Clinical Hours: Mon-Fri, 8AM - 3PM(905) 493-5700
1885 Glenanna Road, Suite 220, Pickering, ON, L1V 6R6
Excessive sweating managed with topical agents, iontophoresis, or neuromodulators.
Hyperhidrosis is a condition characterised by excessive and uncontrollable sweating, produced by the eccrine sweat glands, which generate a weak salt solution. These glands are distributed throughout the body but are densely packed on the palms and soles, with approximately 700 glands per square centimetre.
Hyperhidrosis can manifest as either localised or generalised. Localised hyperhidrosis typically affects the armpits, palms, soles, face, or other specific areas, whereas generalised hyperhidrosis impacts most or all of the body. The condition is also categorised as either primary or secondary.
Primary hyperhidrosis generally begins in youth and may persist throughout life, often involving the armpits, palms, and soles symmetrically. It typically decreases at night and stops during sleep. Secondary hyperhidrosis is rarer and may present unilaterally and asymmetrically or as a generalised condition; it can occur at night or during sleep, often due to underlying endocrine or neurological issues or medication effects.
Primary hyperhidrosis affects approximately 1 to 3% of the population and typically begins during childhood or adolescence. It may be hereditary and is notably prevalent among Japanese individuals. Primary hyperhidrosis is often linked to overactivity of the hypothalamic thermoregulatory centre in the brain, which communicates with the eccrine sweat glands through the sympathetic nervous system. Various triggers can induce sweating episodes, including hot weather, exercise, fever, anxiety, and spicy food.
Secondary hyperhidrosis is less common and can occur at any age. Localised causes include auriculotemporal syndrome (gustatory hyperhidrosis), stroke, spinal or peripheral nerve damage, surgical sympathectomy, neuropathy, brain tumours, and chronic anxiety disorder. Generalised causes include obesity, diabetes, menopause, an overactive thyroid, cardiovascular disorders, respiratory failure, endocrine tumours such as phaeochromocytoma, Parkinson's disease, Hodgkin lymphoma, and certain medications including alcohol, caffeine, corticosteroids, and antidepressants.
The impacts of excessive sweating are significant and vary according to the affected site.
Hyperhidrosis is typically diagnosed through clinical evaluation. Tests to determine the underlying cause are generally unnecessary for primary hyperhidrosis but may be required to diagnose secondary hyperhidrosis.
The Minor test is commonly used to identify the specific sites of localised hyperhidrosis. The skin is painted with an iodine solution, which is allowed to air-dry before starch is applied. Areas of sweating change the iodine-starch combination to a dark blue or black colour.
For secondary generalised hyperhidrosis, screening tests based on other clinical features may include assessments of blood sugar levels, glycosylated haemoglobin, and thyroid function.
General management of hyperhidrosis includes wearing loose-fitting, stain-resistant clothing, changing damp clothing and footwear promptly, and using socks infused with silver or copper to reduce odours and infections. Absorbent insoles, non-soap cleansers, and cornstarch powder after bathing may also be beneficial. Avoidance of caffeinated products and discontinuation of any medications that may be contributing to the condition are also recommended.
Topical antiperspirants, available as creams, aerosols, and gels, typically contain 10 to 25% aluminium salts to mitigate sweating. Clinical-strength products using aluminium zirconium salts are particularly effective. Topical anticholinergics such as glycopyrrolate and oxybutynin gel have also been successful in reducing perspiration. These antiperspirants are applied to dry skin after showering and may be washed off in the morning if irritation occurs, with application frequency adjusted as needed.
Iontophoresis involves the use of electric currents in water or glycopyrronium solution to treat the palms, soles, and armpits. This method requires daily sessions initially, with reduced frequency over time. It may cause discomfort or dermatitis and is not always effective.
Oral anticholinergics such as propantheline and oxybutynin may be prescribed but can cause side effects including dry mouth and blurred vision. These medications are used cautiously, particularly in elderly patients, due to the increased risk of dementia. Beta-blockers, which mitigate the physical effects of anxiety, as well as calcium channel blockers and alpha-adrenergic agonists, may also be beneficial for some patients. Prescription management of these medications is available at the Centre for Medical and Surgical Dermatology.
Botulinum toxin injections are approved for treating hyperhidrosis of the armpits and are currently being investigated for use in other areas. The injections act on the sympathetic nerve endings that stimulate the eccrine glands, thereby reducing sweat production.
Surgical removal of sweat glands may be performed through methods such as tumescent liposuction, subcutaneous curettage, and microwave thermolysis. Sympathectomy, a more invasive procedure, may be considered for severe cases but carries risks including compensatory sweating and serious complications such as Horner syndrome.
Medical attention is recommended when excessive sweating interferes with daily activities, causes significant social discomfort, leads to recurrent skin infections, or is accompanied by other symptoms that may suggest an underlying medical condition such as unexplained weight loss, fever, or palpitations. Secondary hyperhidrosis in particular warrants prompt evaluation to identify and address the contributing cause. A referral from a family physician is typically required to access dermatology services at the Centre for Medical and Surgical Dermatology.
The prognosis for localised primary hyperhidrosis often improves with age, whereas the outlook for secondary hyperhidrosis depends on the underlying cause. Ongoing research aims to develop safer and more effective treatments, including new topical and systemic therapies.
Your feedback helps us improve our condition information
A physician referral is required to access our medical services. Contact your primary care provider to begin the referral process.