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Sweating: Causes, Symptoms and Treatment

Sweating is a natural body function that regulates temperature. Excessive sweating, however, can indicate underlying conditions and significantly affect quality of life.

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Things worth knowing about "Sweating"

Sweating is a natural body function that regulates temperature. Excessive sweating, however, can indicate underlying conditions and significantly affect quality of life.

What is Sweating?

Sweating (medically known as diaphoresis or perspiration) is a physiological process in which the sweat glands of the skin secrete fluid. This process is essential for life, as it regulates body temperature and prevents overheating. The human body contains between two and four million sweat glands distributed across the entire skin surface.

Types of Sweating

Normal Sweating

Normal sweating occurs in response to physical exertion, heat, or emotional stress. It is a healthy and important protective mechanism of the body.

Primary Hyperhidrosis

Primary hyperhidrosis is a condition in which a person sweats excessively without any underlying medical condition as the cause. The most commonly affected areas are the hands, feet, armpits, and face.

Secondary Hyperhidrosis

Secondary hyperhidrosis results from another medical condition or medication use. It often affects the entire body rather than specific areas.

Causes

Sweating can be triggered by a wide range of factors:

Physical causes: Heat, physical activity, exercise
Emotional causes: Stress, anxiety, excitement
Hormonal causes: Menopause, hyperthyroidism (overactive thyroid), diabetes mellitus
Infectious diseases: Fever, tuberculosis, HIV
Neurological conditions: Parkinson disease, stroke
Medications: Antidepressants, fever-reducing drugs, certain blood pressure medications
Malignant conditions: Lymphomas or other cancers (characterized by night sweats as part of so-called B symptoms)

Symptoms and Associated Complaints

Excessive sweating may be accompanied by additional symptoms, including:

Wet or damp hands and feet
Soaked clothing without an obvious trigger
Unpleasant body odor caused by bacterial breakdown of sweat
Skin irritations or fungal infections in moist body areas
Psychological distress due to social embarrassment

Diagnosis

To evaluate excessive sweating, the physician begins with a detailed medical history and physical examination. The following diagnostic measures may be used:

Iodine-starch test (Minor test): Visualizes sweat production on the skin surface
Blood tests: Thyroid levels, blood glucose, hormone levels
Sweat measurement (sudometry): Quantification of sweat volume
Imaging: When a systemic condition is suspected (e.g., X-ray, ultrasound)

Treatment

General Measures

Mild cases can be managed with simple lifestyle adjustments: wearing breathable clothing, avoiding spicy foods and alcohol, and maintaining regular personal hygiene.

Medication-Based Treatment

Aluminum chloride antiperspirants: Block sweat ducts to reduce secretion
Anticholinergics: Medications that inhibit sweat gland activity via the nervous system
Beta-blockers or anxiolytics: Helpful in stress-related sweating

Non-Invasive and Invasive Therapies

Iontophoresis: Weak electrical currents reduce sweat production, especially on hands and feet
Botulinum toxin injections: Block nerve signals to sweat glands for several months
Microwave therapy: Permanently destroys sweat glands in the underarm area
Surgical procedures: Endoscopic thoracic sympathectomy (ETS) as a last resort for severe primary hyperhidrosis

When to See a Doctor

Medical evaluation is recommended when sweating occurs without an obvious trigger, significantly interferes with daily life, is associated with night sweats, is accompanied by additional symptoms such as weight loss, fever, or rapid heartbeat, or appears suddenly and without explanation.

References

Schlereth T, Dieterich M, Birklein F. Hyperhidrosis – Causes and Treatment of Enhanced Sweating. Deutsches Ärzteblatt International. 2009;106(3):32–37.
Hornberger J, Grimes K, Naumann M, et al. Recognition, diagnosis, and treatment of primary focal hyperhidrosis. Journal of the American Academy of Dermatology. 2004;51(2):274–286.
International Hyperhidrosis Society. Clinical Overview of Hyperhidrosis. Available at: www.sweathelp.org. Accessed 2024.

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