Rare Classroom: Hyperhidrosis

Welcome to the Rare Classroom, a new series from Patient Worthy. Rare Classroom is designed for the curious reader who wants to get informed on some of the rarest, most mysterious diseases and conditions. There are thousands of rare diseases out there, but only a very small number of them have viable treatments and regularly make the news. This series is an opportunity to learn the basics about some of the diseases that almost no one hears much about or that we otherwise haven’t been able to report on very often.

Eyes front and ears open. Class is now in session.

The rare disease that we will be learning about today is:


What is Hyperhidrosis?

  • Hyperhidrosis is characterized by excessive sweating​
  • Impairs daily activities and results in substantially diminished health-related quality of life​
  • Affects about 15 million people in the US (4.8% of population)​
    • 1.3 million individuals (0.5% of the population) have sweating that is barely tolerable and frequently interferes with daily activities.
    • Not considered rare
  • Treatment options include antiperspirants, medications, procedures and/or surgery​
  • Diagnosed through physical exam and sometimes a “sweat test”​
  • With treatment, hyperhidrosis can be managed​

How Do You Get It?

  • Up to half of patients have a family history, suggesting a genetic origin
    • However, no precise cause has been identified
  • Can be triggered later in life
    • Often by other diseases and conditions, certain medications, menopause, or low blood sugar

What Are The Symptoms?

  • The primary symptom of hyperhidrosis is heavy, excessive sweating.
    • In some patients, clothing can become soaked in a matter of minutes.
  • Sweating can have economic implications that affect workplace productivity (particularly because it affects individuals during prime employment years)
  • Sweating often impedes normal daily activities and can result in occupational, emotional, psychological, social, and physical impairment in a substantial proportion of individuals
  • The disease comes in two main types: primary (or focal) hyperhidrosis and secondary (or generalized) hyperhidrosis

Primary hyperhidrosis

  • Excessive sweating is unrelated to any other medical cause​
  • Often evident in early childhood or adolescence​
  • Most commonly affects the face, underarms, hands, or feet​


  • Palmar hyperhidrosis – Primarily sweat on palms – one of the most common types​
  • Plantar hyperhidrosis – Impacts the soles of feet​
  • Axillary hyperhidrosis – Concentrated in the underarm area​
  • Facial hyperhidrosis – Excessive sweat on head and face​
  • Truncal hyperhidrosis –  Excessive sweating in the groin, buttock, vagina and/or thigh region​

Secondary hyperhidrosis

  • Excessive sweating results from a separate medical condition or as a side effect of medication​
  • Often begins in adulthood and produces more generalized sweating depending on its cause​

How Is It Treated?

  • Goal: reduce sweating to a normal (or at least reasonably manageable) level
  • Surgery is typically used after failure of other treatments​
    • Endoscopic thoracic sympathectomy​
    • Severing the nerves that carry messages to the sweat glands​
    • Excision of axillary tissue​
    • Subcutaneous axillary curettage and liposuction​
  • Botulinum toxin A​
    • FDA approved for axillary sweating or excessive sweating under the arms​
    • It has not been approved for the treatment of sweaty palms or feet.​
  • Topical Treatments​
    • Prescription antiperspirants​
  • Iontophoresis​
    • A medical device is used to pass a mild electrical current through water (usually using shallow pans for hands or feet or specific pads for other body areas) and through the skin’s surface. Requires regular treatment.​
  • Off label medications​
    • Most commonly used – Anticholinergic agents​
    • Sometimes used – Amitriptyline, clonazepam, Beta-blockers and calcium-channel blockers, gabapentin and indomethacin​
  • Biofeedback training​
  • Hypnosis​
  • Relaxation techniques​
  • Trigger avoidance​
  • Avoid: Caffeine, alcohol, high temperatures, spicy foods​

Where Can I Learn More???

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