News & Perspective
Drugs & Diseases
CME & Education
Academy
Video
Decision Point
Edition: English

Medscape

English
Deutsch
Español
Français
Português
UKNew

Univadis

Sign Up It's Free!
English Edition

Medscape

Univadis

    X
    Univadis from Medscape

    No Results

      News & Perspective Drugs & Diseases CME & Education Academy Video Decision Point
      Drugs & Diseases > Dermatology

      Hyperhidrosis

      Updated: Mar 23, 2021
      • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
      • Print
      Overview

      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 by hyperhidrosis, the sites most commonly affected are the palms, soles, and axillae. See the image below.

      Hyperhidrosis of the palms. Courtesy of DermNet Ne Hyperhidrosis of the palms. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/hair-nails-sweat/hyperhidrosis.jpg).

      Hyperhidrosis may be idiopathic or secondary to other diseases, metabolic disorders, febrile illnesses, or medication use. Hyperhidrosis exists in 3 forms: emotionally induced hyperhidrosis (in which it affects the palms, soles, and axillae), [1, 2] localized hyperhidrosis, and generalized hyperhidrosis. Hyperhidrosis often causes great emotional distress and occupational disability for the patient, regardless of the form.

      Next:

      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] Essential hyperhidrosis does not appear to be a generalized disorder involving vascular endothelium.

      Palmoplantar hyperhidrosis may be inherited in an autosomal dominant manner. [4]

      Previous
      Next:

      Etiology

      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: Contralateral hyperhidrosis in the left ophthalmic trigeminal division was documented on the forehead after a lateral medullary infarction. [5] Paroxysmal sympathetic hyperactivity after a spontaneous intracerebral hemorrhage may also produce hyperhidrosis. [6]

      • Spontaneous periodic hypothermia and hyperhidrosis: This is postulated to be a rare cerebral neurotransmitter disorder. [7, 8]

      • 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. [9]

      • 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. Primary focal hyperhidrosis tends to arise on the palms, plantar feet, and axillae, as well as from the face and scalp of children and young adults; there seems to have a distinct subtype of craniofacial hyperhidrosis in postmenopausal women. [10]

      Unilateral hyperhidrosis with accompanying contralateral anhidrosis is also rare. [11] 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. [12]

      • Eccrine angiomatous hamartoma: This is a rare, benign malformation characterized by both eccrine and vascular components. [13, 14] 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.

      • Blue rubber-bleb nevus

      • Glomus tumor

      • Peripheral neuropathy, organomegaly, endocrinopathy, monoclonal plasma-proliferative disorder, and skin changes (POEMS) syndrome

      • Burning feet syndrome

      • Pachydermoperiostosis

      • Pretibial myxedema

      • Spinal cord tumors: Rarely, hyperhidrosis may be an initial symptom. [15]
      Previous
      Next:

      Epidemiology

      Frequency

      United States

      In the United States and the United Kingdom, 1-1.6% of people have records reflecting hyperhidrosis. [16]  About 60% in both databases were women.

      In adolescents and young adults, an incidence rate of 0.6-1% is reported for hyperhidrosis. [17]

      International

      Palmoplantar hyperhidrosis occurs 20 times more frequently in the Japanese than in any other ethnic group. [18, 19]

      Race

      All races can be affected by hyperhidrosis; however, Japanese are reportedly affected more than 20 times more frequently than other ethnic groups. [18, 19]

      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. [20]

      Previous
      Next:

      Prognosis

      Hyperhidrosis is difficult to treat effectively. Hyperhidrosis is not associated with mortality. Severe cases of hyperhidrosis may adversely affect the patient's quality of life (see Complications). With the newer treatment modalities now available, the patient has numerous options and is offered a better prognosis.

      Previous
      Next:

      Patient Education

      Patients with hyperhidrosis should be educated regarding all of the treatment options, including their corresponding complications and costs.

      For patient education resources, see Hyperhidrosis (Excessive Sweating) and BOTOX® Injections.

      Previous
      Clinical Presentation
       
       
      Media Gallery
      of 1
      Find Us On
      About
      About Medscape Privacy Policy Editorial Policy Cookies Terms of Use Advertising Policy Help Center
      Membership
      Become a Member About You Professional Information Newsletters & Alerts Market Research
      App
      Medscape
      WebMD Network
      Medscape Live Events WebMD MedicineNet eMedicineHealth RxList WebMD Corporate Medscape UK
      Editions
      English Deutsch Español Français Português UK
      All material on this website is protected by copyright, Copyright © 1994-2023 by WebMD LLC. This website also contains material copyrighted by 3rd parties.