Excessive sweating

Excessive sweating, or hyperhidrosis, is a condition characterized by abnormally increased sweating, in excess of that required for regulation of body temperature. Although primarily a physical burden, hyperhidrosis can deteriorate quality of life from a psychological, emotional, and social perspective. It has been called by some 'the silent handicap'. 

Hyperhidrosis can either be generalized, or localized to specific parts of the body. Hands, feet, armpits, groin, and the facial area are among the most active regions of perspiration due to the high number of sweat glands (eccrine glands in particular) in these areas (Pic. 1). When excessive sweating is localized (e.g. palms, soles, face, underarms, scalp) it is referred to as primary hyperhidrosis or focal hyperhidrosis. Excessive sweating involving the whole body is termed generalized hyperhidrosis or secondary hyperhidrosis. It is usually the result of some other, underlying condition.

Primary hyperhidrosis, which is present from birth or young age, must be distinguished from secondary hyperhidrosis, which can start at any point in life. For some, it can seem to come on unexpectedly. 

The cause of primary hyperhidrosis is unknown, although some physicians claim it is caused by overactivity of the sympathetic nervous system. The latter form may be due to a disorder of the thyroid or pituitary gland, diabetes mellitus, tumors, gout, menopause, certain drugs, or mercury poisoning. Such secondary forms may have more serious consequences than just hyperhidrosis, making medical consultation advisable.

Anxiety or excitement can exacerbate the condition for many sufferers. A common complaint of patients is they get nervous because they sweat, then sweat more because they are nervous. Other factors can play a role, including certain foods and drinks, nicotine, caffeine, and smells.

Excessive sweating may be associated with many diseases, including:

Hyperthyroidism

Hyperthyroidism is a condition in which the thyroid gland (Pic. 2) produces and secretes excessive amounts of the free thyroid hormones: triiodothyronine and/or thyroxine. Symptoms are due to an excess of thyroid hormone. Thyroid hormone is important at a cellular level, affecting nearly every type of tissue in the body. Thyroid hormone functions as a controller of the pace of all of the processes in the body. This pace is called the metabolic rate. If there is too much thyroid hormone, every function of the body tends to speed up. Major clinical signs include weight loss (often accompanied by an increased appetite), anxiety, heat intolerance, hair loss (especially of the outer third of the eyebrows), muscle aches, weakness, fatigue, hyperactivity, irritability, excessive urination, excessive thirst, tremor, emotional lability, and sweating.

Infections

Diaphoresis, or excessive sweating, can also be caused by many types of infections, often accompanied by fever and/or chills. Most infections can cause some degree of diaphoresis and it is a very common symptom in some serious infections such as malaria and tuberculosis.

Diabetes mellitus

Diabetes is a chronic disease that requires continuous medical care and patient self-management education to prevent acute complications and reduce the risk of long-term complications. The overall objective of type 2 diabetes’s management is to achieve and maintain blood glucose control and reduce the risk of long-term complications. Many studies have shown that modern management with intensive glycemic control can limit, delayed or even prevent the chronic complications of diabetes. However this intensive diabetes treatment could be associated with an increased risk of hypoglycemia (low blood sugar), particularly in patients with type 1 diabetes mellitus and patients with longstanding insulin-treated type 2 diabetes mellitus. 

Hypoglycemia is one of the most important complications of diabetes treatment. Symptoms typically come on quickly, including shakiness and nervousness, tachycardia (high heart rate), pallor, cold skin, and typically cold sweating.