What is hyperhidrosis?

Sweating is a natural and essential body function. Sweat is a watery fluid that is discharged from the sweat glands onto the skin surface. As the fluid evaporates, it plays a key role in cooling, thus helping the body maintain a stable core temperature. Hyperhidrosis describes excessive sweating, beyond what is needed for temperature control. In primary hyperhidrosis there are no underlying systemic diseases or other factors to explain the excessive sweating. Hyperhidrosis most commonly appears in three localized body regions: axillae (armpits), palms and soles. These areas are naturally rich in sweat glands and over-stimulated in patients with hyperhidrosis. The stimulation is driven by the autonomic nervous system and the neurotransmitter acetylcholine serves as the messenger between the nerve endings and the sweat glands. Patients with hyperhidrosis often have suffered for many years and have a markedly impaired quality of life. They often have to change their clothes several times a day. Patches of moisture under the arms are both unattractive and unhygienic. Sweaty palms do not make a good impression when shaking hands. Moist feet may smell unpleasant, and frequently even the best shoes are damaged after a short period of time. In addition, moist clammy feet are predisposed to a variety of skin diseases, including fungal and bacterial infections as well as warts.

How can I recognize the disease?

The increased sweating appears unpredictably, independent of ambient temperature and is difficult to control. It is almost always symmetrical on one or most predilection sites: axillae, palms or soles. It interferes with daily life and appears more than once a week. Increased sweating does not occur during sleeping in primary hyperhidrosis.

Three grades of hyperhidrosis

Clinically, primary hyperhidrosis can be divided into three grades:

Degree 1: Mild hyperhidrosis

Significantly increased skin moisture (armpits, hands, feet)
Sweat patches 10-15 cm in diameter (armpits)

Degree 2: Moderate hyperhidrosis

Formation of sweat beads (armpits, hands, feet)
Sweat patches 10-20 cm in diameter (armpits)
Sweating limited to inner surfaces and soles (hands, feet)

Degree 3: Severe hyperhidrosis

Sweat dripping (armpits, hands, feet)
Sweat patches ≥ 20 cm in diameter (armpits)
Sweating also on the backs of fingers and toes and on the lateral edges of hands and feet

The guideline – Definition and therapy of hyperhidrosis

German Dermatological Society – AWMF Guideline Register Number: 013/059

I look forward to give you my recommendations for your treatment in a personal consultation.