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Hyperhidrosis (Excessive Sweating)


Disease: Hyperhidrosis (Excessive Sweating) Hyperhidrosis (Excessive Sweating)
Category: Dermatological diseases
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Disease Definition:

The body cools itself by sweating. This is natural and healthy in most cases. However, some people may experience hyperhidrosis, which is frequent or constant excessive sweating.

The secretion of sweat in amounts that are greater than needed to cool the body is referred to as hyperhidrosis. Usually, the palms of the hands, soles of the feet and underarms are affected by hyperhidrosis. Anxiety, embarrassment as well as disruption of normal daily activities could be caused by hyperhidrosis.

There are several treatments for hyperhidrosis. Surgical procedures could be very effective at stopping sweat in severe cases.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


In most cases, when, where and how much people sweat varies widely. However, people usually sweat when they exert themselves, exercise, are under stress, nervous or anxious. The excessive sweating that is experienced with hyperhidrosis greatly exceeds normal sweating.

Some of the signs and symptoms of hyperhidrosis may be:


  • Abnormally excessive and bothersome perspiration on the feet, face, head and underarms.
  • Clamminess or dripping of sweats droplets on the palms of the hands or soles of the feet
  • Frequent, noticeable and excessive sweating that could soak through clothing.

Episodes of hyperhidrosis usually occur at least once a week without an obvious reason. This condition is defined as sweating that disrupts normal activities.

Hyperhidrosis may interfere with the social life of some people. Some people may become withdrawn due to self-consciousness about shaking hands with others, having stained shirts or potential body odor. Some people may also have trouble working or enjoying recreational activities due to their constant wet hands.

In case sweating disrupts someone's daily routine, if someone suddenly begins to sweat more than usual or if someone experiences night sweats for no apparent reason, they should see a doctor.

In case a person experiences a cold sweat, especially if they have symptoms of lightheadedness or chest and stomach pains, they should seek immediate medical attention. Usually, the body responses to a serious illness such as severe pain, anxiety or cardiac disease with a cold sweat.


The body's temperature regulation system, the sweat glands specifically are the cause of hyperhidrosis.

There are two types of sweat glands in the skin, apocrine glands and eccrine glands. Eccrine glands, which occur over most of the body, open directly onto the surface of the skin. Apocrine glands develop in areas that are filled with hair follicles, such as the groin, armpits and scalp.

The autonomic nervous system stimulates these glands when the body temperature rises to secrete fluid onto the surface of the skin, where it cools the body as it evaporates. Mainly water and salt (sodium chloride) are found in this fluid (perspiration). It also contains trace amounts of substances such as urea in addition to other electrolytes, which are substances that help regulate the balance of fluids in the body.

The type of hyperhidrosis usually determines its cause:

Generalized Hyperhidrosis:
Large areas of the body are affected by this type of hyperhidrosis. This type usually has an underlying cause if it develops suddenly, for instance as a sign of a disease or condition, such as low blood sugar, heart attack, overactive thyroid, leukemia, menopause hot flashes or an infectious disease. It could also be a side effect of a drug. The problem is usually solved by adjusting medications or treating the underlying disease if there is one.

Focal Hyperhidrosis:
Excessive daytime sweating of the palms and soles and sometimes the underarms are usually involved in this type. It appears equally on both sides, for instance on both palms. During sleep, the sweating usually stops. This type is not associated with an underlying condition and it usually begins before the age of 20. This type usually runs in families, so it may have a genetic component, but its exact cause is still not known.



Some of the complications that could occur due to hyperhidrosis include:

Bacterial infections and warts:
Warts, which are skin growths that are caused by the human papillomavirus (HPV), could be caused by hyperhidrosis, in addition to delayed resolution of warts after treatment.
Bacterial infections could also be caused by hyperhidrosis, especially around hair follicles or between the toes.

Heat rash or prickly heat:
When the pores around the sweat glands become blocked, this rash occurs. Because of this, sweat will become trapped under the skin and end up causing fine red spots or bumps, which usually occur on the upper back, arms or chest. Usually affecting babies and young children, this rash occurs in hot and humid weather.

Fungal nail infections:
People who sweat a lot are susceptible to many types of fungal infections because fungi thrive in warm and moist environments, such as sweaty shoes. Because of this, someone is more likely to get an infection in their toe nail rather than in their fingernail. A white or yellow spot under the tip of the nail is how a nail infection usually starts. The nail may discolor, thicken and develop crumbling edges as the fungal infection spreads deeper. In some cases, the skin around the nail may become red and swollen, and the nail may separate from the nail bed. A slight odor could also be present.

Social and emotional consequences:
Clammy hands and unpleasant foot odor will be present in people with hyperhidrosis because they usually have excessive sweating of the soles and palms. They could experience significant psychological, social, educational and occupational consequences as a result to this.


For hyperhidrosis, someone may be recommended one of these treatments:

Anticholinergic drugs:
A person may be prescribed an anticholinergic drug such as glycopyrrolate in case they have generalized sweating. Anticholinergics block the actions of a chemical messenger in the body that helps to stimulate the sweat glands, known as acetylcholine. Usually, after using the medication for about two weeks, the signs and symptoms improve. However, this medication could have various side effects because acetylcholine acts on several structures in the body, not just the sweat glands. Some of the signs and symptoms that are usually mild include:


  • Blurry vision
  • Constipation
  • Loss of taste
  • Confusion
  • Urinary retention
  • Dry mouth
  • Dizziness

 However, a person should seek prompt medical help in case they experience hives or rash, diarrhea or difficulty swallowing or breathing because these could be a signal of a more serious problem.

Prescription antiperspirant:
A person may be prescribed aluminum chloride in case over-the-counter antiperspirants don't help. Light to moderate hyperhidrosis is treated with this prescription medication. To achieve the best results, the antiperspirant should be applied at night to the areas that are most prone to sweating. The person should wash the medication off in the morning to prevent irritation because prescription antiperspirants are strong solutions that could cause red, swollen and itchy skin.

Botulinum toxin:
By paralyzing certain muscles, this product helps smooth facial wrinkles. Botulinum toxin injections have also been discovered to be effective in treating hyperhidrosis by blocking the nerves that trigger the sweat glands. However, to achieve the desired results, someone may have to be given several injections, and the results will last only four months. Although uncommon, side effects are possible.

A battery-powered device will be used in this procedure while the patient's body is immersed in water, to deliver a low level of electrical current to the hands or feet and in some cases the armpits. Sweat glands are believed to be temporarily blocked by this procedure. Iontophoresis is usually safe and can be performed at home. It lasts 15 to 30 minutes, and is usually performed once a day for a couple of weeks, and followed by less frequent maintenance therapy.

Surgery could be an option in some rare cases. Removing the sweat glands in the armpits could help in case the excessive sweating occurs only in that area. Cutting the nerves that carry the messages from the sympathetic nerves to the sweat glands is a different procedure. Using a procedure known as endoscopic thoracic sympathectomy, this surgery could be performed. In this procedure, three small incisions will be made for a video camera and small surgical instruments. This procedure requires only a day in the hospital, despite the fact that it is a delicate operation, and causes only minimal scarring. Sweating on the hands stops permanently after the surgery. However, increased sweating could occur on the back, back of the legs or elsewhere in the body.


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