Sweating is a natural physiological phenomenon, essential for regulating body temperature. It allows the body to release internal heat, particularly during physical effort, ambient heat, or temporary stress. However, in some people, this mechanism becomes disproportionate, uncontrollable, and a source of discomfort : this is called excessive sweating, or hyperhidrosis.
This disorder, still little known to the general public, can significantly affect quality of life, both physically and socially or emotionally. Patients who suffer from it often hesitate to talk about it, thinking it is a minor inconvenience or a personal trait. In reality, hyperhidrosis is a well-identified condition that can and should be managed specifically.
To diagnose this disorder, it is essential to recognize its signs. So, what are the typical symptoms of excessive sweating ? How can they be distinguished from normal sweating ? And when should one consult ?
The treatment is done by injection of botulinum toxin (Botox).
The first symptom of excessive sweating is an abnormally high sweat secretion, far exceeding what is necessary for thermoregulation. This excessive sweat production can affect a specific area of the body or manifest in a more generalized way.
In the vast majority of cases, hyperhidrosis is described as “focal,” meaning localized. The most commonly affected areas are the armpits, palms of the hands, soles of the feet, forehead, or scalp, and more rarely, the back or groin.
This localized sweating often occurs symmetrically : both hands, both armpits, or both feet are affected. It appears independently of external temperature, exercise, or clothing. It is not uncommon for it to occur even at rest, in neutral conditions, or even in cold weather.
This context-inappropriate nature is one of the most indicative markers of the disorder. The sweat is abundant, visible, sometimes even streaming. It can soak clothes, cause discomfort to the touch, make certain manual activities difficult, or even produce unpleasant odors despite impeccable hygiene.
Beyond the physical manifestation, what characterizes excessive sweating is its disproportionate psychological and social impact. People who suffer from it often develop a form of anxious anticipation : they fear handshakes, avoid light-colored clothing, limit their mobility in public transport or public places, or give up certain professional activities.
The discomfort becomes omnipresent, sometimes even disabling. Some patients report a decline in self-confidence, a tendency to withdraw socially, or even signs of anxiety or psychological distress. They do not always dare to talk about it with their doctor, thinking it is “not serious” or that no solution exists.
Yet, this silent suffering is one of the most revealing symptoms of hyperhidrosis. It is not merely an excessive reaction to physical discomfort ; it is a sign that sweating has taken a disproportionate place in daily life, to the point of hindering relationships, work, or the freedom to act.
Another characteristic feature of excessive sweating is its early onset. Primary focal hyperhidrosis (that is, without an identified underlying cause) generally begins in adolescence or early adulthood. It then progresses chronically, with periods of stability and sometimes fluctuations related to stress, hormonal changes, or seasons.
In many cases, patients seek consultation late, sometimes after years of discomfort. This delay is explained by the difficulty of discussing the topic, but also by the trivialization of the symptom : many think they simply have to “live with it,” believing it is just excess nervousness or a personal trait.
However, excessive sweating that persists over time, does not improve despite conventional antiperspirant products, and interferes with daily life is not trivial. It deserves a thorough medical evaluation, as it can benefit from effective treatments.
It is essential to distinguish so-called primary hyperhidrosis, which is idiopathic (without an identified organic cause), from secondary excessive sweating, which is related to an underlying condition.
When sweating is generalized, occurs suddenly in adulthood, is accompanied by fever, weight loss, fatigue, or occurs at night, a complete medical evaluation is necessary. Hormonal disorders (hyperthyroidism, diabetes), neurological diseases, certain cancers, or the use of medications can be the cause.
The physician plays a fundamental role here : they identify the patient’s profile, inquire about the symptom history, examine them, and, if necessary, prescribe the required tests. In the case of primary hyperhidrosis, no organic disorder is found. The patient is generally in good health, but their autonomic nervous system, which regulates sweating, is simply overactive.
Excessive sweating does not only have social or psychological consequences. It can also lead to secondary skin symptoms, sometimes overlooked but very common. Constant moisture weakens the skin barrier, alters the skin’s pH, and promotes the growth of certain bacteria or fungi.
Thus, patients with hyperhidrosis may develop chronic irritations, redness, itching, or fissures on the fingers or toes. Skin infections such as intertrigo or fungal infections (especially on the feet) are more frequent. Similarly, repeated friction with clothing soaked in sweat can create constant discomfort, particularly in the armpits or on the back.
These dermatological symptoms, often perceived as minor, actually reflect the real physical impact of hyperhidrosis. They should be taken into account in the overall evaluation of the disorder and guide appropriate management.
It is important to remember that hyperhidrosis, even if it is not a life-threatening disease, is a real, documented, recognized, and disabling condition. The symptoms should not be minimized or dismissed as a temporary inconvenience. They are objective, visible signs, sometimes disabling, which justify a structured medical approach.
Today, effective solutions exist : topical treatments, iontophoresis, botulinum toxin, or even surgery in some cases. But the first step always remains the same : recognizing that sweating is excessive, that it goes beyond normal, and that it is legitimate to seek help.
Excessive sweating does not manifest in the same way depending on whether it affects the hands, feet, armpits, or face. These specific locations give rise to particular symptoms, often very telling for the patient, and guide the diagnosis from the first consultation.
In the armpits, one of the most characteristic signs is the rapid appearance of visible sweat marks on clothing, sometimes just minutes after getting dressed. Fabrics become damp, the patient changes shirts several times a day, and avoids certain materials or colors. This location, although common, is often a source of significant social embarrassment, as it is visible whenever the arms are raised or light-colored clothing is worn.
On the hands, symptoms manifest as constant moisture, sometimes streaming, making it difficult to hold objects, use a pen, or handle paper documents. Handshakes are avoided, and professional gestures (care, aesthetics, customer contact) become stressful. This type of hyperhidrosis is very frequently associated with a major psychological impact, often beginning in adolescence.
On the feet, excessive sweating creates a constantly damp environment, causing discomfort in shoes, slipping, a sensation of maceration, and even recurrent fungal infections. This disorder can limit shoe choices, cause odor issues, or restrict sports practice.
On the face, frontal or scalp hyperhidrosis manifests as visible droplets at the slightest effort or stress, streaming down the forehead, sometimes reaching the temples or neck. This makes makeup application difficult, creates persistent shine, and causes discomfort during public appearances, meetings, or social interactions.
These different clinical expressions, although heterogeneous, share a disproportionate and troublesome nature. They are not simply “localized sweating” : they are genuine symptoms, in their own right, of an autonomic disorder that deserves precise evaluation and targeted treatment.
Another fundamental element for making the correct diagnosis is distinguishing emotional sweating from primary hyperhidrosis. These two manifestations may appear similar, but they differ in cause, duration, and management.
Emotional sweating is a normal physiological reaction to a psychological stimulus : stress, embarrassment, or anxious anticipation. It is occasional, contextual, and often limited to specific situations (public speaking, important appointments, social confrontation). It mainly occurs on the face, hands, or armpits, but disappears as soon as the tension subsides.
Primary hyperhidrosis is a chronic condition that occurs independently of emotional context. Sweating episodes are repetitive, unpredictable, sometimes present at rest or during sleep, and not correlated with perceived stress levels. The autonomic nervous system, for no identifiable reason, excessively stimulates the sweat glands.
The distinction is important because therapeutic approaches differ. Emotional sweating can improve through stress management techniques (psychological support, relaxation, cognitive therapies, or low-dose anxiolytics). Hyperhidrosis, on the other hand, requires targeted dermatological or aesthetic management : botulinum toxin, iontophoresis, anticholinergics, or even surgery in extreme cases.
In some cases, both dimensions coexist : hyperhidrosis worsens anxiety, and anxiety amplifies sweating. Hence the importance of a comprehensive approach, clinical, therapeutic, and human, to break the vicious cycle and restore quality of life.
Article written by Dr Romano Valeria
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