Sweating is a natural bodily function, essential for regulating internal temperature and eliminating toxins. However, when perspiration occurs excessively and out of context — such as at rest or in cold environments — it may be a sign of a condition called excessive sweating or hyperhidrosis. This problem, in addition to being physical, often deeply affects the self-esteem and social life of those who experience it. In this text, we’ll understand what excessive sweating is, why it happens, how it is diagnosed, and what treatments are available.
What is excessive sweating?
Excessive sweating, or hyperhidrosis, is characterized by an abnormally high production of sweat, far beyond what is necessary to maintain the body’s thermal balance. It can occur locally (such as on the hands, armpits, face, or feet) or generally, affecting large areas of the body.
There are two main types of hyperhidrosis:
- Primary hyperhidrosis: more common, usually localized, and with no identifiable medical cause. It often begins in childhood or adolescence.
- Secondary hyperhidrosis: caused by other health conditions or use of medications, and generally causes sweating all over the body.
What are the causes of excessive sweating?
The causes vary according to the type of hyperhidrosis:
Primary hyperhidrosis
It is not related to underlying diseases. A genetic factor is believed to be involved, as many patients report a family history. Sweat usually concentrates on the palms, soles of the feet, armpits, and face. Situations like stress, nervousness, or heat can aggravate the condition, but they are not the only reasons for perspiration.
Secondary hyperhidrosis
It can be triggered by:
- Menopause
- Hypoglycemia
- Hyperthyroidism
- Infectious diseases (such as tuberculosis)
- Neurological disorders
- Cancers, like lymphoma
- Use of certain medications (antidepressants, antipyretics, among others)
In this case, sweating is often more intense during sleep and affects the entire body. Therefore, detailed medical investigation is required.
How is it diagnosed?
Diagnosis of excessive sweating is clinical, based on a conversation with the patient, symptom analysis, and physical examination. In cases of suspected secondary hyperhidrosis, laboratory and imaging tests may be ordered to investigate possible underlying causes.
Clinical criteria for diagnosing primary hyperhidrosis include:
- Excessive sweating for at least six months
- Onset before age 25
- Bilateral and symmetrical episodes
- Interference with daily routine
- Family history
- No sweating during sleep
When associated diseases are suspected, the investigation is expanded.
What are the impacts on quality of life?
Excessive sweating does not pose a direct threat to life but has a significant impact on self-esteem and social and professional life. Many patients avoid handshakes, feel embarrassed in public situations, and even stop wearing certain types of clothing for fear of visible stains.
In addition to emotional discomfort, excessive sweat can promote skin infections, cracking, bad odor, and, in more severe cases, dehydration.
What treatments are available?
Treatment depends on the severity of the condition and the patient’s response to initial approaches.
Antiperspirants
Products with high concentrations of aluminum chloride can be used on the armpits, hands, and feet. They are accessible and work well in mild to moderate cases.
Oral medications
Anticholinergics like oxybutynin help reduce sweat production, but may cause side effects such as dry mouth and constipation.
Botulinum toxin (Botox)
Botulinum toxin injections temporarily block the nerves that stimulate the sweat glands. The effect lasts between 4 and 9 months and is especially effective for armpits, palms, and soles.
Iontophoresis
Involves applying low-intensity electric current in a tray of water where hands or feet are immersed. The treatment is progressive and effective in many cases.
Sympathectomy
Surgery indicated for severe cases resistant to clinical treatment. It involves blocking or removing the sympathetic nerves responsible for sweating. It is effective, but can cause compensatory sweating in other parts of the body.
Complementary therapies
- Psychotherapy for anxiety control
- Relaxation techniques and stress management
- Balanced diet and adequate hydration
Myths and facts about excessive sweating
- “Excessive sweat is a sign of poor hygiene.” False. Hyperhidrosis is not related to lack of cleanliness and can affect people who maintain strict hygiene habits.
- “Intense sweating is normal in nervous people.” Partially true. Emotions can intensify sweating, but when perspiration is disproportionate, it may indicate hyperhidrosis.
- “Excessive sweating can be cured.” In many cases, control is possible with available treatments, but a definitive cure is rare, especially in primary hyperhidrosis.
“Botox is only for aesthetics.” False. Botulinum toxin is one of the most effective options for controlling excessive sweat in specific areas.
