Excess sweating | Hyperhidrosis

Excess Sweating

August 01, 2018

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Excess sweating, also called hyperhidrosis, can be either primary or secondary.

Primary hyperhidrosis is from our sympathetic nervous system (the part of our nervous system activated by the ‘fight or flight’ response)  being overactive.

Secondary hyperhidrosisis when the sweating is from another cause like a medication, hormonal changes, heart problems, cancer, infections, or neurological problems. 

Primary hyperhidrosis is more likely to 

  • last longer than 6 months
  • primarily involve the underarms, palms, soles, head and neck area 
  • affect both sides of the body symmetrically
  • sweating episodes happen at least weekly
  • not sweat during sleep
  • start before the age of 25
  • have a family history of sweating
  • affect day to day activities 


Think of secondary hyperhidrosis as having a cause- so if the onset was sudden I try to determine if 

  • there was anything new in terms of medications
  • if there are other symptoms such as fevers, chills, fatigue, night sweats, shortness of breath?


Normal sweating can range from about a half liter a day to as much as 10 liters with intense exercise or heat  (about 1 Liter per hour extra). 


‘Normal and not’ when it comes to excess sweating is very subjective. We do not really measure directly the amount of sweat produced to make the diagnosis. The real question I ask to my patients is how much is this affecting you? Does sweating interfere with your daily activities? Do you find your sweating embarrassing? Do you find yourself choosing clothing based on your concern about how much the sweat will be noticeable? Do you avoid certain activities because you are concerned about sweating?

If the answer to any of these is yes, then we need to come up with a game plan to address it.


I look for any other associated symptoms that occur at the time of sweating to determine if it could be a worrisome sign. Shortness of breath, racing heart rate with minimal activity, fevers, chills, night sweats, fatigue, etc.. If any symptoms pop up as a concern, then further workup for any underlying cause is important! 


There are several ways to control sweating. If it’s secondary hyperhidrosis from an underlying condition or medication then treating the cause will help the sweating.

For primary hyperhidrosis, the treatment options range from 

  • topical medications such as aluminum chloride or glycopyrronium solution
  • an oral medication called glycopyrolate
  • botulinum toxin injections 
  • a medical device called the driionic that can reduce sweating


Anything that’s drives up your body temperature can cause you to sweat. Sweating, after all, is our body’s way of regulating our body temperature. If the temperature rises, sweat is produced so that as it evaporates off the skin it serves to cool the skin. 


It is absolutely normal to sweat more when you increase your exercise level or when it’s hot or humid out. Sweat is our natural way of cooling itself off!

Normal sweat is about half a liter to a liter a day with minimal activity. However, again, we do not really measure this. The ‘normal’ amount of sweating is the amount that does not interfere with your day to day activities but still regulates your body temperature effectively. In other words, as long as you are or sweating to the point you notice it and you are not overheating, then you are probably doing well! 


Drinking water is always important. If you plan to exercise then you will likely lose more fluid through sweating so it would be important to replace this fluid through drinking water. If your body is well hydrated then it may not have to work so hard to regulate your body temperature so this will likely reduce some of the excess sweat. 

The other key thing to remember for people who sweat excessively is to avoid some foods that may incline you to sweat about more. An example of this would be spicy foods or hot foods.


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