Learning Objectives
This module will update your knowledge on hyperhidrosis, including:
- Criteria to use to diagnose hyperhidrosis
- Investigations to undertake if you suspect a secondary cause
- Drugs that can cause generalised sweating
- Which patients warrant referral to secondary care
Author
Dr Quentin Shaw is a GP in Telford and a member of the Primary Care Dermatology Society
1. What criteria should we use to diagnose hyperhidrosis and how common is it?
Primary or focal hyperhidrosis is simply the diagnostic label for excessive physiological sweating. Patients themselves will tell you what they consider excessive. The sweating usually affects the palms of the hands, soles of the feet and axillae, but other parts of the body can be affected.
Sufferers are often too embarrassed to discuss the problem with family or to seek help from a GP. They may spend hours each day trying to mask the symptoms to avoid social stigma. School children may be bullied by their peers and can become reclusive if not treated satisfactorily. Dripping hands make it difficult to deal with paper, keyboards, mobile phones, sports and musical equipment. Sufferers avoid shaking hands, which makes day-to-day life and business contacts a struggle, and may limit career choices. Many patients report that they are even embarrassed to hold hands with a boy or girlfriend. Affected young people can suffer immense social stress, and become withdrawn, depressed and suicidal.
Primary hyperhidrosis affects at least 1% of the UK population. About a third of patients are aware of a family history. All ethnic groups and both sexes are affected equally. Female sufferers are often aware of variation in their symptoms through the menstrual cycle, or during pregnancy.
The excessive sweating is often obvious in childhood, and usually becomes worse at puberty. The majority of sufferers will have presented by the age of 25.
Primary hyperhidrosis is always bilateral and symmetrical, involving the hands, feet, axillae or face. Other areas are less commonly affected. The symptoms are prominent in daytime, on most days, but absent at night (see below).
The sweating is normally odour-free, but sweaty feet will become smelly if soggy keratin and damp footwear become colonised by bacteria and fungi, resulting in pitted keratolysis.
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