Causes of Hyperhidrosis

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Hyperhidrosis is a clinical disorder characterized by excessive sweating that occurs frequently and is difficult to control. The perspiration is often so severe it's visible to others and can occur even in relatively cool environments, such as a swimming pool.

Sweating is the body’s natural way of cooling off. The normal physiological process of sweating involves the nervous system, which triggers the sweat glands when the body temperature rises. Sweating can also result from nervousness or anxiety, in which case it most commonly occurs on the palms of the hands and in the armpits.

Excessive sweating due to hyperhidrosis can arise as a stand-alone condition or be related to a secondary medical condition, such as thyroid disease, cardiovascular conditions, or menopause.

primary and secondary hyperhidrosis diagnosis
Verywell / Emily Roberts

Common Causes

Hyperhidrosis is classified as either primary focal hyperhidrosis or secondary generalized hyperhidrosis, both of which have numerous individual possible causes.

Primary Focal Hyperhidrosis

Primary focal hyperhidrosis involves sweating in one or more “focal” areas of the body, usually on the palms of the hands, under the arms, or the soles of the feet. Focal hyperhidrosis may also affect the face and/or scalp.

There are several causes of primary focal hyperhidrosis, including:

  • Primary idiopathic hyperhidrosis: Idiopathic means the disease has an unknown cause or mechanism of origin. Most cases of primary hyperhidrosis are idiopathic.
  • Frey’s syndrome: A rare neurological disorder also called gustatory sweating
  • Other neurologic conditions: Examples include spinal injuries and miscellaneous conditions of the nervous system.

Secondary Generalized Hyperhidrosis

Secondary generalized hyperhidrosis refers to sweating that occurs all over the body and may include night sweats (sweating while asleep). It usually develops in adulthood and is caused by a secondary or underlying disorder affecting any of several systems in the body or by other factors:

Endocrine

Neurological

Malignancy

Cardiovascular-Related

Side Effects of Medications

  • Anticholinesterases used to treat Alzheimer’s disease
  • Antidepressants including Prozac (fluoxetine), Sinequan (doxepin), Norpramin (desipramine), Pamelor (nortriptyline), and Effexor (venlafaxine)
  • Anxiolytic drugs used to treat anxiety
  • Asthma inhalers such as albuterol
  • Depo-Provera birth control pills
  • Insulin used to manage diabetes
  • Methadone used to treat heroin addiction
  • Migraine medications such as Triptan (rizatriptan) and sumatriptan
  • Non-steroidal anti-inflammatory drugs like Celebrex (celecoxib)
  • Opioids like Vicodin (hydrocodone) and Oxycontin (oxycodone)
  • Salagen (pilocarpine) used to treat glaucoma
  • Propranolol used to treat angina and hypertension
  • Testosterone
  • Thyroid-regulating drugs

Other Factors

Genetics

In primary focal hyperhidrosis, sweating usually starts during childhood, which suggests it may be genetic. A 2019 review of 20 published studies found a wide range of positive family history—from 5.7% to 65%.

The study authors noted primary focal hyperhidrosis appears to have an autosomal dominant pattern, meaning only one copy of the gene for the disease is required for it to manifest. In addition, the gene can be passed along by either the male or female parent, and both sexes are at equal risk of inheriting hyperhidrosis.

Weight

A common cause of secondary hyperhidrosis is extra body weight and obesity. This is likely due to body heat becoming trapped by adipose tissue, kicking off the body's natural cooling response, and causing excessive perspiration.

A 2019 study published in the Journal of the American Academy of Dermatology assessed the link between body mass index (BMI) and hyperhidrosis. The study included nearly 2.8 million teenagers and higher rates of hyperhidrosis in obese individuals than those who were underweight. In addition, the study authors noted the risk of hyperhidrosis increased for each BMI unit above the normal weight threshold. 

Cardiovascular

Several factors related to normal cardiovascular function overlap with hyperhidrosis. The same mechanism that triggers sweating in hyperhidrosis causes an increase in heart rate and blood pressure.

The sympathetic nervous system, which activates the fight-or-flight response, plays a role in hyperhidrosis. The fight-or-flight response causes an increase in heart rate and blood pressure, which leads to excessive sweating.

People with focal hyperhidrosis may have abnormal heart rate patterns, according to a study published in the journal European Neurology that compared 63 people with focal hyperhidrosis to a group of healthy control subjects.

In addition, a 2016 study assessed post-exercise blood pressure and recovery heart rate in people with hyperhidrosis and those without and found people with secondary generalized hyperhidrosis of unknown origin had a significantly impaired blood pressure recovery and decreased heart rate recovery after exercise.

A Word From Verywell

There are many factors involved in the cause of the different forms of hyperhidrosis, however, perhaps the most important thing to keep in mind is that the condition is treatable. You can explore resources that provide education and support to those who have hyperhidrosis. While hyperhidrosis can be an embarrassing condition, it doesn’t have to be one that takes over a person's life.

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  1. Kargi AB. Plantar sweating as an indicator of lower risk of compensatory sweating after fhoracic sympathectomy. Thorac Cardiovasc Surg. 2017;65(6):479-483. doi:10.1055/s-0036-1579680

  2. Ohshima Y, Tamada Y. Classification of systemic and localized sweating disorders. Curr Probl Dermatol. 2016;51:7-10. doi: 10.1159/000446753

  3. National Organization of Rare Disorders. Hyperhidrosis, primary.

  4. McConaghy JR, Fosselmann D. Hyperhidrosis: Management options. Am Fam Physician. 2018 Jun 1;97(11):729-734.

  5. Henning MA, Pedersen OB, Jemec GB. Genetic disposition to primary hyperhidrosis: a review of literature. Arch Dermatol Res. 2019;311(10):735-740. doi:10.1007/s00403-019-01966-1

  6. Lottenberg AMP, Jensen NSO. Hyperhidrosis and Obesity. In: Loureiro M., Campos J, Wolosker N, Kauffman P (eds). I. 2018. Springer, Cham. doi:10.1007/978-3-319-89527-7_3

  7. Astman N, Friedberg I, Wikstrom JD, et al. The association between obesity and hyperhidrosis: A nationwide, cross-sectional study of 2.77 million Israeli adolescentsJ Am Acad Dermatol. 2019;81(2):624-627. doi:10.1016/j.jaad.2019.01.019

  8. Birner P, Heinzl H, Schindl M, Pumprla J, Schnider P. Cardiac autonomic function in patients suffering from primary focal hyperhidrosis. Eur Neurol. 2000;44(2):112-6. doi:10.1159/000008207

  9. Alihanoglu YI, Yildiz BS, Kilic ID, et al. A new method for evaluation of the autonomic nervous system in patients with idiopathic hyperhidrosis: systolic blood pressure and heart rate recovery after graded exercise. Clin Exp Dermatol. 2016;41(8):847-851. doi:10.1111/ced.12915