Hyperhidrosis [Sweating - excessive; Perspiration - excessive; Diaphoresis]
Definition
- Excessive sweating palms and soles
- Exacerbated by stress or anxiety
- Only occurs while awake
Differential Diagnosis
- Acromegaly
- Anxiety conditions
- Cancer
- Carcinoid syndrome
- Certain medications and substances of abuse
- Glucose control disorders
- Heart disease
- Hyperthyroidism
- Lung disease
- Menopause
- Parkinson’s disease
- Pheochromocytoma
- Spinal cord injury
- Stroke
- Tuberculosis or other infections
- Exams and Tests
Visible signs of sweating may be noted during a doctor's visit. A number of tests may also be used to diagnose excessive sweating.
Tests include:
Starch-iodine test. An iodine solution is applied to the sweaty area. After it dries, starch is sprinkled on the area. The starch-iodine combination turns a dark blue color wherever there is excess sweat.
Paper test. Special paper is placed on the affected area to absorb the sweat, then weighed. The heavier it weight, the more sweat has accumulated.
The patient may be also be asked details about the sweating.
Treatments may include:
Antiperspirants: Aluminum Chloride: Initially a patient may need to use it three to seven times a week.
Medication. Anticholinergics drugs, such as glycopyrrolate (Robinul, Robinul-Forte),
Iontophoresis. It is most effective for sweating of the hands and feet.
Botox. Botulinum toxin type A (Botox) was approved by the FDA in 2004 for the treatment of severe underarm sweating, a condition called primary axillary hyperhidrosis. Small doses of purified botulinum toxin injected into the underarm temporarily block the nerves that stimulate sweating. Side effects include injection-site pain and flu-like symptoms. If you are considering Botox for other areas of excessive sweating talk to your doctor in detail. The effect of a single injection can last up to a few months. Some patients need additional injections.
Preferred option for axillary hyperhidrosis
- Serial intracutaneous injections
- Each injection spaced 0.5 to 2 cm apart
- Anhidrosis at each site persists 4-13 months
Endoscopic thoracic sympathectomy (ETS). In severe cases, a minimally-invasive surgical procedure called sympathectomy may be recommended.
When to Contact a Medical Professional
There is prolonged, excessive, and unexplained sweating.
Sweating is accompanied or followed by chest pain or pressure.
Sweating is accompanied by weight loss or most often occurs during sleep.
If sweating is accompanied by fever, weight loss, chest pain, shortness of breath, or a rapid, pounding heartbeat. These symptoms may indicate an underlying problem, such as hyperthyroidism.