Ep 85 – Hyperhidrosis

Sweating is a crucial way to reduce our body temperature, such as when doing strenuous physical activity or when in a hot environment. Hyperhidrosis is defined as excessive sweating beyond what is physiologically required or normal. It can be categorised as primary (idiopathic), secondary to other conditions, or as a side effect of some medications. Primary hyperhidrosis can affect people at any age, but often starts in early life. The diagnosis of hyperhidrosis is typically made initially on the clinical history, and this can also determine between primary or secondary hyperhidrosis. It is usually diagnosed where there is visible sweating, which interferes with daily activities and which has lasted for at least 6 months. In this podcast, Dr Roger Henderson discusses what to look for when making the diagnosis, what investigations to undertake and the range of treatments currently available. 

Key references

1. NICE. Hyperhidrosis. September 2023. 
2. NHS. Excessive sweating (hyperhidrosis). 7 November 2023. 
3. British Association of Dermatologists. Hyperhidrosis. May 2022. 
4. BMJ Best Practice. Hyperhidrosis. 28 October 2023.
5. Dunford L, et al. Cochrane Database of Systematic Reviews. 2022;2:CD015135.doi: 10.1002/14651858.CD015135. 

Key take home points

• Primary hyperhidrosis affects the sites with the greatest concentration of eccrine glands, i.e., the palms, soles and axillae. It usually presents soon after puberty and typically remits spontaneously in mid-life.
• It presents twice as frequently in women as in men, although this may in part be because women seek advice more often about it. It is thought to affect around 1–2% of the population. In roughly half of affected individuals there is a positive family history.
• Patients with primary hyperhidrosis do not sweat at night (patients wake up dry) – this can help to distinguish it from secondary hyperhidrosis. During the day, sweat often drips off their skin without evaporating.
• The Hyperhidrosis Disease Severity Score can be useful in assessing the degree of hyperhidrosis present.
• There are a great many potential causes of secondary hyperhidrosis, including prescribed medication.
• Excessive washing with soap should be discouraged as this may promote body odour.
• Roll-on aluminium-based treatments must always be applied to dry skin.
• Treat any anxiety that may be present.
• Systemic anticholinergics can be effective, but side effects may limit their use.
• Botulinum injections are only licensed for axillary hyperhidrosis.
• Surgical sympathectomy should be avoided, if possible, although may be necessary as a treatment of last resort.