History and exam

Key diagnostic factors

common

excessive palmar sweating

Mild disease is a moist palmar surface without visible droplets of perspiration. If palmar sweating extends toward the fingertips, the condition can be considered moderate. If sweat drips off the palm and reaches all the fingertips it is severe. [Figure caption and citation for the preceding image starts]: Profound sweating provoked in a patient with palmoplantar hyperhidrosis after administration of a small amount of hand lotionFrom the personal collection of Fritz Baumgartner, MD [Citation ends].com.bmj.content.model.Caption@5abd5d3f

excessive plantar sweating

Moist socks and shoes.

In some patients, soles of feet sweat to a level approximating excessive palmar sweating.

onset in early childhood or puberty

Typically, palmoplantar hyperhidrosis has a bimodal onset starting in early childhood or at puberty.[2]​[8]​​[9]

exacerbation of palmar sweating with use of hand lotion

Usually, patients with a history for palmoplantar (or palmar) hyperhidrosis present with completely dry hands. However, on application of ordinary hand lotion, their palms sweat profusely within minutes. [Figure caption and citation for the preceding image starts]: Profound sweating provoked in a patient with palmoplantar hyperhidrosis after administration of a small amount of hand lotionFrom the personal collection of Fritz Baumgartner, MD [Citation ends].com.bmj.content.model.Caption@7cf60434

severe facial sweating

Occurs in patients with primary facial hyperhidrosis.

severe axillary sweating

Occurs in patients with primary axillary hyperhidrosis.

generalized sweating

Secondary hyperhidrosis tends to occur as a more generalized all over body sweating.

Risk factors

strong

family history

At least 50% of patients with palmar hyperhidrosis report a positive family history.[6][7]

medications

Several types of medications can cause secondary hyperhidrosis as a side effect. These include insulin, meperidine, emetics, cholinesterase inhibitors, selective serotonin reuptake inhibitors, opioids, propranolol, pilocarpine, and physostigmine.

endocrine disorders

Generalized secondary hyperhidrosis may be caused by disorders of the thyroid, pituitary, pancreas, or adrenal glands (e.g., thyrotoxicosis, pituitary tumors, diabetes, or pheochromocytoma).

cardiovascular diseases

Cardiovascular disorders, including congestive heart failure, acute coronary syndrome, and rhythm disorders, may cause generalized secondary hyperhidrosis.

hypoglycemia

May cause generalized secondary hyperhidrosis.

menopause

May cause secondary hyperhidrosis or hot-flushes.

infectious diseases

Infectious diseases such as tuberculosis and malaria may cause generalized secondary hyperhidrosis.

sepsis

Septic states can cause secondary hyperhidrosis.

neoplastic diseases

May cause generalized secondary hyperhidrosis. For example, a patient with a neoplasia such as a lymphoma may have extensive night sweats of the entire body, lymphadenopathy, and shaking chills.

carcinoid tumors

May cause generalized secondary hyperhidrosis.

neurologic injuries

May cause focal secondary hyperhidrosis. Injuries such as acute spinal cord injury, cerebral or medullary infarcts, or other nerve injuries (e.g., posttraumatic vasomotor dystrophy) may cause focal sweating. In addition, Frey syndrome (sweating on one side of the forehead, face, scalp, and neck occurring soon after ingesting food as a result of damage to the nerve that innervates the parotid gland) may cause facial gustatory sweating.

weak

spicy foods

May provoke the symptoms of primary hyperhidrosis, particularly the focal craniofacial variety.

obesity

Although obesity is not a direct cause of hyperhidrosis, it may lead to a condition of generalized secondary hyperhidrosis.

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