Hyperhidrosis is a medical condition in which a person sweats much more than is needed for regulating body temperature. It is not a simple increase of sweat, but sweat production excessive relative to environmental heat or physical exertion. Hyperhidrosis can be classified as primary when there is no other underlying disease, or secondary when another condition or a medication causes the excessive sweating.
Primary hyperhidrosis tends to be focal—it is localized to certain areas such as the armpits, palms, soles of the feet, or the face region. Secondary hyperhidrosis may be generalized (involving many parts of the body), may begin later in life, can occur during sleep, and is tied to systemic illness or drugs.
How Common Is Hyperhidrosis and When Does It Begin?
The prevalence of primary hyperhidrosis in the world population ranges between about 0.6% to 5% depending on the region and how hyperhidrosis is defined. Onset is most often in childhood or adolescence, typically before age 25. Many patients report a family history, supporting a genetic predisposition.
The distribution by sites: axillary hyperhidrosis is the most common, followed by hands, feet, and craniofacial involvement. Many individuals with hyperhidrosis of one site also have involvement in other sites.
Can Dermatoscope Detect Hyperhidrosis?
Dermoscopy is a non-invasive skin imaging technique; it uses a handheld magnifier plus light (polarized or non-polarized), sometimes with immersion fluid, to visualize skin surface and superficial structures with more detail than by eye alone. It’s mostly used for pigmented lesions, skin tumors, vascular lesions, etc.
A 2023 case report of nevus sudoriferous (an eccrine sweat gland nevus) on the forearm found that dermoscopy showed larger and clearly visible sweat pores compared with adjacent normal skin. That suggests that dermoscopy can reveal morphological changes in sweat gland openings or ducts in certain focal hyperhidrosis or sweat gland abnormality contexts.
Why Does Hyperhidrosis Occur?
The exact pathophysiology of primary hyperhidrosis is not fully understood. However, current evidence suggests that it is largely due to neurogenic overactivity of the sympathetic nervous system—especially the cholinergic (acetylcholine‐mediated) nerves that stimulate sweat glands.
Some detailed observations include:
·The eccrine sweat glands themselves are usually histologically normal in primary hyperhidrosis, so the excessive sweating is not usually because of more glands or larger glands, but because of increased stimulation.
·Stimuli that are normal (emotional stress, heat, or exercise) may provoke exaggerated responses.
·Genetic components: familial patterns are common. Some studies have mapped possible loci in certain populations.
In contrast, secondary hyperhidrosis occurs because of disease or drugs—for example, hyperthyroidism, infections, or diabetes. In such cases the mechanism may be systemic or metabolic, rather than localized overactivity in certain sympathetic pathways.
What Impacts Does Hyperhidrosis Have on Daily Life?
Hyperhidrosis can substantially affect quality of life. The impacts are not just physical but psychosocial.
Physical issues include:
·Skin maceration, irritation, fungal or bacterial infections in moist areas.
·Difficulty with grip, tasks involving paper, handling objects, slipping in shoes, particularly with palmar or plantar hyperhidrosis.
Psychosocial effects include:
·Feelings of embarrassment, social anxiety, avoidance of certain social or professional situations, and negative self‐image.
·Emotional distress, sometimes associated with depressive symptoms.
·Delays in diagnosis are common; many people suffer for years before seeking medical help.
What Treatment Options Exist, and Which Are First-Line?
Treatment depends on severity, site (axillae, palms, soles, face), and patient preference.
First-line treatments
For focal primary hyperhidrosis, initial treatments often include:
Topical antiperspirants / aluminum chloride solutions: e.g. 20% aluminum chloride. These are generally the first treatment attempted for many sites (especially axillae). They work by obstructing eccrine sweat gland ducts and damaging secretory cells.
Topical anticholinergic agents are used especially when sweating is on the face or head.
Intermediate options
If first-line fails or symptoms are more severe:
Iontophoresis: useful especially for palms and soles. It uses electrical current to reduce sweating.
Botulinum toxin injections: for axillary, palmar, plantar or facial hyperhidrosis. Botulinum toxin blocks release of acetylcholine at nerve endings, reducing sweat gland activation. The effect may last several months.
Advanced and last-resort treatments
Oral anticholinergic medications: for more severe or generalized cases, or when topical or local treatments are insufficient. Side effects are common.
Procedural / device-based therapies: for example, microwave thermolysis or microneedle radiofrequency for axillary hyperhidrosis. These heat or injure sweat glands locally.
Surgical options, including excision of sweat gland–rich skin in axillae; or sympathectomy (endoscopic thoracic sympathectomy) for palmar hyperhidrosis or severe cases. These carry higher risk and are considered when other treatments have failed.
What Lifestyle Measures Help?
Patients should wear breathable, moisture-wicking fabrics and change clothing frequently. Black or white garments mask sweat stains. Absorbent insoles and antiperspirant wipes are useful for palms and soles. Stress-reduction techniques such as cognitive behavioural therapy can reduce situational sweating.