Excessive Sweating

Primary focal hyperhidrosis is far more common than people expect and has a characteristic pattern: onset in childhood or adolescence, symmetrical involvement of palms, soles, armpits or face, at least weekly episodes, and complete cessation during sleep. It is not caused by anxiety, though it certainly generates it, and the underlying issue is excessive cholinergic signalling to eccrine glands rather than any gland abnormality. Treatment is a clear ladder and most people never climb past the first rung properly. Aluminium chloride antiperspirant applied at night to dry skin, when sweat glands are least active, is markedly more effective than morning application and is the single most common mistake in self-treatment. Beyond that: glycopyrrolate topically or orally, iontophoresis for hands and feet, botulinum toxin injections lasting six to nine months, and microwave thermolysis. Secondary hyperhidrosis behaves differently and matters more. Generalised sweating that begins in adulthood, occurs at night, or comes with weight loss, fever or palpitations should prompt evaluation for hyperthyroidism, diabetes with hypoglycaemia, infection including tuberculosis, lymphoma, phaeochromocytoma, menopause and medication effects — SSRIs and opioids are frequent culprits. Supplement evidence is close to nonexistent; sage has weak data for menopausal sweating and no serious evidence in primary hyperhidrosis.

• •Visible dripping from palms or soles
• •Sweat marks through clothing
• •Symmetrical armpit, hand or foot involvement
• •Difficulty gripping paper or tools
• •Skin maceration or fungal infection
• •Night sweats in secondary causes

• •Primary focal hyperhidrosis
• •Hyperthyroidism
• •Menopause
• •Hypoglycaemia in treated diabetes
• •Infection or lymphoma
• •SSRIs, opioids and other medications
• •Anxiety disorders

Excessive cholinergic sympathetic outflow to eccrine glands in primary hyperhidrosis, hyperthyroidism, hypoglycaemia, menopause, infection, lymphoma, phaeochromocytoma, anxiety disorders, obesity, and medications including SSRIs, opioids and cholinesterase inhibitors.