What Is Hyperhidrosis?When Sweating Is More Than Normal

You change your shirt before the meeting, and again after. Your hands leave a damp print on the pen. You carry a spare top in your bag the way other people carry gum. Everyone else in the room seems comfortable, and you’ve been sweating since you walked in.

How to tell if it’s more than normal

The AAD¹ says signs include sweating heavily when it’s cool, or sweating a lot when everyone else finds the temperature comfortable. The common spots are the palms, underarms, soles and head. Cleveland Clinic² says an estimated 3% of US adults between 20 and 60 have it.

The AAD¹ says it often starts in childhood or adolescence. Sweating that begins later, or with a new medicine, is a reason to ask about the second type below.

Two types

Cleveland Clinic² separates them:

• Primary focal hyperhidrosis. A chronic skin condition tied to genetics, usually affecting the armpits, hands, feet and face. The AAD¹ says it may involve overactive nerves.
• Secondary generalized hyperhidrosis. Sweating triggered by another condition or a medicine. Cleveland Clinic² lists medicines like naproxen, and conditions such as diabetes and Parkinson’s disease.

The NHS³ adds that sweating can come on for no obvious reason, because of another condition you have, or as a side effect of a medicine you take.

Triggers that make either type worse, per Cleveland Clinic²: stress, anxiety, fear or nervousness, warm temperatures, exercise and certain foods or drinks. See our articles on sweating when you’re nervous, sweaty palms, sweaty feet and sweating under the breasts. If it’s mostly at night, see night sweats, and for flushing and heat waves, hot flashes.

How it’s diagnosed

Cleveland Clinic² says providers use a physical exam and diagnostic criteria. A starch-iodine test, which turns dark blue where you sweat heavily, and a paper absorption test can measure it, and blood tests or imaging may look for an underlying cause.

What helps

The AAD¹ says there’s no cure, but a dermatologist can develop an individualized treatment plan that can reduce excessive sweating, or end it, using medicines, procedures or both along with self-care.

At home. The NHS³ suggests stronger antiperspirants rather than deodorant, sweat shields, loose moisture-wicking clothing, and changing socks twice a day. It says to avoid tight or synthetic clothing and enclosed shoes, and to limit alcohol and spicy food. A pharmacist can advise on antiperspirants.

Medical treatments. The NHS³ lists tablets that reduce sweating, creams, iontophoresis (a weak electric current passed through water) and Botox injections, plus surgery to remove sweat glands in severe cases. Cleveland Clinic² lists anticholinergic medicines, Botox, iontophoresis, microwave therapy and a surgery called endoscopic thoracic sympathectomy.

Which of those suits you is a conversation with a dermatologist, who can pick based on where you sweat and how much.

The play

Try this: a sweat diary

For two weeks, write down where you sweat, what you were doing, what you’d eaten or drunk, the room temperature and how it affected your day.

List every medicine and supplement you take. Bring the diary to your appointment, with a note on whether it happens at night.

When to get checked

The AAD¹ says to consult a dermatologist if you suspect hyperhidrosis. Cleveland Clinic² says to see a provider if sweating negatively affects your life, makes you avoid activities, worsens over time or happens during sleep. The NHS³ says to see a GP if self-help doesn’t work, it affects daily life or it happens at night for no obvious reason.

Book an appointment if any of these fit:

• You sweat heavily when the room is cool
• You avoid handshakes, outfits, work or social events because of it
• It started suddenly, or it’s getting worse
• It wakes you at night or soaks the bedding
• Over-the-counter antiperspirants no longer help
• It began after you started a new medicine

Heavy sweating is a recognized condition with a list of treatments. You can skip the spare shirt and ask about them.