Excessive Sweating (Hyperhidrosis)

Excessive sweating (hyperhidrosis) is a condition characterised by the body sweating more than normal. The sweating is often greater than can be explained by ambient temperature, physical activity or emotional state, and can significantly affect a person's daily life, work, social relationships and quality of life.

Hyperhidrosis is divided into two groups: primary and secondary. Primary hyperhidrosis is localised; no underlying condition is found, and it usually begins in childhood or young adulthood. Secondary hyperhidrosis, on the other hand, can develop due to an underlying cause such as thyroid disease, infections, hormonal disorders, neurological conditions or certain medications. For this reason, it is important to investigate underlying causes, particularly in excessive sweating that starts later or affects the whole body.

Primary hyperhidrosis appears most often in the underarms, palms, soles and facial area. In some people only a single area is affected, while in others several areas are affected together. Sweating of the hands can cause difficulty with handshaking, writing, using a keyboard or tasks requiring fine motor skill. Excessive sweating of the soles can create a constantly moist environment inside shoes, making it easier for fungal and bacterial infections to develop, causing odour and markedly reducing everyday comfort. Underarm sweating, meanwhile, can cause noticeable wetting of clothing and odour, adversely affecting social life.

The diagnosis is usually made from the patient's history and dermatological examination. Where needed, an iodine-starch test can be used to assess the areas where sweating is heaviest and its severity. This examination is a useful guide, particularly in patients for whom botulinum toxin treatment is planned, in determining the areas to be injected, and in assessing the response to treatment in both underarm and hand-and-foot sweating.

Treatment is planned according to the area and severity of the sweating. Topical treatments, iontophoresis and botulinum toxin (Botox) applications are among the effective options. With appropriate, individually planned treatment, excessive sweating can be brought largely under control and quality of life markedly improved.