TYPES OF HYPERHIDROSIS

Hyperhidrosis isn’t one disorder; it’s an umbrella term for several patterns of excessive sweating. Knowing which type you have helps guide treatment and set realistic expectations.

PRIMARY (FOCAL) HYPERHIDROSIS

Sweating that starts in childhood or teens and affects localised areas.

Most cases fall into this group. The sweat glands themselves are healthy, but the nerves that trigger them misfire. Episodes flare without heat, exercise or illness, often during the day and ease during sleep.

Common focal sites:

SECONDARY (GENERALISED) HYPERHIDROSIS

Sweating driven by another condition or medication.

Secondary sweating usually starts in adulthood and involves larger body areas - even during sleep.

Triggers include:

Hormonal: menopause, pregnancy, hyperthyroidism
Metabolic: diabetes, gout, obesity‑related metabolic stress
Infections: tuberculosis, HIV, endocarditis
Medications: certain antidepressants, opioids, antipyretics
Neurological: Parkinson’s disease, spinal‑cord injury

Key step is ruling out and treating the underlying cause; focal treatments alone give limited relief.

HOW SWEAT GLANDS WORK

Most “problem” sweating comes from over‑active eccrine glands -tiny coils embedded in the skin.

These glands:

Receive signals from the sympathetic nervous system (the ‘fight‑or‑flight’ branch).
Release a salt‑water solution that evaporates to cool the body.
Sit densely on palms, soles, forehead and underarms—exactly where focal hyperhidrosis strikes.

In hyperhidrosis the sympathetic signal is amplified, not the number of glands.

HEAVY SWEATING vs. NORMAL PERSPIRATION

Thermoregulatory sweat rises with heat/exercise and stops quickly.
Hyperhidrosis sweat appears out of context and soaks through clothing.
Simple screening tool: the Hyperhidrosis Disease Severity Scale (HDSS) - if sweating is intolerable or interferes with daily life (scores 3–4), treatment is justified.

DOES BEING OVERWEIGHT CAUSE EXCESSIVE SWEATING?

Extra body mass increases heat production, so people with obesity often perspire more - but that is not primary hyperhidrosis.

Clues favouring obesity‑related sweating:

Perspiration mainly on chest, back, thighs
Improves with weight reduction
Starts or worsens after weight gain, not childhood

Someone can, of course, have both obesity and focal hyperhidrosis; treat each driver for best results.

COMPENSATORY & GUSTATORY SWEATING

Compensatory sweating: overactive sweating on the trunk/legs after endoscopic thoracic sympathectomy (ETS). It can be more troublesome than the original focal problem.
Gustatory sweating: facial or scalp sweating while eating spicy or sour foods; often follows parotid surgery (Frey’s syndrome).

TAKEAWAY

Whether sweating is limited to the hands or covers the whole torso, the underlying pattern guides therapy -from prescription antiperspirants and iontophoresis to botulinum toxin or systemic medication. Unsure which type fits you? Start with a clinician visit to exclude secondary causes before jumping to treatments.

DISCLAIMER

This content is for general educational purposes only and does not replace medical advice.