The diagnosis of hyperhidrosis can often be made by patient history
alone, without the necessity for many tests. The main question to be answered is whether this is primary
hyperhidrosis, or whether the sweating is a symptom
of a larger disease.
Primary hyperhidrosis typically is not generalized sweating, but involves only a single portion of the body. The remainder of the body sweats normally. The most common places for hyperhidrosis to affect are:
Facial, involving the face and often involving severe redness as well. This is often considered the most socially debilitating form.
Palmar/Plantar: involing the hands, feet, or both.
Axillary: involving the armpits.
Gustatory: invovling the trunk or face during meals, especially with spicy food. This is often a side effect of surgical hyperhidrosis treatment.
Primary hyperhidrosis begins at an early age, does not occur during sleep, and becomes worse with heat or anxiety. If symptoms occur during sleep, begin during adulthood, are asymmetric, or occur in the context of hypertension or hyperthyroidism, they may be a symptom of another disease, and deserve a more detailed workup.
Treatment of hyperhidrosis typically begins with antiperspirants, such as aluminum chloride, available in nonprescription or prescription strength. This is effective for mild hyperhidrosis.
Tap water iontophoresis is effective for many patients, though this is a time-consuming treatment.
Anticholingergics such as glycopyrrolate are effective, but have side effects such as dry mouth and constipation.
Surgical treatment is effective but almost universally results in side effects including gustatory sweating or compensatory sweating.
Injection of Botox has also been effective, but must be repeated. Long-term effectiveness is not yet known.