Fast Five Quiz: Embarrassing Medical Conditions

George D. Harris, MD, MS


June 27, 2019

Diagnostic criteria favoring primary hyperhidrosis include excessive sweating of 6 months or more in duration, with four or more of the following:

  • Sweating primarily involving eccrine-dense (axillae/palms/soles/craniofacial) sites

  • Bilateral and symmetric sweating

  • Absent nocturnal sweating

  • Episodes at least weekly

  • Onset at age 25 years or younger

  • Positive family history

  • Impairment of daily activities

Hyperhidrosis may be idiopathic or secondary to other diseases, metabolic disorders, febrile illnesses, or medication use. Generalized hyperhidrosis may be secondary to numerous conditions, including the following:

  • Neurologic or neoplastic diseases

  • Spontaneous periodic hypothermia and hyperhidrosis

  • Metabolic disorders or processes

  • Febrile illnesses

  • Medications

  • Chronic alcoholism

  • Hodgkin disease or tuberculosis (in nocturnal hyperhidrosis)

Localized unilateral or segmental hyperhidrosis is rare and of unknown origin. Unilateral hyperhidrosis with accompanying contralateral anhidrosis is also rare.

Localized hyperhidrosis, unlike generalized hyperhidrosis, usually begins in childhood or adolescence. Hyperhidrosis beginning later in life should prompt a search for secondary causes, such as systemic diseases, adverse effects of medication use, or metabolic disorders.

Therapy for hyperhidrosis can be challenging for both the patient and the physician. Both topical and systemic medications have been used in the treatment of hyperhidrosis. The US Food and Drug Administration approved glycopyrronium tosylate topical cloth in June 2018 for primary axillary hyperhidrosis in adults and children aged 9 years or older. It is an anticholinergic agent that inhibits the action of acetylcholine on sweat glands. Aldehydes may be used to treat the palms and soles; they are not as effective in the axillae. Because of the limitations of other agents, Drysol (20% aluminum chloride hexahydrate in absolute anhydrous ethyl alcohol) has been commonly used as a first-line topical agent.

Read more about hyperhidrosis.


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