Hyperhidrosis
Hyperhidrosis is a disorder of the sweat glands in which the body produces far more sweat than it needs to regulate temperature. It may be focal, affecting only certain areas, or generalized over the whole body, and it can take a heavy toll on a person's confidence, social life and overall quality of life.
Hyperhidrosis is classified by its underlying cause:
- Primary hyperhidrosis: driven by overactivity of the sympathetic nervous system, which stimulates the eccrine sweat glands through the neurotransmitter acetylcholine. The glands themselves are normal in number and structure, but they overreact to emotional triggers and small changes in temperature.
- Secondary hyperhidrosis: the result of an underlying systemic condition (such as hyperthyroidism, diabetes, pheochromocytoma or a neurological disorder), perimenopause, or a side effect of certain medications (such as antidepressants and blood pressure drugs).
At Haute-Derma, our approach starts with accurately determining whether hyperhidrosis is primary or secondary and measuring its impact with validated clinical scales. We then build an individualized treatment plan to bring sweating under control while protecting the skin's natural barrier.
Clinical Features and Differential Diagnosis
The clinical assessment looks at where and how the sweating occurs, so that primary focal hyperhidrosis can be clearly separated from secondary generalized forms:
- Typical focal sites: in primary hyperhidrosis, sweating is concentrated in areas rich in eccrine glands: the palms (palmar), soles (plantar), underarms (axillary) and face and scalp (craniofacial).
- Symmetry: primary focal hyperhidrosis is almost always clearly symmetrical on both sides of the body.
- No sweating during sleep: this is a key diagnostic criterion for primary hyperhidrosis. In deep sleep, sympathetic activity falls and sweating stops completely. Night sweats, by contrast, are a warning sign of secondary hyperhidrosis due to an internal disease or infection.
- Onset and family history: the condition usually begins in childhood or before puberty and tends to persist. About 30%–50% of patients have a family member with the same tendency.
- Secondary skin complications: constantly damp skin becomes macerated and white, which raises the risk of fungal infection (such as athlete's foot and tinea), bacterial overgrowth causing body odor (from Corynebacterium), and irritant contact dermatitis.
The Haute-Derma Approach to Diagnosis and Treatment
- Classification and mapping of affected areas: after a clinical examination, the doctor performs Minor's starch-iodine test to outline exactly how large the overactive area is and how densely it sweats. A full medical history is taken to rule out secondary causes.
- HDSS scoring and trigger control: the Hyperhidrosis Disease Severity Scale (HDSS) is used to grade the impact and guide treatment choice. Patients are also advised on managing sympathetic triggers such as alcohol, caffeine, spicy food and psychological stress.
- Individualized specialist treatment: treatment is matched to each body site, ranging from high-strength aluminum chloride topicals and iontophoresis for the hands and feet to botulinum toxin (Botox) injections, which block acetylcholine release from sympathetic nerve endings.
- Protecting the skin barrier: we provide a medical skin-care routine using gentle antibacterial cleansers, together with moisturizers that restore the lipid barrier and support a balanced skin microbiome, to prevent maceration, body odor and secondary infection.
Common Types of Hyperhidrosis
| Type | Mechanism and Clinical Features |
|---|---|
| Primary focal hyperhidrosis | Caused by overactivity of the sympathetic nervous system. Symmetrical sweating of the hands, feet, underarms and face; starts early in life and stops completely during sleep. |
| Secondary generalized hyperhidrosis | Caused by an underlying medical condition (hyperthyroidism, diabetes, infection) or a medication side effect. Sweating affects the whole body and can occur during sleep. |
| Emotional hyperhidrosis | An exaggerated central nervous system response to anxiety, stress or nervousness. Sweating is most pronounced on the palms and soles. |
