Excessive Sweating

Hyperhidrosis occurs when the sweat glands become overactive, leading to excessive sweating. Sweat glands are distributed throughout the body, with higher concentrations in the palms, soles, underarms, face, and scalp. People with hyperhidrosis may notice that sweating occurs even in cool environments or without physical exertion. The condition can affect a specific area (focal hyperhidrosis) or multiple regions of the body (generalized hyperhidrosis).

Although primary hyperhidrosis is not a life-threatening condition, excessive sweating can be socially and emotionally distressing. It can make simple daily tasks, such as shaking hands, writing, or wearing specific clothing, difficult or embarrassing. Persistent moisture can also increase the risk of skin irritation, infections, and discomfort.

Hyperhidrosis is typically classified into two main categories:

• Primary focal hyperhidrosis affects specific areas such as the underarms (axillary), palms (palmar), soles (plantar), or face (craniofacial). This form often begins in childhood or adolescence and is not caused by another medical condition. It is believed to be linked to overactivity of the sympathetic nervous system, which controls sweat production.
• Secondary generalized hyperhidrosis occurs as a result of another medical condition or as a side effect of certain medications. Unlike primary hyperhidrosis, secondary hyperhidrosis usually affects larger areas of the body and can occur during sleep.

The exact cause of primary focal hyperhidrosis remains unclear, but it is thought to involve an inherited tendency toward overactive sweat glands. Genetics plays a role, as the condition often runs in families.

Secondary hyperhidrosis, on the other hand, has identifiable causes. It may result from medical conditions such as:

• Endocrine disorders, including hyperthyroidism or diabetes
• Hormonal changes during menopause or pregnancy
• Infections such as tuberculosis or HIV
• Neurological disorders like Parkinson’s disease or spinal cord injury
• Certain cancers, such as lymphoma
• Medications, including antidepressants, pain relievers, or drugs for high blood pressure

Identifying the underlying cause is essential, especially for secondary hyperhidrosis, as effective treatment often depends on managing the associated condition or adjusting medication use.

The sweating may be mild or severe, and symptoms typically appear symmetrically on both sides of the body. Common areas affected include the:

• Palms of the hands, leading to difficulty gripping objects or shaking hands
• Soles of the feet, causing discomfort when wearing shoes
• Underarms often result in visible stains or odor concerns
• Face and scalp, leading to embarrassment during social interactions

In severe cases, the constant moisture can cause maceration of the skin (softening and breakdown), rashes, and fungal or bacterial infections. Some individuals also experience emotional effects, such as social anxiety, embarrassment, or avoidance of public situations due to fear of visible sweating.

Diagnosis begins with a thorough evaluation by a board-certified dermatologist like Dr. Joshua Freedman, who will review the patient’s medical history, discuss symptoms, and perform a physical examination. The goal is to determine whether the sweating is localized or generalized and to identify any underlying medical causes. He will inquire about when and where sweating occurs, its frequency, and whether it disrupts daily activities. This helps distinguish between primary and secondary hyperhidrosis.

He may order sweat tests such as the starch-iodine test, which involves applying an iodine solution and starch powder to the skin. When the area sweats, it turns dark blue or black, helping map regions of excessive sweating.

Blood and urine tests may be ordered to rule out underlying conditions such as thyroid disorders, diabetes, or infections that could contribute to secondary hyperhidrosis.

If the sweating pattern suggests nerve involvement or systemic disease, additional diagnostic imaging may be performed.

Early and accurate diagnosis allows for a tailored treatment plan that can significantly improve quality of life. Dr. Freedman focuses not only on identifying the cause but also on understanding how the condition affects each patient personally, helping develop a compassionate and individualized care strategy.

Although excessive sweating can be a lifelong condition, effective treatments and management strategies are available. From clinical-strength antiperspirants to advanced dermatologic procedures, modern medicine provides many ways to reduce sweating and restore comfort and confidence. Lifestyle modifications such as wearing breathable fabrics, staying hydrated, and managing stress can also help minimize episodes of sweating.

Seeking medical evaluation is essential, especially when sweating interferes with daily activities, causes emotional distress, or appears suddenly without explanation. Hyperhidrosis is a medical condition—not simply a cosmetic concern—and professional evaluation ensures that both the symptoms and any underlying causes are addressed.