Hyperhidrosis is excessive sweating that's not always related to heat or exercise, causing social anxiety and embarrassment. In this article, we have covered the symptoms, assessment, evaluation, triggers and treatment advice to deal with this condition in patients.

Hyperhidrosis is one of the most common presenting symptoms of patients coming to OPD. It's important to rule out more significant reasons for sweating with anxiety, which is a typical cause. Hyperhidrosis, or excessive sweating, is a non-specific symptom with several potential causes. There are many other symptoms present in patients with hyperhidrosis that point to a specific cause; nonetheless, it is crucial to ask about the warning symptoms in order to rule out more severe conditions.

Signs that should raise an alarm

• Night sweats
• Systemically unwell patient
• Unintentional weight loss
• Chest pain
• Palpitations

What should patients be asked?

Take careful notes on how long the sweating lasts and where it occurs. Infection or heart problems are two possible explanations for the sudden onset of symptoms. Anxiety might be diagnosed based on a long-term pattern of symptoms.

Sweating may be caused by worry, but there are often other factors at play, and nocturnal sweats are not typical of anxiety.

A diagnosis of primary localised (focal) hyperhidrosis should be considered if at least two of the following characteristics apply and the sweating has continued for more than six months and is localised (in the palms, soles, or axillae):

Symptoms include: sweating on both sides, more than usual, at least once a week, interfering with everyday life, stopping at night, and a strong family history of the condition.

Among other potential infection risk factors, the patient's recent travel history and line of work are important questions to ask. It's important to have a complete drug and alcohol history.

Assessment

Lymphadenopathy, hepatomegaly, and splenomegaly are all abnormalities that need to be checked for during a complete physical examination. It's important to keep track of the patient's pulse and blood pressure. Both thyrotoxicosis and phaeochromocytoma, which may grow in the thyroid, are associated with rapid heart rate and atrial fibrillation. If an infection is suspected, a fever should be measured.

Evaluation

In order to rule out infections and cancers, a complete blood count and inflammatory markers would be performed, as well as a thyroid function test.

A finger prick blood glucose test (ideally at the time of sweating) may be helpful in determining whether or not hypoglycemia is the cause of perspiring. Testing blood glucose levels is recommended for those experiencing severe symptoms.

Check for follicle-stimulating hormone levels and inquire about any symptoms of menopause in women under 45 if menopause is being investigated. A chest x-ray should be obtained if infection, notably TB, or cancer is suspected, and an electrocardiogram should be conducted if warranted by the results of the examination.

Phaeochromocytoma is uncommon, however, a 24-hour urine test for catecholamines may either rule it out or confirm it. The result may be inaccurate if the urine collection is not carried out in accordance with local laboratory guidelines. Suspicion should lead to a visit to an endocrinologist if possible.

Possible triggers for excessive sweating

• Anxiety
• Infection - HIV, tuberculosis, infective endocarditis
• Drugs - alcohol, drug withdrawal, venlafaxine
• Thyrotoxicosis
• Menopause
• Hypoglycaemia
• Acromegaly
• Phaeochromocytoma
• Syncope
• Acute coronary syndrome
• Primary localised hyperhidrosis
• Malignancy

Treatment

It is recommended that people stay away from any evident triggers. Antiperspirants, looser clothing, more frequent garment changes, and wearing white or black may all help conceal perspiration.

In addition to keeping an extra pair of shoes on hand to let wet ones dry off, people may try non-occlusive footwear. In order to alleviate symptoms, 20% aluminium chloride formulations may be used as directed.

Concerns about this symptom need to be addressed and dealt with effectively. If the problem persists after these interventions, seeing a dermatologist is recommended.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.