What is hyperhidrosis?Hyperhidrosis is a medical condition characterized by excessive sweating. It is thought to affect in excess of 5% of the global population, or approximately 365 million people worldwide. It can affect anyone regardless of factors such as age, sex, or ethnicity.
excessive, above normal
the action of sweating
HyperhidrosisHyperhidrosis is the term used to describe excessive sweating beyond what is physiologically necessary. It can be localized or generalized, based on the distribution of sweat (certain areas of the body vs. full body, respectively), and is also classified as primary or secondary, based on the cause of the sweating. Primary = of primary origin (unknown cause). Secondary = secondary to another medical condition, or side-effect of a medication. Want to learn more about hyperhidrosis? Subscribe to our newsletter for our full hyperhidrosis treatment guide.
What is primary hyperhidrosis?Primary hyperhidrosis is a chronic condition of unknown cause. Hyperhidrosis is an exaggerated response of the sweat glands to release excessive amounts of sweat, in absence of appropriate stimuli. Those with hyperhidrosis can sweat anytime, anywhere, in any temperature, and up to 4-5x more than the average person or what is needed for thermoregulation. It is believed to be caused by an overactive sympathetic nervous system. Some research indicates that there may be a hereditary component to the condition, meaning it can be passed on through generations. Primary hyperhidrosis is of primary origin, meaning it is not a side-effect or secondary to another underlying condition. It is not caused by external stimuli, body temperature, or associated to any other conditions or medications. Primary hyperhidrosis is most commonly localized, meaning it typically affects certain areas of the body, most commonly the hands, feet, underarms, and craniofacial region. Those with hyperhidrosis will generally start experiencing symptoms in childhood to adolescence, particularly with the onset of puberty. In nearly all cases, symptoms (excessive sweating) will appear before the age of 25.
How is hyperhidrosis diagnosed?
A dermatologist can do a medical diagnosis for hyperhidrosis, but in the case of primary hyperhidrosis is not always necessary. Those with hyperhidrosis, that is excessive sweating in specific areas of the body, often self-diagnose, as the condition itself does not pose any direct threat to overall health. If you consider your sweating level to be excessive, experience excessive sweating in your hands, feet, and/or underarms, and sweating impacts your daily life and takes a mental toll on you, you’re likely suffering from hyperhidrosis. A diagnosis is not always necessary to begin treatment, but some treatment options are only available under clinical guidance or prescription, so speaking to a healthcare professional is recommended. There is no threshold or level of sweat that automatically determines if you have hyperhidrosis. In fact, hyperhidrosis is generally categorized as mild, moderate, or severe, though all levels are deemed excessive.
During a consultation with a dermatologist, they will generally do a physical examination (focusing on looking at the areas that sweat excessively) and ask you questions to determine if you have hyperhidrosis. The questions can range from physical symptoms to mental and emotional wellbeing. Sometimes, medical testing is necessary, and is done with a starch iodine test, also known as the “sweat test”. This test involves coating the skin with a powder that turns purple when the skin gets wet (sweat, in this case). This helps determine which areas are sweating excessively, and narrow down which sweat glands are the most hyperactive, as these areas will appear darkest. This kind of test is most commonly done prior to certain treatments such as injections and microwave thermolysis to better localize treatment. Hyperhidrosis can also be diagnosed via telemedicine, and in this case photos of your excessive sweating (in addition to your responses to questions) will generally suffice to make a diagnosis and get a prescription for your recommended or desired treatment.
Some questions to ask yourself when determining if you have hyperhidrosis, or that you may be asked if going in to a dermatologist for a consultation are the following:If you answered “yes” to any or all of the above, then you likely suffer from hyperhidrosis (excessive sweating). The first step would be to either consult a professional for more information, or open up to a trusted person (a partner, friend or family member) to ease the mental toll this condition has. We then recommend to start doing your own research, join a hyperhidrosis community, and look at the available treatment options. Note: If you experience a sudden onset of excessive full-body sweating, then it is recommended that you speak with your healthcare provider to rule out any underlying causes or medications that can have sweating as a side effect.
- Do you consider your sweating level to be excessive?
- Do you often find yourself sweating excessively for no apparent reason?
- Have you noticed certain areas of your body sweat more (hands, feet, underarms)?
- Do you think about sweating all the time?
- Do you plan your life around excessive sweating?
- Have you ever canceled plans because of your sweating?
- Do you often find yourself trying to conceal your sweat from others?
- Do you suffer from anxiety and/or depression as a result of your sweating?
- Do you think that your sweating will have a negative effect on the way people perceive you?
- Has sweating made you less outgoing and more reserved?
- Do you often have to change clothes or shower more than once a day on account of your sweating?
- Do you carry anything to absorb/conceal sweat when you are out (tissues, changes of clothing, towels, antiperspirants, etc.)?
- Has sweating had an impact on your studies, career path, or employment opportunities?
What are the symptoms of hyperhidrosis?The symptoms of hyperhidrosis are excessive, uncontrollable sweating in the affected region(s) that disrupts daily life. Symptoms can easily be spotted if sweating is dripping down palms, leaving sweat marks on clothing, or dampening shoes. Those who suffer from hyperhidrosis may have “episodes” when they start sweating excessively for no reason (i.e. absence of appropriate stimuli). Most report this as a daily occurrence, with some experiencing this multiple times a day. A noticeably absent symptom that can help in diagnosis, is that those with primary hyperhidrosis tend to not sweat excessively while they sleep, and experience their symptoms during the day.
How is hyperhidrosis treated?There is currently no cure for hyperhidrosis, but fortunately there are many treatments available.
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What are the side-effects of hyperhidrosis?The side effects of hyperhidrosis are wide-ranging and life-impacting in more ways than one. While this condition is non-life-threatening, it can have considerable physical, emotional, and mental impacts, and can negatively impact someone’s occupational and social life. The condition can take a significant toll on its sufferer, leading them to live and plan their life around the condition, even leading them to avoid social interaction and situations. It is often referred to as the “silent handicap”, as people rarely talk about the condition nor seek medical help, leaving many to suffer in silence. There are a lot of misconceptions about hyperhidrosis — in fact, many sufferers don’t even realize that excessive sweating is a recognized, treatable medical condition, nor that there is a word for it.
Quality of Life
Hyperhidrosis can impact social and professional lifestyle, as well as mental and emotional health. These negative effects, which have been studied extensively, lead to an overall lower quality of life. Hyperhidrosis is reported to be the dermatologic condition with the greatest impact on quality of life, even greater than psoriasis and eczema. In a 2017 study analyzing the effects of hyperhidrosis on quality of life, nearly all those studied reported an effect on their quality of life and lifestyle.
Daily Life and Lifestyle
From taking public transport, to seeking out clothes and developing personal style, hyperhidrosis can affect every aspect of mundane life and simple everyday tasks. Some ways hyperhidrosis can affect daily choices and lifestyle include clothing choices (color and material), food and drink choices (staying away from foods and drinks that trigger a sweating response), performing household chores, using technology tools (fingerprint ID on touchscreens do not work with sweaty fingertips), and the completion of mundane tasks such as turning door knobs, opening jars, and driving.
Social and Professional
Those who suffer from hyperhidrosis are hyper-aware of their condition and are often in a state of constant fear that others may take notice. Besides experiencing discomfort from the sweating itself, they develop a sense of shame and embarrassment, exacerbated by social and professional situations (e.g. parties, job interviews, presentations, and dates). In extreme cases, they may seek complete social isolation and become incapable of going to work, attending school, or fulfilling any other obligations. Turning down invitations and avoiding social situations, may give those around them the sense they are unsociable when it is just an undesired side-effect of their hyperhidrosis, and a coping mechanism to hide their condition from those around them out of a fear of judgement and misunderstanding. Hyperhidrosis is the sole dermatologic condition with a functional impairment. It can have a negative impact on education and studies, and even alter career paths for those otherwise fully committed and capable of following certain career trajectories.
Hyperhidrosis can also lead to physical side-effects. Excessive sweating can cause constant skin dampness, which can lead to skin maceration that leads to conditions such as athlete’s foot and ingrown toenails. Skin dampness, especially when constricted by footwear or clothing also creates the ideal environments for fungus to spread, and can lead to recurring cases. A study found a 3.5-fold increase in risk for patients with athlete’s foot to also have hyperhidrosis. The risk of skin infections, dermatophytes, psoriasis, and/or warts is increased secondary to sweating. Hyperhidrosis is considered a predisposing factor for both bacterial growth and the dermatologic condition known as pitted keratolysis. Additionally, constant moisture from sweating can lead to skin maceration. This increases the risk of skin conditions such as athlete’s foot and more severe conditions such as bacterial infections or pitted keratolysis. The International Hyperhidrosis Society (IHHS) reports that those with hyperhidrosis have a 300% greater risk of skin infections than those not experiencing the disease. The link between plantar hyperhidrosis has been further analyzed in several clinical studies. A study found that the overall risk of any skin infection was increased in sites with hyperhidrosis. There is also an increased risk of fungal infections, with a particularly increased risk for dermatophyte infections (those responsible for athlete’s foot). In a recent German study, researchers noted a 3.5-fold increased risk for patients with athlete’s foot to have hyperhidrosis. This is caused by the maceration (softening) of the skin due to excessive sweating.
Mental Health and Emotional Wellbeing
Excessive sweating leads to embarrassment for many patients. Other feelings consistently reported by those suffering from excessive sweating include anxiousness, loneliness, sadness, anger, and hopelessness. Low self-esteem and confidence are also widely reported There is a significant association between hyperhidrosis and the prevalence of anxiety, depression and attention deficit disorder (ADD) across all age groups and genders. Compared to the nationally reported prevalence of anxiety, depression and ADD, hyperhidrosis patients have a statistically significant higher prevalence than the general public. One international study determined that the prevalence of anxiety and depression was 21.3% and 27.2%, respectively, in patients with hyperhidrosis compared with 7.5% and 9.7% in those without the disease. Another study concluded that patients with severe hyperhidrosis had a rate of social anxiety disorder was 47.1% compared with 13.8% in patients without hyperhidrosis. Social anxiety is one of the most common conditions reported and diagnosed in hyperhidrosis patients.
What are the side-effects of hyperhidrosis?
What causes hyperhidrosis?
How common is hyperhidrosis?
Who is most commonly affected?
What areas are most commonly affected by hyperhidrosis?
Is there a cure for hyperhidrosis?
Is hyperhidrosis genetic?
Is hyperhidrosis dangerous?
How can I treat hyperhidrosis?
How to approach your doctor about hyperhidrosis
Dr. Ramin Fathi, MD
- I see patients who are impacted professionally from their hyperhidrosis and who suffer socially from their hyperhidrosis. It impacts their quality of life because it stops them from doing the normal things that you should be doing. There’s no medical condition that should be holding you back to live your life at its fullest.
- Hyperhidrosis is a big deal for those who suffer from it. What is considered “mild hyperhidrosis” can still have a significant difference in their day-to-day life. There's so many different areas of your life it can affect.
Dr. Hope Mitchell, MD
- Hyperhidrosis is that it actually was more common than people led us to believe in medical school. And even back then, and still today with hyperhidrosis, a lot of the diagnosis is made incidentally. What I find in my practice is that people come in for another thing, and I'm the one that notices that they have hyperhidrosis.
- There are still many people that don't know that it's a medical condition. A lot of people suffer in silence. I know that there may be adolescents that may say something to their parents, but their mom or dad may say “your body is changing” or “that's normal, that will go away”. I also know that although it runs in families, it's not discussed—it's a condition that I think a lot of people live with in silence, unfortunately.
- I know that it can be embarrassing, I know that it can be dismissed. Luckily, today we have a lot of information online and more and more people are figuring it out.
Dr. Amy Shah, MD
- If you're suffering from hyperhidrosis, don't be embarrassed. There are many thousands of people just like you. The incidence is between five and 14%. There are so many more people that have it that don't even talk about it. So make sure you feel that you're not alone. Make sure that you talk to someone, a provider, a physician, that you feel comfortable with. Please, the only way you can get help and improve this condition is by talking about it.
- Another thing is to know that there are solutions. I think one of the big misnomers is that you can't do anything. I think that a lot of people feel helpless, and should know that there's a solution like tap water iontophoresis and various other solutions to this problem. It should empower you to go and seek this out, talk to someone you trust about it, see what your options are and choose an option. You don't have to live like this. Other Sweating Conditions
Dr. Robert Strimling, MD
- My first experience with hyperhidrosis was learning about it during my dermatology training, where I met a young man who was just beginning his professional career and suffered from idiopathic palmar hyperhidrosis and extreme social anxiety, due to his affliction. Since then, I have always been motivated to seek out the best possible solutions for this not-so-uncommon problem.
Dr. Leona Yip, MD
- Commonly social disruptions that affect personal relationships and work e.g. too embarrassed to hold or shake hands, avoidance of meeting people and public speaking for fear of looking drenched with sweat, need to change drenched clothes every few hours throughout the day. Psychological effects are also very common e.g. lack of self-confidence, anxiety and depression. Ongoing high costs of replacing damaged clothing is another very common complaint. Lastly, functional issues e.g. inability to hold pens/pencils properly, unable to grip sports equipment, increased skin infections e.g. fungal, warts, bacteria.
- People with hyperhidrosis are at higher risk of skin infections e.g. bacterial, fungal and warts; as well as worsening of skin conditions e.g. eczema, seborrheic dermatitis, acne etc. Treating hyperhidrosis often helps improve treatment outcomes of these skin issues.
What is secondary hyperhidrosis?Excessive sweating can be the result of an underlying medical condition or can be a side effect of a medication. If that is the case, then it is referred to as secondary hyperhidrosis, as it is secondary to another (primary) condition or a secondary effect to a medication. Secondary hyperhidrosis is typically generalized, meaning it affects the entire body and is not localized to certain body parts, as is the case with primary hyperhidrosis. In some cases, it can be localized to certain body parts, but this is less common, and is generally the result of traumatic injury to one part of the body that results in compensatory sweating in another part. Infections, diabetes, heart failure, obesity, menopause, and alcoholism are some of the conditions that can cause excessive sweating. Some common medications that can cause excessive sweating are antidepressants, migraine medications, pain relievers, opioids, and diabetes medications. The best course of treatment is to consult a medical professional to identify and treat the underlying condition or identify the medication causing excessive sweating.
Other Sweating Conditions
Compensatory HyperhidrosisCompensatory hyperhidrosis happens when you completely stop sweating in one area, and your body compensates by sweating more in another. It is generally the result of trauma to a part of the body, and is also the most common side-effect of endoscopic thoracic sympathectomy (ETS).
Gustatory HyperhidrosisGustatory hyperhidrosis, also known as Frey’s syndrome, is sweat triggered by food. Eating, seeing, dreaming, thinking, or talking about food can trigger a sweating response in those affected. It is generally the result of surgical trauma to the parotid gland. Following surgery, a mix up causes your body to secrete sweat, rather than saliva when needed. Read more about gustatory hyperhidrosis.
ChromhidrosisChromhidrosis is a very rare medical condition characterized by the presence of colour in sweat. It can occur by the presence of lipofuscin (a yellowish-brown pigment found in several organs and cells of the human body) that mistakenly makes its way into the sweat glands, where it oxidizes and can cause black, blue, green, brown, red, and yellow sweat. This is called apocrine chromhidrosis. Eccrine chromhidrosis can be caused by the ingestion of certain dyes, chemicals, or drugs, which then find their way into the eccrine glands and where they are excreted with the sweat. Sometimes sweat can come into contact with pigments and dyes externally (e.g. hair dye and clothing dyes), which can give the appearance of coloured sweat but this is not considered chromhidrosis and sometimes referred to as pseudochromhidrosis. Read more about chromhidrosis.
BromhidrosisWhile everyone suffers from occasional body odour, some have it a lot worse than others, and in these severe cases, it’s called bromhidrosis. Sweat is an odorless liquid, but when it comes in contact with the bacteria on your skin, it can release unpleasant odours. Most people deal with body odor, however, this can be managed by following an adequate hygiene routine. In the case of those with bromhidrosis, they will suffer from a very strong pungent smell, even just minutes after showering in some cases, making it very difficult to manage. Bromhidrosis is common in those who suffer from hyperhidrosis. Read more about bromhidrosis.
AnhidrosisAnhidrosis is the complete absence of sweating. It can affect a specific area of the body (e.g. following a burn injury) where the sweat glands are damaged and can no longer function. If anhidrosis is present in several large areas of the body, it poses serious life-threatening risks, as the body can overheat if not able to control core body temperature through sweat excretion.
HypohidrosisHypohidrosis is a decreased ability to sweat. It is a less severe form of anhidrosis, which is when a person is completely unable to sweat. Someone who suffers from hypohidrosis is less able to sweat, meaning their body cannot cool down as efficiently, which exposes them to a higher risk of developing heat-related illnesses.
HematidrosisHematidrosis is an extremely rare medical condition that is characterized by blood found in sweat. It happens when blood vessels that feed the sweat glands rupture, and traces of blood are excreted through the sweat glands. It’s the result of severe mental anxiety and anguish to a degree that causes hemorrhage of the blood vessels supplying the sweat glands. It is not pure blood that is excreted through the sweat glands, but rather traces of blood that give the sweat a red-tinged hue.
Sources + Further Reading
Atkins JL, Butler PE. Hyperhidrosis: a review of current management. Plastic and Reconstructive Surgery. 2002 Jul;110(1):222-228. DOI: 10.1097/00006534-200207000-00039.Connolly, M., de Berker, D. Management of Primary Hyperhidrosis. Am J Clin Dermatol 4, 681–697 (2003). https://doi.org/10.2165/00128071-200304100-00003David R Strutton, Jonathan W Kowalski, PharmD, Dee Anna Glaser, Paul E Stang, US prevalence of hyperhidrosis and impact on individuals with axillary hyperhidrosis: Results from a national survey,Journal of the American Academy of Dermatology, Volume 51, Issue 2,2004, Pages 241-248, ISSN 0190-9622, https://doi.org/10.1016/j.jaad.2003.12.040.Kamudoni, P., Mueller, B., Halford, J. et al. The impact of hyperhidrosis on patients' daily life and quality of life: a qualitative investigation. Health Qual Life Outcomes 15, 121 (2017). https://doi.org/10.1186/s12955-017-0693-xMoraites E, Vaughn OA, Hill S. Incidence and prevalence of hyperhidrosis. Dermatol Clin. 2014 Oct;32(4):457-65. doi: 10.1016/j.det.2014.06.006. Epub 2014 Jul 19. PMID: 25152338.Lenefsky M, Rice ZP. Hyperhidrosis and its impact on those living with it. Am J Manag Care. 2018 Dec;24(23 Suppl) S491-S495. PMID: 30589248.Lewis P. Stolman, Treatment of Hyperhidrosis, Dermatologic Clinics, Volume 16, Issue 4,1998, Pages 863-869,ISSN 0733-8635, https://doi.org/10.1016/S0733-8635(05)70062-0.