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Hyperhidrosis (Excessive sweating)

Hyperhidrosis is a condition that causes excessive sweating. It is considered to be present if the degree of sweating is out of proportion to the stimulus.

Everyone is expected to sweat after any serious exertion such as running or even brisk walking. However, some individuals experience excessive sweating without any form of exertion. At times the stimulus may be anxiety but other times it may be spontaneous or following minimal stress.


Hyperhidrosis describes excessive sweating in one or more of the following sites:


            Hands – palmar hyperhidrosis.

            Arm pits – axillary hyperhidrosis.

            Feet – plantar hyperhidrosis.

            Face – craniofacial hyperhidrosis.

            Excessive facial blushing can also be a manifestation of hyperhidrosis.


This condition can ruin sufferer’s lives and affect their ability to perform their job with confidence. In fact a lack of confidence and severe embarrassment are often what patients complain about and is the main reason to go to a doctor. Sufferers become anxious about how they appear and this may be a stimulus for increased sweating thus creating a vicious cycle which becomes very hard to break.


Individuals with hyperhidrosis may report any of the following problems:


Physical effects:

                       Physical discomfort with wet clothing and shoes.

                       Skin maceration from constant wetness can lead to fungal and bacterial overgrowth resulting in smelly sweat and recurrent skin infections.

                       Excessive sweat can stain and eventually destroy clothing meaning sufferers spend a lot of money on dry cleaning or replacing clothes.


Social embarrassment and Psychological effects:

                        Patients with axillary hyperhidrosis use various strategies to deal with excessive sweat soaking through their clothing. They include use of pads, shields, absorbent tissues and frequent clothing changes. Around 70% of sufferers will change their clothes 2 or more times a day.

                        Patients with palmar hyperhidrosis have constantly damp hands that need to be wiped on clothing or a towel. Handshaking is avoided when possible making social and business situations difficult.


Effects on occupational tasks and activities of daily living:

                        Excessive sweating particularly in palmar hyperhidrosis can cause difficulties in gripping instruments, tools and electronic devices. Paper can be stained and ink smeared by dripping sweat and patients often report problems with writing, dropping objects and getting frequent electric shocks. Studies have shown that hyperhidrosis can influence career choice because sufferers will avoid jobs that may stimulate further sweating or cause embarrassment.


Most patients with hyperhidrosis will have tried a variety of anti–perspirants and behavioural methods to control their symptoms with little or no success.


What is Hyperhidrosis?

Hyperhidrosis is a condition that causes excessive sweating. It is considered to be present if the degree of sweating is out of proportion to the stimulus.


Why does Hyperhidrosis (excessive sweating) happen?

Sweating is a normal response by the body that allows us to control our temperature. Fluid secreted by over 4 million sweat glands evaporates generating a cooling effect. Many of these sweat glands are concentrated in the feet, hands, arm pits and face. They are controlled by the sympathetic nervous system which is a series of nerves originating in the brain that run down the spine in a structure called the “sympathetic chain” giving off millions of tiny branches to amongst other things sweat glands. We know that in patients with hyperhidrosis there is excessive activity of the sympathetic nervous system resulting in profuse sweating. The sympathetic nervous system is out of our conscious control and can be triggered by many emotional stimuli including anxiety and embarrassment.


What forms of hyperhidrosis are there?

Hyperhidrosis can be primary (no underlying cause) or secondary (underlying cause identified). Furthermore, it can be focal (affecting specific areas of the body) or generalised (affecting the whole body).



Primary Focal Hyperhidrosis – usually starts in childhood or adolescence but can occur at any age. There is no underlying cause. It commonly affects one or more of the following areas:


                                           Hands – palmar hyperhidrosis.

                                           Arm pits – axillary hyperhidrosis.

                                           Feet – plantar hyperhidrosis.

                                           Face – craniofacial hyperhidrosis


Excessive facial blushing can also be a manifestation of hyperhidrosis.


Secondary Focal Hyperhidrosis – involves specific areas of the body but is caused by an underlying condition. They include diabetes, neurological disorders and rarely as consequence of treatment of primary hyperhidrosis.


Generalised Hyperhidrosis – affects the whole body and is usually the result of medications or other illnesses. Causes include pregnancy, anxiety, heart failure, overactive thyroid and some anti–depressant medications.


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