Hyperhidrosis is a medical condition that causes excessive sweating. Everyone sweats – sweating is one way we regulate our body temperature. However, people with hyperhidrosis sweat far more than is normal. Hyperhidrosis can cause people to drip with sweat even when they are not exercising or overheated.
In people with hyperhidrosis, the nerves responsible for triggering the sweat glands are overactive. There are two types of hyperhidrosis. In primary focal hyperhidrosis, there is no underlying cause for the condition, and sweating tends to occur in specific areas – especially the underarms, hands and feet, face or head. In secondary generalized hyperhidrosis, sweating is caused by another health condition or a medication, and sweating tends to occur over larger areas of the body.
Read more about the types and causes of hyperhidrosis.
Ancient Greek physicians Hippocrates and Galen were uncertain about the origin of sweat. Did it emerge from tiny openings in the skin, or condense like water vapor on the outside of a cold drink on a hot day? Early physicians were also aware that water evaporated from the skin – a phenomenon they referred to as "insensible perspiration" – but were unsure about the relationship of these invisible vapors to liquid sweat that appeared on the skin. Hidros is the Greek word for sweat, while hyper comes from the Greek for "over" or "beyond." Hence, the word hyperhidrosis means "excessive sweating."
In the 17th century, Italian doctor Sanctorius performed a science experiment that proved he lost tiny amounts of weight through perspiration over many hours. Later that century, Italian anatomist Marcello Malpighi identified the source of sweat as tiny openings – pores – in the skin.
In 1833, Czech anatomist Jan Evangelista Purkinjè identified the existence of sweat glands. Almost a century later, German scientist Paul Schiefferdecker discovered the two types of sweat glands: eccrine and apocrine. Eccrine glands are widespread over the body, and they secrete water and salt. Apocrine glands are focused in areas of thick hair growth, and they secrete a milky fluid in response to stress.
The first antiperspirant was marketed in 1903. Antiperspirants did not become popular for many years due to cultural reluctance to discuss issues involving bodily fluids. However, doctors were aware of hyperhidrosis and actively trying new treatments to relieve excessive sweating.
The first sympathectomy (surgery to cut the sympathetic nerves responsible for stimulating sweating) for hyperhidrosis was attempted in 1919 by French physician Anastas Kotzareff. American neurosurgeon Alfred Adson successfully treated a patient with hyperhidrosis of the hands using cervical sympathectomy in 1935. Over the decades, thoracoscopic sympathectomy underwent several improvements, including the advent of less invasive endoscopic procedures using small incisions and tiny cameras.
The use of anticholinergic drugs to treat hyperhidrosis began in the 1950s. Anticholinergics such as Glycopyrrolate and Oxybutynin are believed to work by blocking chemical messengers that trigger the sweat glands to produce sweat.
In 2004, the U.S. Food and Drug Administration (FDA) approved the use of Botox (OnabotulinumtoxinA) injections for the treatment of hyperhidrosis of the underarms. In 2015, the FDA approved miraDry, a procedure that utilizes microwave technology, to reduce hyperhidrosis of the underarms.
In the United States, between 3 and 5 percent of the population – around 1 to 1.5 million people – have hyperhidrosis. It is likely that many more people have hyperhidrosis than have been diagnosed. People of any age can develop hyperhidrosis, but symptoms most commonly begin in childhood or adolescence.
How is hyperhidrosis diagnosed?
Dermatologists usually diagnose hyperhidrosis. To diagnose hyperhidrosis, the doctor performs a physical exam, asks questions about individual and family medical history, and may take a blood sample or administer a painless “sweat test” to check for potential underlying conditions.
Learn more about the hyperhidrosis diagnosis process.
What are the symptoms of hyperhidrosis?
The main symptom of hyperhidrosis is excessive sweating, which may affect different parts of the body in different people. Some people with hyperhidrosis experience skin rashes and infections or having difficulty holding objects. Depression and anxiety are common in hyperhidrosis, as in all chronic conditions.
Learn more about hyperhidrosis symptoms.
How is hyperhidrosis treated?
Many people treat their hyperhidrosis with over-the-counter or prescription antiperspirants. Some people take prescription oral medications to improve sweating. Procedures used to treat hyperhidrosis include Botox injections, laser surgery, sweat gland removal, miraDry microwave surgery, or endoscopic thoracic sympathectomy to disconnect the nerves that signal the sweat glands.
Learn more about hyperhidrosis treatments.