You need to sweat: It's the body's cooling mechanism. But when you sweat four to five times more than the typical person, you've got a very drippy situation—often quite literally—on your hands.
This sort of excessive sweating may be diagnosed as focal hyperhidrosis or primary focal hyperhidrosis. Here's how dermatologists describe the condition, its symptoms, and treatments that can keep your profuse sweating in check.
focal hyperhidrosis that begins early in life and causes excessive sweating from specific, "focal," areas of the body, typically the armpits, hands, feet, and head, says Cleveland Clinic. It's also known as primary hyperhidrosis or primary focal hyperhidrosis.
"By definition, primary focal hyperhidrosis happens for no reason—not from secondary issues," says Adam Friedman, MD, professor of dermatology at George Washington University School of Medicine and Health Sciences in Washington, DC. The sweating should be going on for more than six months, he says.
"I will say most people have had it since childhood but didn't connect the dots," Dr. Friedman tells Health.
Focal hyperhidrosis differs from secondary or generalized hyperhidrosis, a type of excessive sweating triggered by a medical condition or drug that someone is taking.
"Secondary usually comes out of nowhere, and it doesn't stop when you're sleeping. It's important to rule out a medication or other medical condition as the cause of excessive sweating before diagnosing a person with [focal] hyperhidrosis," he says.
If the cause of sweating is due to a medication or an underlying condition, Dr. Friedman says he refers the patient to his or doctor who treats them for that condition.
What are the symptoms of focal hyperhidrosis?
The American Academy of Dermatology says people with primary focal hyperhidrosis may have excessive sweating:
- In a single area of the body (such as the armpits) or several areas (like some combination of armpits, hands, feet, or forehead)
- On both sides of the body (both feet, for example)
- Soon after waking up
- At least once a week
The back, chest, groin, and under the breasts are also prone to this type of sweating, per the International Hyperhidrosis Society (IHS).
What causes focal hyperhidrosis?
Focal hyperhidosis occurs when sweat glands are overactive, producing too much sweat, notes the Mayo Clinic.
And why does that happen? Cleveland Clinic points out that the condition tends to run in families, so it's possible that there's a genetic component.
How do doctors diagnosis focal hyperhidrosis?
First, your doctor will determine whether your sweating is secondary, which may involve reviewing your medical history and performing certain laboratory tests. Once secondary causes have been ruled out, a primary hyperhidrosis diagnosis may be considered. The IHS states that a dermatologist will take the following into consideration:
A: Age of onset
Focal hyperhidrosis tends to start during childhood or adolescence. Many times, though, people don't seek out help until they have suffered for years, says Dr. Friedman.
"I often ask patients, 'Think back. Were you embarrassed by holding someone's hand or have you always chosen clothes based on whether or not they might show your sweat?' Oftentimes, this helps them realize their condition," Dr. Friedman says.
B: Bilateral sweating
Focal hyperhidrosis typically occurs on both sides of the body, says IHS. For instance, if you experience hyperhidrosis in the underarms, both arms would sweat excessively, not one.
C: Cessation during sleep
When hyperhidrosis is primary, excessive sweating typically stops during sleep. "Oftentimes, if someone is sweating excessively at night, it might be a sign of an underlying condition," says Dr. Friedman.
Assuming your doctor has ruled out secondary causes of hyperhidrosis, duration of symptoms, specifically, two or more episodes of disruptive, extreme sweating per week for the past six-plus months, can serve as another sign of primary hyperhidrosis.
IHS states that with primary focal hyperhidrosis:
- Sweating doesn't happen constantly
- Sweating episodes vary in frequency, length, and degree
- Sweating is unrelated to the weather, hot conditions, exercise, or stressful situations
Dee Anna Glaser, MD, dermatologist at SLUCare Physician Group in St. Louis explains: "If you are out in a hot, humid summer day at a baseball game, sweating profusely might be [a normal reaction to the weather]. But if you're sitting at a ball game on a non-humid, mid-70-degree day, perhaps sweating profusely is not [typical]." Similarly, gushing sweat while sitting in air conditioning at your desk might indicate hyperhidrosis, she adds.
Two-thirds of people with primary hyperhidrosis say that they know family members who also excessively sweat, according to the IHS.
G: Gets in the way
Hyperhidrosis can interfere with your ability to function, participate in social activities, attend outings, and have an impact on mental health.
"For most people, it's a quality-of-life impairment. They're embarrassed at work or at school," says Dr. Glaser. "Some of that can be the discomfort from the physical aspects of having hyperhidrosis, such as having wet underwear from sweating too much from your groin to chaffing under your breast."
She adds that the condition's impact on mental health is serious. "We brought in 300 people with hyperhidrosis and their families, and I heard some patients saying they were considering suicide because of the sweating, which is really terrible. This really affects their quality of life," says Dr. Glaser.
Living with focal hyperhidrosis
Research suggests that 5% of the world's population—hundreds of millions of people—have hyperhidrosis, per the IHS. More people probably have hyperhidrosis but don't realize it or are embarrassed to seek treatment for it, says Dr. Glaser.
"Some teenagers who have underarm sweating say they will never raise their hand in class because they are too embarrassed to show sweat under their arms," she says.
Dermatologists measure quality of life based on 10 domains, such as how a condition is affecting sexual relationships and workability, she says. "We find that people who have hyperhidrosis have impairment among all of them and have some of the worst quality of life scores compared to any other dermatology diseases that we take care of," says Dr. Glazer. It's even worse than severe scaring from acne, psoriasis all over the body, or severe eczema that requires a patient be hospitalized, she says.
While this doesn't mean that hyperidrosis is worse than other skin conditions, Dr. Glazer says it shows that the condition has a bigger impact on a patient's perceived quality of life.
On a positive note, when Dr. Glaser treats patients for focal hyperhidrosis, she says the gains that these patients make in their quality of life are notably better than improvements seen after the treatment of other dermatologic conditions.
How Is focal hyperhidrosis treated?
Various treatments are available for focal hyperhidrosis. The regimen your doctor recommends may depend on the frequency and severity of your symptoms, the body parts affected, and your overall health, notes the Cleveland Clinic.
A 2019 review in the Skin Therapy Letter describes the various options for this type of hyperhidrosis. First-line therapies include antiperspirants and topical wipes. Botox is often next in line, especially for axillary (underarm) hyperhidrosis.
Iontophoresis, a procedure that involves passing a mild electrical current through water into the skin, is considered an effective treatment for people who sweat profusely from hands and feet, the review article notes.
Laser and microwave therapies, oral medications, and surgery are among the other options for treating focal hyperhidrosis. But the first step is to work with your doctor to find the treatment or combination of therapies that works best for you.
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