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Hyperhidrosis (excessive sweating) Causes, Symptoms and Treatment

The hyperhidrosis, Greek HIDROSmeaning sweat, means excessive sweat production. On the basis of what criterion can we describe perspiration as “excessive”? If excess sweat appears obvious in the case of fever or hot flash, it is more difficult to identify when it is not associated with a particular disease or condition. Hyperhidrosis can be considered as any unpleasant sweating that is difficult to control by the use of antiperspirants.

From 1% to 3% of the population would suffer from hyperhidrosis. Because this is a taboo subject, few people dare to see a doctor. Yet, there are ways to better control the production of sweat.

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Types hyperhidrosis (excessive sweating)

Most of the time, hyperhidrosis is not related to any other health problem. It is then primary or essential hyperhidrosis. Primary hyperhidrosis can be localized or generalized:

  • Localized. Only certain areas of the body produce more sweat. The palms of the hands and feet are most often affected, usually at the same time. The armpits can also be the target, alone or with the hands and feet. More rarely, exaggerated sweating can affect the face and scalp , in isolation;
  • Generalized. Sweat emanates excessively from the whole body.

Sometimes a health problem or other specific reason causes heavy sweats. In this case, hyperhidrosis is called secondary. An infection, hyperthyroidism, diabetes, hypoglycaemia or menopause, with its typical hot flashes, may be the cause, for example. Exposure to a biochemical agent can also lead to secondary hyperhidrosis (such as organophosphates already used as a chemical weapon in times of war or during terrorist attacks). In these cases, it is necessary to attack the cause to treat hyperhidrosis. This leaflet focuses on hyperhidrosis related to no other disease.

Causes hyperhidrosis (excessive sweating)

The sweating usually begins at puberty. It occurs mainly in people who experience social discomfort, redness, heart palpitations, etc. It occurs during the day, never at night.

During physical exertion or when it is hot, the body produces more sweat under the control of a gland called the hypothalamus (see box below). In case of hyperhidrosis, two phenomena could occur. This is, at least, what has been observed in cases of hyperhidrosis related to anxiety or stress experienced in society. First, there would be a hyperfunctioning of the usual circuitinitiated by the hypothalamus. In addition, other nerve circuits controlled by the anterior cingulate cortex would be involved. This region of the brain plays an important role in controlling emotions and adapting to different situations.

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The body thermostat

Sweating is a normal physiological phenomenon. Sweating helps to cool the body when body temperature rises, for example during physical activity or hot weather. Normally, it is the hypothalamus, a gland located in the brain that acts as a control center. The hypothalamus maintains body temperature around 37 ° C. When the internal temperature rises, it reacts to dilate the arteries and increase the production of sweat. As sweat evaporates, it cools the body. 2 to 5 million sweat glandsare distributed on the surface of the skin. They produce 1 liter of sweat a day, on average. In case of hyperhidrosis, the production can be three to four times higher.

Possible consequences

Depending on its size, hyperhidrosis can be experienced with difficulty. It can constantly worry the mind and cause significant discomfort in public (sweaty hands, smells, wet clothes, etc.). The person then finds himself in a vicious circle, since the sweat itself is lived in an embarrassing way, and the embarrassment triggers the sweats. In a study, it has been shown that about one in four people who suffer from social phobia has hyperhidrosis which itself tends to aggravate this phobia.

In terms of physiological consequences, people with hyperhidrosis are obviously at greater risk of dehydration. In addition, sweating makes the skin more sensitive to various conditions, such as heat sores, athlete’s foot, onychomycosis and warts.

When to consult?

The hyperhidrosis is a chronic problem. Seek medical attention when needed for excessive sweating that undermines quality of life.

However, in case of unexplained sudden hyperhidrosis, hyperhidrosis accompanied by weight loss or which occurs mainly at night, it is best to consult a doctor without delay.

Symptoms hyperhidrosis (excessive sweating)

Symptoms are triggered by physical exertion, warm weather and strong feelings such as stress or anxiety:

  • Excessive sweating on the feet, palms, underarms, or on the face and scalp.
  • Sweating all over the body in case of generalized hyperhidrosis.
  • Sweating may be abundant enough to wet a garment.

People at risk hyperhidrosis (excessive sweating)

  • People predisposed by their inheritance. From 25% to 50% of people with hyperhidrosis of the hands have a family history Every child born to a parent with hyperhidrosis of hands has one in four chance of being affected;
  • The  obese people  are more at risk of generalized hyperhidrosis;
  • People from Southeast Asia are more affected by hand hyperhidrosis.

Risk factors

Since the causes of hyperhidrosis are not well known, no risk factor has been discovered.

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Preventing Hyperhidrosis (Excessive Sweating)

Measures that help overcome hyperhidrosis
There is no way to prevent hyperhidrosis. However, it is important to be aware of the elements that cause sweats to learn to overcome them. Here are some examples:

  • Learn to relax. In cases where emotions are a trigger for sweating, relaxation techniques provide valuable tools for learning to prevent or reduce sweating. There are various techniques, such as yoga, meditation and biofeedback, which suggest the experts at the Mayo Clinic in the United States.
  • Modify your diet. Watch out for alcohol, tea, coffee and other caffeinated beverages that increase body temperature. Eating spicy foods has the same effect. On the other hand, garlic and onion give sweat a strong smell.


Medical treatments for hyperhidrosis (excessive sweating)

The treatments depend on the extent of the problem. As a general rule, people who consult a doctor or dermatologist have tried several over-the-counter deodorants and antiperspirants, with unsatisfactory results.


Before consulting a doctor, you can experience antiperspirants that are more potent than regular antiperspirants by consulting a pharmacist. These products are kept behind the pharmacy, because their use requires a good knowledge of the procedure to follow.

The products suggested for excessive perspiration contain aluminum chloride, which is more effective than aluminum or zirconium hydrochloride, which is commonly used in regular antiperspirants.

Nonprescription products:

  • solution of ethyl alcohol containing aluminum chloride in varying concentrations: 6% (Xerac AC), 6.25% (mild Drysol) and 20% (Drysol). Available as underarm applicator and bottled solution for hands and feet;
  • hydroalcoholic gel containing 15% aluminum chloride, for underarms, hands and feet (eg Hydrosal). The gel usually causes less skin reactions than the alcohol solution;
  • Product Certain Dri also contains aluminum chloride (12%). It is for its part offered in pharmacies on tablets because it is in aqueous solution.

The risk of irritation, itching and redness is greater than with conventional antiperspirants. Follow the directions of the manufacturer and the pharmacist.

If these products do not control sweating satisfactorily, a physician or dermatologist may prescribe an antiperspirant that contains a mixture of aluminum chloride and other active ingredients.

Antiperspirants and deodorants are often confused, two products with very different effects. Deodorants mask odors by replacing them with perfumes, while antiperspirants reduce the production of sweat. Antiperspirants are produced from metal salts (aluminum or zirconium) that obstruct the ducts of the sweat glands. In addition, they have antibacterial properties. Antiperspirants have the disadvantage of causing irritation, redness and itching in some people.

In more serious cases

Iontophoresis. Iontophoresis consists in using an electric current to decrease the secretion of sweat. It is indicated for people who have severe hyperhidrosis on their hands or feet. The hands, for example, are immersed in two water tanks, in which we put an electrode connected to a device that generates a current of 20 milliamperes. The session lasts about twenty minutes and is repeated several times a week. Once the person is familiar with the procedures, they can get a fixture and do their home treatments. This method must be continued to maintain its effectiveness. It has certain contraindications. Ask your dermatologist.

Injection of botulinum toxin. The subcutaneous injection of botulinum toxin (Botox) is used to treat severe hyperhidrosis of the underarmshandsfeet and face. Botulinum toxin blocks nerve transmissions to the sudorific glands. The effect of the injections persists about four months. Local anesthesia is necessary. It can be done by injecting lidocaine or by a gun (without needle). A treatment requires several injections and costs a few hundred dollars. This use of Botox is authorized by Health Canada and in France for severe axillary hyperhidrosis. Contraindications apply.

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Warning. If you have difficulty swallowing, breathing or talking after Botox treatment, seek medical attention promptly. Health Canada issued a warning in January 2009 that botulinum toxin can disperse into the body and cause significant side effects: muscle weakness, swallowing problems, pneumonia, speech problems and breathing difficulties.

Anticholinergic drugs. These oral medications, such as glycopyrollate and propantheline, block the action of acetylcholine. This chemical messenger stimulates a host of biological reactions, including the production of sweat. This option is however little used and not very interesting in the long term because of the side effects (dry mouth, constipation, loss of taste, dizziness, etc.). Anticholinergics are mainly used in cases of generalized sweating (all over the body). There are also topical anticholinergics in the form of aqueous solutions, applied on the forehead and the scalp.

Cognitive behavioral therapy, antidepressants. When the psychic component is important, some doctors prescribe tranquilizers, antidepressant drugs or anxiolytics. Cognitive-behavioral therapy may also be recommended.

Surgical treatments

Thoracic sympathectomy. This surgery, which consists in permanently destroying the sympathetic ganglia that innervate the sweat glands, treats underarm and hand hyperhidrosis. The procedure can be done with an endoscope , which reduces both the size of the incision and the recovery time. Nevertheless, compensating hyperhidrosis may occur in the back or back of the legs.

Excision of the sweat glands. By surgery, it is possible to remove some of the sweat glands armpits. Local complications are rare.


Tips for a better everyday comfort :

  • Wash daily to eliminate bacteria.
  • Dry properly after bathing or showering. Bacteria and fungi tend to overgrow on moist skin. Particularly monitor the skin between the toes. If necessary, sprinkle the feet with an antiperspirant after drying;
  • Drink plenty of water to make up for losses, which can be up to 4 liters a day. The urine must be clear;
  • Change every day of shoes if sweat is located at the feet. The shoes will probably not dry overnight. It is better not to put the same pair two days in a row;
  • Choose clothes in natural fabrics (cotton, wool, silk) that allow the skin to breathe. For sports activities, focus on “breathable” fibers that allow perspiration to evaporate;
  • Wear appropriate clothing at room temperature. Have a spare garment close at hand ;
  • Opt for leather shoes and socks in cotton or wool. When practicing sports activities, wear suitable sports socks and shoes with absorbent or antifungal soles. Change socks once or twice a day;
  • Ventilate his feet most of the time;
  • Use antiperspirants at night on the palms and soles of the feet. Prefer antiperspirants without perfume.

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