Y, Kawada M, Mizutani K, Watanabe D, Matsumoto Y. Analysis of family history of palmoplantar hyperhidrosis in Japan. J Dermatol. 2009 Dec. 36(12):628-31. [Medline].

  5. Adar R, Kurchin A, Zweig A, Mozes M. Palmar hyperhidrosis and its surgical treatment: a report of 100 cases. Ann Surg. 1977 Jul. 186(1):34-41. [Medline].

  6. Cloward RB. Hyperhydrosis. J Neurosurg. 1969 May. 30(5):545-51. [Medline].

  7. Cloward RB. Treatment of hyperhidrosis palmaris (sweaty hands); a familial disease in Japanese. Hawaii Med J. 1957 Mar-Apr. 16(4):381-7. [Medline].

  8. Drott C, Gothberg G, Claes G. Endoscopic transthoracic sympathectomy: an efficient and safe method for the treatment of hyperhidrosis. J Am Acad Dermatol. 1995 Jul. 33(1):78-81. [Medline].

  9. Saglam M, Esen AM, Barutcu I, et al. Impaired left ventricular filling in patients with essential hyperhidrosis: an echo-Doppler study. Tohoku J Exp Med. 2006 Apr. 208(4):283-90. [Medline].

  10. Tugnoli V, Eleopra R, De Grandis D. Hyperhidrosis and sympathetic skin response in chronic alcoholic patients. Clin Auton Res. 1999 Feb. 9(1):17-22. [Medline].

  11. Moon SY, Shin DI, Park SH, Kim JS. Harlequin syndrome with crossed sympathetic deficit of the face and arm. J Korean Med Sci. 2005 Apr. 20(2):329-30. [Medline]. [Full Text].

  12. Karaca S, Emul M, Kulac M, et al. Temperament and character profile in patients with essential hyperhidrosis. Dermatology. 2007. 214(3):240-5. [Medline].

  13. Walling HW. Clinical differentiation of primary from secondary hyperhidrosis. J Am Acad Dermatol. 2011 Feb 17. [Medline].

  14. Rodrigues Masruha M, Lin J, Arita JH, DE Castro Neto EF, Scerni DA, Cavalheiro EA, et al. Spontaneous periodic hypothermia and hyperhidrosis: a possibly novel cerebral neurotransmitter disorder. Dev Med Child Neurol. 2010 Dec 17. [Medline].

  15. Mehta S, Ralot T, Masatkar V, Agarwal N, Rana A. A curious case of hourly attacks of disabling episodic spontaneous hypothermia with hyperhidrosis. Indian J Dermatol Venereol Leprol. 2015 Mar-Apr. 81(2):185-6. [Medline].

  16. Martín AF, Figueroa SC, Merino Mde L, Hurlee AD. Hyperhidrosis in association with efavirenz. AIDS Patient Care STDS. 2009 Mar. 23(3):143-5. [Medline].

  17. Kocyigit P, Akay BN, Saral S, Akbostanci C, Bostanci S. Unilateral hyperhidrosis with accompanying contralateral anhidrosis. Clin Exp Dermatol. 2009 Dec. 34(8):e544-6. [Medline].

  18. Lera M, España A, Idoate MÁ. Focal hyperhidrosis secondary to eccrine naevus successfully treated with botulinum toxin type A. Clin Exp Dermatol. 2015 Mar 28. [Medline].

  19. López V, Pinazo I, Santonja N, Jordá E. Eccrine angiomatous hamartoma in a child. Pediatr Dermatol. 2010 Sep-Oct. 27(5):548-9. [Medline].

  20. Sanusi T, Li Y, Sun L, Wang C, Zhou Y, Huang C. Eccrine Angiomatous Hamartoma: A Clinicopathological Study of 26 Cases. Dermatology. 2015 Apr 14. [Medline].

  21. Shelley WB, Laskas JJ, Satanove A. Effect of topical agents on planter sweating. AMA Arch Derm Syphilol. 1954 Jun. 69(6):713-6. [Medline].

  22. Sato K, Kang WH, Saga K, Sato KT. Biology of sweat glands and their disorders. II. Disorders of sweat gland function. J Am Acad Dermatol. 1989 May. 20(5 Pt 1):713-26. [Medline].

  23. Streker M, Reuther T, Verst S, Kerscher M. [Axillary hyperhidrosis--efficacy and tolerability of an aluminium chloride antiperspirant. Prospective evaluation on 20 patients with idiopathic axillary hyperhidrosis]. Hautarzt. 2010 Feb. 61(2):139-44. [Medline].

  24. Yanagishita T, Tamada Y, Ohshima Y, Ito K, Akita Y, Watanabe D. Histological localization of aluminum in topical aluminum chloride treatment for palmar hyperhidrosis. J Dermatol Sci. 2012 Mar 3. [Medline].

  25. Del Boz J, Millán-Cayetano JF, Blázquez-Sánchez N, de Troya M. Individualized Dosing of Oral Oxybutynin for the Treatment of Primary Focal Hyperhidrosis in Children and Teenagers. Pediatr Dermatol. 2016 May. 33 (3):327-31. [Medline].

  26. Klaber M, Catterall M. Treating hyperhidrosis. Anticholinergic drugs were not mentioned. BMJ. 2000 Sep 16. 321(7262):703. [Medline].

  27. Wozniacki L, Zubilewicz T. Primary hyperhidrosis controlled with oxybutynin after unsuccessful surgical treatment. Clin Exp Dermatol. 2009 Dec. 34(8):e990-1. [Medline].

  28. Bouman HD, Lentzer EM. The treatment of hyperhidrosis of hands and feet with constant current. Am J Phys Med. 1952 Jun. 31(3):158-69. [Medline].

  29. Karakoç Y, Aydemir EH, Kalkan MT, Unal G. Safe control of palmoplantar hyperhidrosis with direct electrical current. Int J Dermatol. 2002 Sep. 41(9):602-5. [Medline].

  30. Murphy R, Harrington CI. Treating hyperhidrosis. Iontophoresis should be tried before other treatments. BMJ. 2000 Sep 16. 321(7262):702-3. [Medline].

  31. Sato K, Ohtsuyama M, Samman G. Eccrine sweat gland disorders. J Am Acad Dermatol. 1991 Jun. 24(6 Pt 1):1010-4. [Medline].

  32. Abell E, Morgan K. The treatment of idiopathic hyperhidrosis by glycopyrronium bromide and tap water iontophoresis. Br J Dermatol. 1974 Jul. 91(1):87-91. [Medline].

  33. Siah TW, Hampton PJ. The effectiveness of tap water iontophoresis for palmoplantar hyperhidrosis using a Monday, Wednesday, and Friday treatment regime. Dermatol Online J. 2013 Mar 15. 19(3):14. [Medline].

  34. Ozcan D, Güleç AT. Compliance with tap water iontophoresis in patients with palmoplantar hyperhidrosis. J Cutan Med Surg. 2014 Mar 1. 18(2):109-13. [Medline].

  35. Fujita M, Mann T, Mann O, Berg D. Surgical pearl: use of nerve blocks for botulinum toxin treatment of palmar-plantar hyperhidrosis. J Am Acad Dermatol. 2001 Oct. 45(4):587-9. [Medline].

  36. Moraru E, Voller B, Auff E, Schnider P. Dose thresholds and local anhidrotic effect of botulinum A toxin injections (Dysport). Br J Dermatol. 2001 Aug. 145(2):368. [Medline].

  37. Naumann M. Evidence-based medicine: botulinum toxin in focal hyperhidrosis. J Neurol. 2001 Apr. 248 Suppl 1:31-3. [Medline].

  38. Naumann M, Lowe NJ. Botulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: randomised, parallel group, double blind, placebo controlled trial. BMJ. 2001 Sep 15. 323(7313):596-9. [Medline]. [Full Text].

  39. Kang A, Burns E, Glaser DA. Botulinum toxin A for palmar hyperhidrosis: associated pain, duration, and reasons for discontinuation of therapy. Dermatol Surg. 2015 Feb. 41(2):297-8. [Medline].

  40. Shelley WB, Talanin NY, Shelley ED. Botulinum toxin therapy for palmar hyperhidrosis. J Am Acad Dermatol. 1998 Feb. 38(2 Pt 1):227-9. [Medline].

  41. Swartling C, Farnstrand C, Abt G, Stalberg E, Naver H. Side-effects of intradermal injections of botulinum A toxin in the treatment of palmar hyperhidrosis: a neurophysiological study. Eur J Neurol. 2001 Sep. 8(5):451-6. [Medline].

  42. Lecouflet M, Leux C, Fenot M, Célerier P, Maillard H. Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis: A study of 28 patients. J Am Acad Dermatol. 2014 Mar 12. [Medline].

  43. Schnider P, Binder M, Auff E, Kittler H, Berger T, Wolff K. Double-blind trial of botulinum A toxin for the treatment of focal hyperhidrosis of the palms. Br J Dermatol. 1997 Apr. 136(4):548-52. [Medline].

  44. Vadoud-Seyedi J, Simonart T. Treatment of axillary hyperhidrosis with botulinum toxin type A reconstituted in lidocaine or in normal saline: a randomized, side-by-side, double-blind study. Br J Dermatol. 2007 May. 156(5):986-9. [Medline].

  45. Flanagan KH, King R, Glaser DA. Botulinum toxin type a versus topical 20% aluminum chloride for the treatment of moderate to severe primary focal axillary hyperhidrosis. J Drugs Dermatol. 2008 Mar. 7(3):221-7. [Medline].

  46. Woolery-Lloyd H, Elsaie ML, Avashia N. Inguinal hyperhidrosis misdiagnosed as urinary incontinence: treatment with botulinum toxin A. J Drugs Dermatol. 2008 Mar. 7(3):293-5. [Medline].

  47. Gregoriou S, Rigopoulos D, Chiolou Z, Papafragkaki D, Makris M, Kontochristopoulos G. Treatment of bromhidrosis with a glycine-soja sterocomplex topical product. J Cosmet Dermatol. 2011 Mar. 10(1):74-7. [Medline].

  48. Purtuloglu T, Atim A, Deniz S, Kavakli K, Sapmaz E, Gurkok S, et al. Effect of radiofrequency ablation and comparison with surgical sympathectomy in palmar hyperhidrosis. Eur J Cardiothorac Surg. 2013 Feb 21. [Medline].

  49. Naeini FF, Saffaei A, Pourazizi M, Abtahi-Naeini B. Histopathological evidence of efficacy of microneedle radiofrequency for treatment of axillary hyperhidrosis. Indian J Dermatol Venereol Leprol. 2015 Apr 8. [Medline].

  50. Kumagai K, Kawase H, Kawanishi M. Health-related quality of life after thoracoscopic sympathectomy for palmar hyperhidrosis. Ann Thorac Surg. 2005 Aug. 80(2):461-6. [Medline].

  51. Kotzareff A. Resection partielle de trone sympathetique cervical droit pour hyperhidrose unilaterale. Rev Med Suisse Romande. 1920. 40:111-3.

  52. Chen HJ, Lu K, Liang CL. Transthoracic endoscopic T-2, 3 sympathectomy for facial hyperhidrosis. Auton Neurosci. 2001 Oct 8. 93(1-2):91-4. [Medline].

  53. Hsu CP, Shia SE, Hsia JY, Chuang CY, Chen CY. Experiences in thoracoscopic sympathectomy for axillary hyperhidrosis and osmidrosis: focusing on the extent of sympathectomy. Arch Surg. 2001 Oct. 136(10):1115-7. [Medline].

  54. Kim BY, Oh BS, Park YK, Jang WC, Suh HJ, Im YH. Microinvasive video-assisted thoracoscopic sympathicotomy for primary palmar hyperhidrosis. Am J Surg. 2001 Jun. 181(6):540-2. [Medline].

  55. Panhofer P, Zacherl J, Jakesz R, Bischof G, Neumayer C. Improved quality of life after sympathetic block for upper limb hyperhidrosis. Br J Surg. 2006 May. 93(5):582-6. [Medline].

  56. Lai YT, Yang LH, Chio CC, Chen HH. Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. Neurosurgery. 1997 Jul. 41(1):110-3; discussion 113-5. [Medline].

  57. Chwajol M, Barrenechea IJ, Chakraborty S, Lesser JB, Connery CP, Perin NI. Impact of compensatory hyperhidrosis on patient satisfaction after endoscopic thoracic sympathectomy. Neurosurgery. 2009 Mar. 64(3):511-8; discussion 518. [Medline].

  58. Chou SH, Kao EL, Li HP, Lin CC, Huang MF. T4 sympathectomy for palmar hyperhidrosis: an effective approach that simultaneously minimzes compensatory hyperhidrosis. Kaohsiung J Med Sci. 2005 Jul. 21(7):310-3. [Medline].

  59. Heckmann M. Complications in patients with palmar hyperhidrosis treated with transthoracic endoscopic sympathectomy. Neurosurgery. 1998 Jun. 42(6):1403-4. [Medline].

  60. Li X, Tu YR, Lin M, Lai FC, Chen JF, Miao HW. Minimizing endoscopic thoracic sympathectomy for primary palmar hyperhidrosis: guided by palmar skin temperature and laser Doppler blood flow. Ann Thorac Surg. 2009 Feb. 87(2):427-31. [Medline].

  61. Neves S, Uchoa PC, Wolosker N, Munia MA, Kauffman P, de Campos JR, et al. Long-Term Comparison of Video-Assisted Thoracic Sympathectomy and Clinical Observation for the Treatment of Palmar Hyperhidrosis in Children Younger Than 14. Pediatr Dermatol. 2012 Apr 4. [Medline].

  62. Kim WO, Kil HK, Yoon KB, Yoon DM. Topical glycopyrrolate for patients with facial hyperhidrosis. Br J Dermatol. 2008 May. 158(5):1094-7. [Medline].

  63. Goldman A, Wollina U. Subdermal Nd-YAG laser for axillary hyperhidrosis. Dermatol Surg. 2008 Jun. 34(6):756-62. [Medline].

  64. Schick CH, Grallath T, Schick KS, Hashmonai M. Radiofrequency Thermotherapy for Treating Axillary Hyperhidrosis. Dermatol Surg. 2016 May. 42 (5):624-30. [Medline].

  65. Lillis PJ, Coleman WP 3rd. Liposuction for treatment of axillary hyperhidrosis. Dermatol Clin. 1990 Jul. 8(3):479-82. [Medline].

  66. Gross KM, Schote AB, Schneider KK, Schulz A, Meyer J. Elevated social stress levels and depressive symptoms in primary hyperhidrosis. PLoS One. 2014. 9(3):e92412. [Medline]. [Full Text].

  67. Na GY, Park BC, Lee WJ, Park DJ, Kim do W, Kim MN. Control of palmar hyperhidrosis with a new "dry-type" iontophoretic device. Dermatol Surg. 2007 Jan. 33(1):57-61. [Medline].

  68. Choi YH, Lee SJ, Kim do W, Lee WJ, Na GY. Open clinical trial for evaluation of efficacy and safety of a portable "dry-type" iontophoretic device in treatment of palmar hyperhidrosis. Dermatol Surg. 2013 Apr. 39(4):578-83. [Medline].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.