eMedicine Specialties > Dermatology > Diseases of the Adnexa

Hyperhidrosis

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Rachel Altman, MD, Staff Physician, Department of Dermatology, UMDNJ-New Jersey Medical School; George Kihiczak, MD, Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital
Contributor Information and Disclosures

Updated: May 29, 2009

Introduction

Background

Hyperhidrosis, which is sweating in excess of that required for normal thermoregulation, is a condition that usually begins in either childhood or adolescence. Although any site on the body can be affected, the sites most commonly affected are the palms, soles, and axillae. This condition may be idiopathic or secondary to other diseases, metabolic disorders, febrile illnesses, or medication use. Hyperhidrosis exists in 3 forms: emotionally induced (in which it affects the palms, soles, and axillae1,2 ), localized, or generalized. The condition often causes great emotional distress and occupational disability for the patient, regardless of the form.

Pathophysiology

Generalized hyperhidrosis may be the consequence of autonomic dysregulation, or it may develop secondary to a metabolic disorder, febrile illness, or malignancy. In its localized form, hyperhidrosis may result from a disruption followed by abnormal regeneration of sympathetic nerves or a localized abnormality in the number or distribution of the eccrine glands, or it may be associated with other (usually vascular) abnormalities.

Essential hyperhidrosis, a disorder of the eccrine sweat glands, is associated with sympathetic overactivity.3 It does not appear to be a generalized disorder involving vascular endothelium.

Frequency

United States

In adolescents and young adults, an incidence of 0.6-1.0% is reported.4

International

Palmoplantar hyperhidrosis occurs 20 times more frequently in the Japanese than in any other ethnic group.5,6

Mortality/Morbidity

Hyperhidrosis is not associated with mortality. Severe cases of hyperhidrosis may adversely affect the patient's quality of life (see Complications).

Race

All races can be affected; however, Japanese are reportedly affected more than 20 times more frequently than other ethnic groups.5,6

Sex

Both sexes can be affected by hyperhidrosis.

Age

Persons of all ages can be affected by hyperhidrosis. Localized hyperhidrosis, unlike generalized hyperhidrosis, usually begins in childhood or adolescence. In a study of 850 patients with palmar, axillary, or facial hyperhidrosis, 62% of patients reported that sweating began since before they could remember; 33%, since puberty; and 5%, during adulthood.7

Clinical

History

  • Essential hyperhidrosis is a dermatologic and neurologic disorder characterized by excessive sweating of the eccrine sweat glands.8
  • 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.9
  • 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.10 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.8 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,11 but data suggest that hyperhidrosis is not related to social phobia or personality disorder.

Physical

  • Visible signs of hyperhidrosis are clearly evident.
  • If direct visualization of the affected areas 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 will turn black.

Causes

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
    • 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.12 The clinical trial Excessive Sweating Caused by Antidepressants: Measurement and Treatment With Terazosin (ADIES) is currently recruiting.
    • Chronic alcoholism
    • 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.13 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:

More on Hyperhidrosis

Overview: Hyperhidrosis
Differential Diagnoses & Workup: Hyperhidrosis
Treatment & Medication: Hyperhidrosis
Follow-up: Hyperhidrosis
References
[ CLOSE WINDOW ]

References

  1. Altman RS, Schwartz RA. Emotionally induced hyperhidrosis. Cutis. May 2002;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. Jun 2005;69(6):707-10. [Medline].

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

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

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

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

  8. 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. Apr 2006;208(4):283-90. [Medline].

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

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

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

  12. Martin AF, Figueroa SC, de la Paz Valverde Merino M, Hurle AD. Hyperhidrosis in Association with Efavirenz. AIDS Patient Care STDS. Feb 9 2009;[Medline].

  13. Kocyigit P, Akay BN, Saral S, Akbostanci C, Bostanci S. Unilateral hyperhidrosis with accompanying contralateral anhidrosis. Clin Exp Dermatol. Feb 13 2009;[Medline].

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

  15. 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. May 1989;20(5 Pt 1):713-26. [Medline].

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

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

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

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

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

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

  22. 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. Oct 2001;45(4):587-9. [Medline].

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

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

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

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

  27. 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. Sep 2001;8(5):451-6. [Medline].

  28. 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. Apr 1997;136(4):548-52. [Medline].

  29. 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. May 2007;156(5):986-9. [Medline].

  30. 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. Mar 2008;7(3):221-7. [Medline].

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

  32. [Guideline] Naumann M, So Y, Argoff CE, et al. Assessment: Botulinum neurotoxin in the treatment of autonomic disorders and pain (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. May 6 2008;70(19):1707-14. [Medline].

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

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

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

  36. 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. Oct 2001;136(10):1115-7. [Medline].

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

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

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

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

  41. 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. Jul 2005;21(7):310-3. [Medline].

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

  43. 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. Feb 2009;87(2):427-31. [Medline].

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

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

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

  47. 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. Jan 2007;33(1):57-61. [Medline].

  48. Atkins JL, Butler PE. Treating hyperhidrosis. Excision of axillary tissue may be more effective. BMJ. Sep 16 2000;321(7262):702; author reply 703. [Medline].

  49. Bajaj V, Langtry JA. Use of oral glycopyrronium bromide in hyperhidrosis. Br J Dermatol. Jul 2007;157(1):118-21. [Medline].

  50. Bechara FG, Gambichler T, Bader A, Sand M, Altmeyer P, Hoffmann K. Assessment of quality of life in patients with primary axillary hyperhidrosis before and after suction-curettage. J Am Acad Dermatol. Aug 2007;57(2):207-12. [Medline].

  51. Bechara FG, Sand M, Hoffmann K, Altmeyer P. Aggressive shaving after combined liposuction and curettage for axillary hyperhidrosis leads to more complications without further benefit. Dermatol Surg. Jul 2008;34(7):952-3. [Medline].

  52. Cheshire WP, Odell JA, Woodward TA, Wharen RE Jr. Cervical sympathetic neuralgia arising from a schwannoma. Headache. Mar 2007;47(3):444-6. [Medline].

  53. de Berker D. Treating hyperhidrosis. Treatment options must be balanced against each other. BMJ. Sep 16 2000;321(7262):703. [Medline].

  54. Lear W, Kessler E, Solish N, Glaser DA. An epidemiological study of hyperhidrosis. Dermatol Surg. Jan 2007;33(1 Spec No.):S69-75. [Medline].

  55. Neumayer CH, Bischof G, Fugger R, et al. Efficacy and safety of thoracoscopic sympathicotomy for hyperhidrosis of the upper limb. Results of 734 sympathicotomies. Ann Chir Gynaecol. 2001;90(3):195-9. [Medline].

  56. Rompel R, Scholz S. Subcutaneous curettage vs. injection of botulinum toxin A for treatment of axillary hyperhidrosis. J Eur Acad Dermatol Venereol. May 2001;15(3):207-11. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

hyperhidrosis, excessive sweating, palmoplantar hyperhidrosis, emotionally induced hyperhidrosis, generalized hyperhidrosis, localized hyperhidrosis, palmoplantar sweating, axillary hyperhidrosis, nocturnal hyperhidrosis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

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 and 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, and Medical Society of New Jersey
Disclosure: Nothing to disclose.

Medical Editor

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, American Medical Association, Royal Society of Medicine, Society for Investigative Dermatology, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

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, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

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

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.