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Excessive sweating
Hyperhidrosis: when sweating goes beyond heat and exertion, and what can be done.
Sweating is normal and useful: it is how the body regulates temperature. We speak of hyperhidrosis when the amount of sweat far exceeds what is needed for cooling, to the point of conditioning daily life — the choice of clothes, a handshake, the fear of standing up from a chair. It is a medical problem, not a matter of hygiene or nervousness, and it has solutions.
The most important distinction is between two pictures that resemble each other little and are approached differently. Primary hyperhidrosis affects circumscribed, symmetrical areas — underarms, palms, soles, face — usually begins at a young age, often runs in the family and, a revealing detail, stops at night. It is a condition in its own right: the sweat glands are normal, but they receive a disproportionate nerve signal.
Secondary hyperhidrosis behaves in the opposite way: it tends to be generalised over the whole body, appears in adulthood, does not spare the night, and depends on something else — a current medication, an endocrine or metabolic condition, other general causes. Here the first step is not a treatment for the sweating, but understanding what lies behind it.
The practical consequence is that the visit does not serve to confirm that you sweat too much — the patient already knows that — but to establish which of the two pictures applies. Sweating heavily at night, or having started suddenly as an adult, is not a detail: it changes the whole path completely.
If the sweating does not stop at night either, we start from a different question
It is the most useful dividing line and the patient already knows it without realising. Primary hyperhidrosis switches off during sleep; sweating that soaks the bed, is spread over the whole body, or began suddenly in adulthood indicates a different picture, which must be assessed first. If it is also accompanied by fever, weight loss or marked fatigue, the priority is not to treat the symptom but to look for its cause. This is not an alarm: it is why the visit comes before the treatment.
How it shows
- Sweating out of proportion to temperature and physical activity
- Typical areas: underarms, palms, soles of the feet, face and scalp
- Symmetrical distribution, the same on both sides
- Marks on clothing, wet hands, difficulty writing or using devices
- Onset at a young age and, often, other cases in the family
- Social and professional impact out of proportion to how the problem is described
How we proceed
- 1Visit: areas involved, age of onset, night-time pattern, family history and current medication
- 2Distinction between primary and secondary forms, which do not share the same path
- 3In the primary form: topical measures as a first step, where they are sufficient
- 4Botulinum toxin on the indicated areas when topical measures are not enough
- 5Follow-up to assess the response and plan the timing of maintenance
Available treatments
- Dermatology visit
- Primary/secondary assessment
- Botulinum toxin
- Topical measures
- Scheduled follow-up
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Frequently asked questions
Is botulinum toxin for sweating the same as for wrinkles?+
It is the same molecule, but the target and technique differ. On wrinkles it acts on the signal to the muscle; in hyperhidrosis it acts on the nerve signal to the sweat glands, with superficial injections distributed over the area concerned. It does not «dry out» the body: it reduces sweat production in the treated area, while general thermoregulation continues to work normally.
How long does the effect last?+
Some months, with real individual variability: it depends on the area treated, the quantity used and each person's response. It is not a definitive treatment and it is designed to be repeated: the point of the follow-up is precisely to measure how long it lasted in that specific patient and adjust the timing accordingly, rather than applying the same calendar to everyone.
I only sweat a lot when I am anxious: is it hyperhidrosis or stress?+
The two are not mutually exclusive, and this is the point most often misunderstood. In primary hyperhidrosis, emotion is one trigger among many, not the cause: the predisposition is there regardless, and sweating also appears at rest and in neutral situations. Putting it all down to personality is why many people live for years with a condition that has a name and a treatment.
I started sweating heavily as an adult, it never happened before: does that change anything?+
It changes a great deal, and it is the main reason it is worth being seen. Onset in adulthood, especially if the sweating is generalised and also present at night, points towards a secondary form: it depends on something else — a current therapy, a general condition — and the first objective becomes identifying that cause. Treating the symptom alone would, in that case, mask useful information.
Related reading
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