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Hyperhydrosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Hyperhidrosis is the production of sweat which is in excess of that needed for normal thermoregulation (1).

  • the condition, although it often goes unreported, can have a negative effect on quality of life
  • it may be associated with an unpleasant odour (bromhidrosis) caused by by-products of bacteria that colonise sweaty areas (1)

Hyperhydrosis can be primary (idiopathic hyperhidrosis) and secondary hyperhidrosis. Furthermore, excessive sweating in patients can be either in a localized area (focal) or over the entire body (generalized) (2)

  • primary disease is usually focal and may affect
    • axillae (73%)
    • hands (45.9%)
    • feet (41.1%)
    • scalp (22.8%)
    • groin (9.3%)
  • secondary hyperhidrosis can be generalized or focal (1,2)

Primary hyperhidrosis commonly starts during childhood or adolescence (3):

  • believed to be caused by overactive hypothalamic thermoregulation
  • commonly focal, and in 30% to 50% of cases a family history is reported
  • people with primary hyperhidrosis may find that the disease persists or improves as they age
  • is a clinical diagnosis where sweating is visible, excessive, focal, and has no apparent cause
    • further diagnostic criteria include:
      • a duration of more than 6 months and/or occurrence in at least one focal area;
      • bilateral and approximately symmetrical sweat pattern;
      • positive family history;
      • frequency of at least twice a week; interference with daily activities;
      • onset before the age of 25; and
      • cessation during sleep (unlike secondary hyperhidrosis)

Secondary hyperhidrosis can start at any age (3)

Considerations:

  • palmar hydrosis can affect manual tasks, such as writing, using tools, and playing instruments
  • plantar hyperhidrosis can ruin footwear and make the feet more prone to pompholyx or secondary bacterial or fungal infection

Reference:

  1. Benson RA, Palin R, Holt PJ, Loftus IM. Diagnosis and management of hyperhidrosis. BMJ. 2013;347:f6800
  2. Perera E, Sinclair R.Hyperhidrosis and bromhidrosis - a guide to assessment and management. Aust Fam Physician. 2013;42(5):266-9
  3. Ashton S et al. Hyperhidrosis: assessment and management in general practice. British Journal of General Practice 2024; 74 (742): 236-238. DOI: 10.3399/bjgp24X737361

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