Diaphoresis

Hyperhidrosis is the production of sweat which is in excess of that needed for normal thermoregulation (1).

• the condition, although it often goes unreported, can have a negative effect on quality of life
• it may be associated with an unpleasant odour (bromhidrosis) caused by by-products of bacteria that colonise sweaty areas (1)

Hyperhydrosis can be primary (idiopathic hyperhidrosis) and secondary hyperhidrosis. Furthermore, excessive sweating in patients can be either in a localized area (focal) or over the entire body (generalized) (2)

• primary disease is usually focal and may affect
  • axillae (73%)
  • hands (45.9%)
  • feet (41.1%)
  • scalp (22.8%)
  • groin (9.3%)
• secondary hyperhidrosis can be generalized or focal (1,2)

Primary hyperhidrosis commonly starts during childhood or adolescence (3):

• believed to be caused by overactive hypothalamic thermoregulation
• commonly focal, and in 30% to 50% of cases a family history is reported
• people with primary hyperhidrosis may find that the disease persists or improves as they age
• is a clinical diagnosis where sweating is visible, excessive, focal, and has no apparent cause
  • further diagnostic criteria include:
    • a duration of more than 6 months and/or occurrence in at least one focal area;
    • bilateral and approximately symmetrical sweat pattern;
    • positive family history;
    • frequency of at least twice a week; interference with daily activities;
    • onset before the age of 25; and
    • cessation during sleep (unlike secondary hyperhidrosis)

Secondary hyperhidrosis can start at any age (3)

Considerations:

• palmar hydrosis can affect manual tasks, such as writing, using tools, and playing instruments
• plantar hyperhidrosis can ruin footwear and make the feet more prone to pompholyx or secondary bacterial or fungal infection

Reference:

1. Benson RA, Palin R, Holt PJ, Loftus IM. Diagnosis and management of hyperhidrosis. BMJ. 2013;347:f6800
2. Perera E, Sinclair R.Hyperhidrosis and bromhidrosis - a guide to assessment and management. Aust Fam Physician. 2013;42(5):266-9
3. Ashton S et al. Hyperhidrosis: assessment and management in general practice. British Journal of General Practice 2024; 74 (742): 236-238. DOI: 10.3399/bjgp24X737361