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Which Kind of Hyperhidrosis Do You Have?
Every day, the staff at the International Hyperhidrosis Society receive queries from teens and adults who produce excess sweat. We often read notes that say: "I sweat so bad under my arms that I can't raise my hands at school." Or "My hands sweat so much I can't hold my baby." Most of the time we can help the people who write to us. But sometimes, the problem is "secondary hyperhidrosis" caused by a medication a person is taking or by one of a host of underlying medical conditions that we're not equipped to treat or diagnose.
So, how do you know which type of hyperhidrosis you have? And how do you know where to turn for help?
"It's actually pretty easy to figure out," says Toronto dermatologist and IHHS Board Member Dr. Nowell Solish, co-author of "Focal Hyperhidrosis: Diagnosis and Management" (Canadian Medical Association Journal, Jan. 4, 2005.) "With secondary hyperhidrosis, the onset is sudden."
Unlike secondary hyperhidrosis, primary hyperhidrosis is a longstanding medical condition that begins before age 25. Primary hyperhidrosis can affect one or more body areas, most often the palms, armpits, soles of the feet or face and sometimes the groin and under the breasts in men and women.
Secondary hyperhidrosis, on the other hand, is generalized, typically involving the whole body. This type of excess sweat may seem to come on for no apparent reason – although a closer look at the patient will typically reveal a root problem. This is why this type of hyperhidrosis is called "secondary." The excess sweat is secondary to the more primary condition.
"Someone comes in and says, 'I'm 40 years old, and I just got it.' I'm a little more suspicious than if someone comes in and says, 'I'm 12 years old, and I've got it under my arms and nowhere else.' That fits the classic build, and I don't worry," says Solish, who treats hundreds of patients at his Sweat Clinics of Canada where he specializes in Botox injections for hyperhidrosis.
Whether you have primary or secondary hyperhidrosis can be determined by asking yourself a few questions as outlined by (and published in the Journal of the American Academy of Dermatology, 2004, Vol. 51, P. 274-86) St. Louis dermatologist Dr. Dee Anna Glaser. Dr. Glasher in an IHHS founding board member and an internationally recognized expert in hyperhidrosis.
First, says Glaser, ask yourself if you have experienced focal visible excess sweat for at least six months without apparent cause. If the answer is "yes," then the next step is determining whether you meet at least two of the following criteria:- Your sweat is bilateral and relatively symmetrical, meaning you sweat the same amount on both sides of your body.
- Your excess sweat impairs your daily activities.
- You experience at least one episode a week.
- The onset of your excess sweat is earlier than age 25.
- You have a positive family history. (Meaning that other members of your family suffer from similar sweating problems.)
- You stop sweating when you're sleeping.
If you meet at least two of the above criteria, chances are you have primary hyperhidrosis, and you should make an appointment with a dermatologist familiar with treatment options for people with hyperhidrosis. (Check our physician finder database for a doctor near you.) Some dermatologists believe upwards of 90 percent of people who present with excessive sweating will be diagnosed with primary hyperhidrosis.
"Certainly we know that hypherhidrosis seems to affect at least three percent of the population, if not more, depending on which research is looked at," says Dr. Glaser. "That's pretty consistent around the globe. For the dermatological community, most patients that we see are more likely to be in that primary category."
If you don't meet the criteria for primary hyperhidrosis, then it gets a little more complicated, as your doctor may end up needing to do a complete workup to determine why you are sweating excessively. The cause may be as simple as a new medication you've been taking. Or, you might be suffering from one of a range of medical conditions – most commonly an infective or malignant disease or another medical disorder such as cancer, diabetes or gout. A hormonal imbalance related to pregnancy or menopause could be another potential root cause. For a complete list of medications and diseases that can cause excess sweat, go to "Causes of Secondary Hyperhidrosis".
A person who thinks he or she is suffering from secondary hyperhidrosis should seek help from a general practitioner, ideally an internal medicine specialist. It's important to find the right doctor (again see our section on choosing the right doctor, as not all doctors will delve deep enough to find the cause of the excessive sweating.
"Generalized excessive sweating can occur in response to so many different medical conditions, disease states and medication treatments," says Dr. Glaser. "It's kind of a moving target depending on what kinds of medications are being used for different problems."
"If you see one physician and don't get the sense that the answer given is sufficient or satisfying, you certainly may need to seek out a second opinion. Sometimes that first response is: 'Don't worry about it. It's not going to kill you.' If you get an answer like that, and it's not satisfying to you, you should go ahead and seek out another opinion."
Whatever the reason for your excess sweat, there are people in the medical community who want to help. Finding a nearby physician sympathetic to and experienced in treating patients with hyperhidrosis may be as simple as going to the physician finder service on our Web site. Simply type in your zip code and the mileage distance you are willing to drive, and within seconds you will have the names and phone numbers of physicians near you. A gold star next to a physician's name means the physician is not only familiar with treatment options for hyperhidrosis, but also that he or she has attended one of our educational events and is up-to-date on the most current treatment options. We are proud to note that both Dr. Glaser and Dr. Nolish have gold stars beside their names!
Our Web site can also provide you with a comprehensive collection of insurance and reimbursement tools, including downloadable forms, that can help you work with your physician and health insurance plan to get the correct coverage for necessary treatments.
However you find help, don't let fear or embarrassment keep you from seeking out the attention you need and deserve. Always remember you are not alone. We at IHHS are here to serve and help you on your path to care and relief!
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