Presentation and assessment of primary hyperhidrosis

Primary hyperhidrosis refers to endogenous excessive sweating that is usually long term. It can affect most or all of the body (generalised hyperhidrosis); however, the symptoms are more severe when present in localised areas (primary focal hyperhidrosis), such as the palms, soles, axillae and sometimes the face. The symptoms in primary focal hyperhidrosis are usually symmetrical.

Primary hyperhidrosis affects approximately 2 to 3% of the population. Onset is most common in childhood or puberty, and patients may have a family history of the condition. The condition is exacerbated by stress, and is relatively independent of temperature (can occur in both warm and cool climates) but is usually more severe with warm weather.

Severe primary hyperhidrosis can be debilitating, affecting the patient’s quality of life socially, emotionally and professionally. Despite this, many patients seek treatment late, often years after onset.

Management of primary hyperhidrosis depends on whether hyperhidrosis is localised or generalised . Management may involve referral to a specialist (eg dermatologist or neurologist with expertise in sweating disorders).

Patients with primary hyperhidrosis are at a higher risk of secondary bacterial, fungal and viral skin infectionsWalling, 2009—monitor for signs of secondary skin infections.

Hyperhidrosis can be secondary to many causes. If sweating occurs at night during sleep, or is not consistent with primary hyperhidrosis (eg pattern, typical age of onset, distribution), consider other causes, including:

  • fever
  • chronic infection (eg endocarditis)
  • endocrinopathy (eg hyperthyroidism, diabetes, phaeochromocytoma)
  • certain neurological conditions (eg Parkinson disease)
  • drugs (especially antidepressants)
  • malignancies (especially lymphomas)
  • Raynaud phenomenon
  • trauma (eg after surgery [Frey syndrome], spinal cord injury).

In practice, only hyperthyroidism routinely needs to be excluded, because the other triggers usually present with specific symptoms.