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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.

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.


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

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.

hyperhidrosis treatment

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

hyperhidrosis treatment 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.

hyperhidrosis doctor

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Click here: @dr_sandra_hyperhidrosis

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m cdag iontophoresis machine review
5 stars: excellent
m cdag has submitted a review about Hidroxa
“Have been using the iontophoresis machine for about 3 weeks now and I couldn’t be happier. I purchased it to treat aquagenic wrinkling of the palms, and I had it so bad I had been showering with gloves on for 2 years. After about 3 sessions of iontophoresis I have been able to say goodbye to the gloves and my hands look almost normal after exposure to water. I had tried topical antiperspirants before and nothing worked; this machine has changed my life. My condition is related to sweating so I would have sweating on my hands now and then, and that is gone too. Also have to say customer service is amazing! They always answer my emails on the same day and are extremely nice and helpful! Thank you !!“
Lotta iontophoresis machine review
5 stars: excellent
Lotta has submitted a review about Hidroxa
"I have suffered from excessive hand sweat since I was a teenager and I bought a iontophoresis device this spring. After 9 treatments I was totally sweat free and since then I have only had to perform maintenance treatments twice a week. I perform these 2 days in a row. My self esteem has really improved and it is absolutely amazing not having to worry about occasions when I need to shake someone’s hand. I am so pleased! Best purchase ever!"
Eva iontophoresis machine review
5 stars: excellent
Eva has submitted a review about Hidroxa
"After only 2 weeks of treatment of my feet every other day I can feel the effect! Totally amazing!"