What is hyperhidrosis?

sandra eriksson mirkovic hyperhidrosis

Written by: Sandra Eriksson Mirkovic, MD

Hyperhidrosis - excessive sweating is a condition characterized by an abnormal sweating level that isn’t caused necessarily by heat or exercise. The condition affects about 1-3% of the world population, men and women equally.

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Excessive sweating can completely disappear for some people over the years, while for others, it can get worse over time.

This type of sweating causes embarrassment, social anxiety, emotional and physical problems.


Two main types of hyperhidrosis

People mainly associate excessive sweating with armpits and hands. However, the problem can appear almost anywhere on the body - head, face, groin, torso, or feet.

Understanding the difference helps patients and clinicians to understand the cause of the condition and then to perform the best treatment option.


Excessive sweating is divided into two types:
  • Primary hyperhidrosis
  • Secondary hyperhidrosis

Primary hyperhidrosis

Primary hyperhidrosis isn’t caused by medications, side-effects, or other medical conditions. This type of excessive sweating appears on specific (focal) areas of the body.

Sweating mainly occurs in adolescence or childhood. But it can also affect several body parts or almost the whole body and is then called multifocal or even generalized hyperhidrosis. The generalized kind often appears in adulthood.

Common parts of the body affected by primary focal hyperhidrosis are:

  • Hands
  • Feet
  • Armpits
  • The groin area
  • Face and/or head

Most people with this type of excessive sweating experience it in multiple body areas. For example, sweaty palms are usually accompanied by sweaty feet. The groin area is often combined with excessive sweating of the armpits. These patients mostly don’t sweat when they are sleeping.

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Secondary hyperhidrosis

Secondary hyperhidrosis is caused by other medical conditions or can be a side effect of a medication. People that suffer from this type of excessive sweating most often experience sweating in general body areas.

Unlike the people affected by the primary type, people who have secondary excessive sweating often experience sweating when they are asleep, and sweating often starts in adulthood.

hyperhidrosis

What causes hyperhidrosis?

The focal hyperhidrosis does not have a known medical cause (idiopathic). It can occur in completely healthy people. It can be hereditary and run in families.
Excessive sweating can also occur because of neurological disorders, dysregulation of the neurologic system, spinal injury, etc. In that case, it is called secondary.

Extreme sweating can appear on the face, head, and scalp right after ingesting food. It can be either a form of primary type if no other medical conditions are causing the sweating.

It can be secondary due to surgery after the nerves from the sweat glands have found their way to connect with the salivary glands. This condition is known as Frey’s syndrome.
Secondary types of extreme sweating can result from medications, infections, metabolic disorders and diseases, stress, autonomic dysfunctions, menopause, malignancies, etc.


Complications of excessive sweating

People who are affected by excessive sweating experience agonizing difficulties in their everyday life. They avoid social interactions with other people and feel embarrassment in professional and in private life. They are more likely to experience anxiety, depression, emotional distress, etc.

Studies have shown that physiological conditions aren’t the cause of extreme sweating in most cases, but it can lead to depression and anxiety in the long run because it is so exhausting living with the condition.

The constant moistness on the skin caused by sweat will cause fungus to thrive. This fungal infection starts to appear between the toes, and usually after wearing tight shoes. The wet can also harm the skins’ barrier and bacteria that normally live outside the body, on the skin, can penetrate into deeper tissues.

Usually, the majority of people that suffer from excessive sweating do not experience problems with body odor. That is because the sweat doesn’t produce an unpleasant smell. The smell occurs when sweat comes in contact with the bacteria on the skin.

Everyone has a different bacterial flora. Some that cause a very bad smell and some that produce a pleasant smell. Changing the skin bacterial flora to get rid of a bad smell can be really hard. Common parts where bromhidrosis (body odor) can occur are the armpits, groin, and feet area.

Maceration is a condition where the skin becomes softened and starts to break. It occurs after the skin is exposed to the moist for too long. Damp skin is prone to breaking, and that is why staying dry is important.

Unfortunately, that is not always the easiest thing to achieve for people with excessive sweating. Also, it is hard for people with abnormal sweating to use moisturizing creams because it just comes right off.

Hyperhidrosis symptoms

Healthcare personnel often don't have enough knowledge to take symptoms of abnormal sweating seriously. The condition is referred to as "silent disease" because patients suffer in silence.

It can be challenging to find a solution to the problem.


Signs of primary hyperhidrosis may include:
  • Visible sweating in specific areas that occurs for at least 6 months without supposed cause
  • Relatively symmetric sweating
  • Decreased sweating or total absence of sweat during sleep
  • Family history of excessive sweating
  • Onset before the age of 25

Signs of excessive sweating of the hands - palmar hyperhidrosis may include:
  • Wet, clammy, and cold palms
  • Sweat dripping of palms of the hands
  • Recurring sweating that is relatively symmetrical
  • Severe sweating in the palms and fingers area. Less common is sweating in the other parts of the hand
  • Pale or bluish color of the fingers (Raynaud’s phenomenon)
  • Swollen and sometimes red fingers

Signs of excessive sweating of the feet - plantar hyperhidrosis may include:
  • Wet, clammy, and cold feet
  • Sweating that soaks through socks
  • It can be accompanied by extreme sweating of the hands

Signs of excessive sweating of the armpits - axillary hyperhidrosis may include:
  • Noticeable sweating in the armpits
  • Sweating that soaks through clothing
  • Sweating in the armpits usually lessens or stops during sleep time

Signs of excessive sweating of the face - craniofacial hyperhidrosis may include:
  • Severe sweating in the face and/or scalp area
  • Sweating episodes that occur multiple times a week
hyperhidrosis diagnosis

Diagnosis of hyperhidrosis

The first step that dermatologists, clinicians, and doctors have to do when they are diagnosing excessive sweating is to differentiate if the condition is primary or secondary.

Primary hyperhidrosis is of unknown cause, and secondary is a part of other conditions.

Other medical conditions can also cause excessive sweating. If you're experiencing severe sweat problems, you should contact a doctor to examine your case and exclude other diseases.

The primary type is not visible on blood tests, even though the symptoms are severe. To make sure you're getting the right diagnosis, we suggest that you seek out a proper sweat clinic.


Diagnosis methods that are often used to identify hyperhidrosis are:


Clinicians ask patients a set of questions that help them establish the cause of the condition, such as other medical conditions, family history, etc. It can help them understand better why the patient is experiencing sweating.

Clinicians closely examine the areas that are affected by sweating. Also examination to exclude secondary causes to the sweat problem.

This test is not required for diagnosis, but it can help to outline the areas of sweating. Firstly, the iodine is applied to the skin, and then starch is sprinkled over iodine. If the sweat is present, it will cause the area to become purple-ish.

To establish an underlying condition that is possibly causing sweating, clinicians can do different medical and lab tests.

Questions about Hyperhidrosis

You can say that there are two main forms of hyperhidrosis: the one that affects young people, and the one that comes later in life. Men and women are affected to about the same extent. When children are affected, it is usually on hands and feet, then armpits and possibly groins/buttocks in their teens, and facial sweating, or more general sweating when you get older. But there are also mixed forms of this condition.

Yes, hyperhidrosis can decrease or disappear over time. Hyperhidrosis can also deteriorate or change over time, for example, by affecting a new area of ​​the body.

There are no blood tests or objective methods that can tell who is suffering from hyperhidrosis. The patient's story is an important part, and sometimes, you can even see the sweating which strengthens the diagnosis, but it is not mandatory to get the diagnosis of hyperhidrosis. Different types of forms, such as HDSS (Hyperhidrosis severity scale) and DLQI (Dermatology life quality index) are often used to estimate the symptoms and the impact on life quality.

Severe sweating, can in some cases, be caused by diseases other than hyperhidrosis. It is therefore important that if you suffer from excessive sweating, especially if this is new to you, you seek medical advice.

Hyperhidrosis is a physical condition, like a lot of other diseases. Actually, there is not much that you can do about how you act or how your life to cure your hyperhidrosis. Although stress can aggravate the symptoms, it is not the cause of hyperhidrosis. The same goes for obesity. In some cases, you sweat more if you have to put a lot of effort into moving because you are heavy, but being overweight is not the cause.

Many overweight people do not sweat a lot, and many slim people are affected by hyperhidrosis. Being happy with life, in general, makes it easier to deal with hyperhidrosis, but never blame yourself or anyone else who suffers from excessive sweating - hyperhidrosis is an illness.

It is a medical condition that needs to be diagnosed by a doctor. You can read a lot on the internet in various forums, but it is important to remember that there may also be other causes of excessive sweating that may need medical treatment. Therefore, you should consult a physician to undergo necessary examinations and tests to exclude other causes of excessive sweating.

No, that's not true. It is regrettable, but the ignorance of hyperhidrosis is great, both among the general public and unfortunately also among healthcare personnel. Hyperhidrosis is an almost forgotten condition and as a physician, I often meet medical colleagues who have not heard of the diagnosis or who do not know that there are treatments available.

The fact that excessive sweating is so stigmatized does not make it better. But, brighter times are ahead. I notice that younger medical colleagues more often have heard of the condition. Still, a great deal of work remains.

Most treatments available today are symptom-relieving treatments. Thus, they focus on relieving the symptoms and not on curing the condition. miraDry is a relatively new treatment that consists of microwaves. This method is primarily tested for the treatment of hyperhidrosis of the armpits and it is believed that it is a method that can give a permanent result. However longer follow-ups are required to be certain.

In the past, so-called sympathectomies were done when cutting nerve fibers to reduce sweating or redness. It produced a permanent result, but many people got a lot of trouble later on with compensatory sweating on large parts of the body. In some countries, sympathectomies are still widely performed. We strongly advise against this type of treatment in most cases.

Injection treatment is a tested and safe method of treating hyperhidrosis. The method has been around for many years. It has been found that treatment with injection can produce few, short-term side effects but no long-term or serious side effects.

In the doses, very diluted, that injection treatment is used, it is a pretty mild drug when it comes to adverse effects. There is also no indication that injection treatment would be carcinogenic, which many might be afraid of. The substance produced by a particular type of bacterium. The body, therefore, has a natural way of breaking down the substance. I, therefore, somewhat jokingly, say that injection treatment can be classified as a herbal remedy that many do not equate to ordinary drugs.

You should not be afraid to be treated with, or let your children be treated with injection, as long as the assessment is done in consultation with a doctor and on the correct indication. For those who still doubt I usually say, inform yourself. Read the facts. But watch what you read. Do not read on alarmist forums online but check the source and who is behind the text.

Yes, it works. Studies show that iontophoresis is very effective in treating hyperhidrosis, especially in the palms, feet, and in the axillae. Up to 90-95% of patients can get a good effect from the treatment, but it is necessary to set aside some time for the treatments in the beginning so that you can find the settings that suit you. The mechanisms behind iontophoresis are not yet fully known.

Previously, it was believed that the ions in the water formed a mechanical block that prevented the sweat from coming out of the sweat glands. Recent studies suggest that iontophoresis increases the threshold value in the nerve cells so that more stimuli is required for an action potential, a signal to the sweat gland, to arise.

We spread as much knowledge as we can here on our website. We are also trying to become more active on social media such as Instagram and Facebook. I, Sandra Eriksson Mirkovic, together with Emmili Yoshiguchi, who suffers from hyperhidrosis, run a podcast in Swedish, “Svettpodden” (The sweat podcast) where we talk about hyperhidrosis and issues connected to the condition. In the future, we hope to do an English version of this concept.

Patient association for hyperhidrosis

If you are affected by hyperhidrosis, you can join the Hyperhidrosis Patient Association in your country/region. More members strengthen the possibility of pushing the issue of hyperhidrosis patients' situations where you live. If you feel comfortable speaking about your pains and problems with hyperhidrosis with your surroundings, it can help you normalize the condition and make others with hyperhidrosis open up.

If you have a person close to you that is affected by hyperhidrosis, it's important to learn how to communicate with your loved ones about their condition. It's critical not to accuse your loved ones of being responsible for their situation because they're stressed or overweight, etc. To discover more about how to deal with these situations, visit SweatHelp.org

Together we can make a difference and make sure that everyone who's affected by hyperhidrosis gets the right diagnosis, the right information, and good help.

Hyperhidrosis Treatment

Currently, there is no cure available for hyperhidrosis. Several treatment options are available for the treatment of excessive sweating.

All options are worth testing, depending on the location of your sweat problems. Treatments like iontophoresis can help decrease the sweat level and alleviate the symptoms.


  • Prescription antiperspirants
  • Regular antiperspirants are often not enough to battle excessive sweating. Antiperspirants that contain aluminum chloride are the first line of “defense” when it comes to extreme sweating.

    They are often available on prescription from your general practitioner or can be bought prescription free at a pharmacy.

    Antiperspirants can help to decrease sweating to a certain point. When it comes to severe sweating, there are other efficient treatment options available. Some antiperspirants can cause skin irritation.

    It is important to keep the skin dry when applying the antiperspirant to avoid a chemical reaction that causes skin irritation.


  • B. toxin injections
  • This treatment can be efficient but requires to be repeated a couple of times a year. The B. toxin substance is injected into the skin of the body parts affected with abnormal sweating.

    Primarily it serves as a treatment for the armpits and palms area. It is also possible to use this treatment for feet, head, back, groin, buttocks, and chest but that might require other anesthesia and larger doses of the toxin.

    One of the disadvantages of this treatment is that it is hard to find clinics that offer this treatment. Besides, it can become expensive since repetition is required after a few months.

    Two types of B. toxin substances can be used for treatment - type A and type B. Some people can be immune to type A. There is an alternative treatment with type B. Type B causes less impact on your muscles, such as temporarily reduced grip function compared to type A. However, type B often has a shorter effect.

    Many people find this type of treatment painful. In some countries, this treatment is covered by health insurance providers. Unfortunately, a negative trend of removing the therapy from the list of covered treatments is ongoing.


  • Oral medications
  • Your general practitioner can prescribe you a pill that helps control excessive sweating. Sadly, these pills often have multiple side effects. If you are affected by other conditions, it might be unsafe to use the medicine.

    It is prominent to consult with your doctor at a sweat clinic to learn if the medication is the right treatment for you. Some side effects of pills that are used to treat abnormal sweating are dry mouth, lowered blood pressure, fatigue, slow heart rate, bowel problems, etc.

    Sometimes, a combination of the pills and b. toxin injections or other treatments serve as a solution for people affected by the general type of extreme sweating.


  • miraDry
  • miraDry is a method for treating excessive sweating in the armpit area. It is based on microwaves that “boil” the sweat glands. That can lead to about 70-85% permanent reduction of sweating after a couple of treatments.

    This treatment has been tested/approved only on the armpits so far.


  • Axillary evacuation
  • When it comes to armpit sweat, surgery may be an alternative solution. Axillary evacuation is a treatment where sweat glands are removed. On the other side, side effects of this surgery can be permanent scarring and swelling.

    Before you consider this surgery, we suggest that you gather information from experts. We highly advise that you consult an experienced surgeon with knowledge and experience in the procedure.


  • Sympathectomy (ETS)
  • Endoscopic thoracic sympathectomy (ETS) is a surgical option for a permanent treatment of sweating. It is performed to reduce sweating of the armpits and palms. The procedure consists of cutting the nerves that convey the sweat signals to these areas.

    The procedure is associated with severe compensatory sweating in other body areas after the procedure and other unpleasant side effects.

    This procedure was discovered in Sweden. It was also banned in Sweden in 2003 because of the complaints from patients who experienced severe side effects and serious risks to the procedure.


Iontophoresis


Iontophoresis is a method that successfully treats hyperhidrosis. It is a painless method that doesn’t require medications, needles, and drugs.

You can use it to treat your palms, armpits, and feet successfully. You can perform the treatment at home and see great results when you do it regularly.

During the iontophoresis treatment, the device delivers mild electrical currents to your skin and changes the way the nerve signals are conducted to your sweat glands. An iontophoresis treatment session lasts for 20-40 minutes.


Science facts behind iontophoresis treatments:

  • 92.9% of patients see improvements in sweat reduction after two weeks of treatment. [1]
  • The life quality improved for 78.6% of patients after they started to perform the treatment. [1]
  • The effect of iontophoresis usually appears after 6-15 treatments. [2]
  • Iontophoresis is an effective and safe treatment for palmoplantar (hands and feet hyperhidrosis) and axillary (hyperhidrosis in armpit area), with minimal side effects. [3]
  • Iontophoresis has been used for the treatment of palmar and/or plantar hyperhidrosis since 1952. [4]

You can also use iontophoresis as the treatment of the face. It's not yet proven as efficient on the face as it is in the other areas. The effect on the face is individual.

More than 90% of our satisfied customers who use our iontophoresis machine say that the treatment produces excellent results and helps ease their everyday life.

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Join the patient association for hyperhidrosis

If you are affected by extreme sweating or have a close person that is affected by it, you can join the Hyperhidrosis patient association in your country/region. More members strengthen the possibility of pushing the issue to become more public.

If you feel comfortable speaking about your problems with other people, you can normalize the condition, and make other people with abnormal sweating open up. If a person close to you is affected by extreme sweating, it’s important to learn how to communicate with them regarding their condition.

The most important thing is to let them know that they aren’t guilty of their condition. Being stressed or overweight and other conditions aren’t very often the reason for extreme sweating.

To discover more about how to deal with these conditions visit the International Hyperhidrosis Society website.

Together we can make a difference and make sure that everyone who is affected by excessive sweating gets the right information, diagnosis, and treatment.

Follow Dr. Sandra Eriksson Mirkovic on Instagram!

Click here: @dr_sandra_hyperhidrosis

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iontophoresis machine review
5 stars: excellent
Kate has submitted a review about Hidroxa
"I bought this product because my excessive hand sweating was in certain ways limiting my social life, and disturbing me while doing sports. I did the treatments on my hands and feet every day for 12 days. I noticed small improvements already after 6 treatments, and significant results after 10 treatments. After the first 12 treatments I started to use it every other day. When writing this review I have completed 18 treatments, and I’m really happy with the result. The positive problem I have today is that my skin is very dry, and I need to moisturize frequently."
iontophoresis machine review
5 stars: excellent
Dario has submitted a review about Hidroxa
"After 8-9 treatments/days, I became completely dry on my hands. I started using Hidroxa almost a month ago. Now I do treatments every three days and am still completely sweat-free.The treatments are very easy to perform and painless. So far I have only treated hands but I have noticed that my feet also sweat much less than before. Do not really know why but it may be because my hand sweat triggered the foot sweat. It is a very desirable side effect. I would definitely recommend Hidroxa and am completely satisfied with the purchase. It's a game changer!"
m cdag iontophoresis machine review
5 stars: excellent
Nina has submitted a review about Hidroxa
“I had surgery for hand sweat at a young age, but since this surgery is no longer performed (in Norway) and I am still very bothered by foot sweat, I decided to try Hidroxa. Already after 6 treatments, I noticed a big difference, and now I am completely dry on the underside of the soles of my feet, even during training! I will try with a little salt in the water and with socks for treatment on the upper side of the toes. I have always received very quick answers when I have wondered about something. Very satisfied!“