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Rarely patients may present with sweating everywhere. This is called generalised hyperhidrosis. Many cases are unknown; however it is important to exclude secondary causes of sweating. Certain medical conditions such as thyroid disease, infections, diabetes & drugs can cause secondary generalised hyperhidrosis. With this pattern of sweating, finding a physician to exclude potential underlying problems is very important.
FactsFacts on Generalized Sweating
- This pattern of excessive sweating is rare
- Generalised sweating can be due to endocrine, drug, infections & malignancy
- Secondary causes of sweating have a sudden onset compared to primary sweating which is frequently insidious
- Focal treatments on the sweaty areas can provide some relief
- Tablets provide the greatest overall benefit for all-over-sweating, but side effects are commonly encountered
- This condition is best managed by a physician or medical dermatologist
What is the difference between primary & secondary causes of sweating?
Most patients who have sweating will exhibit primary essential hyperhidrosis- this means that there is no cause for excess sweating. Secondary hyperhidrosis can be due to drugs or diseases and present in a different way compared to essential sweating.
Primary Hyperhidrosis/ essential hyperhidrosis will have the following pattern: the onset of sweating is usually early, mostly in the teens. Sweating stops when you are sleeping. Your sweating is symmetrical, meaning you sweat equal amounts on both sides of your body.The onset is gradual. You may have a positive family history of sweating
Secondary hyperhidrosis / secondary sweating may have the following pattern: you sweat in your sleep, or wake up sweating. The onset is sudden. The onset of sweating is usually later in life. Sweating is asymmetrical.
Sounds confusing? If in doubt see your GP. In some cases, they may refer you to a physician for more investigations.
Disclaimer: I do not investigate or treat HH medically as I am a procedural dermatologist.
What causes need to be excluded?
Many patients will have no cause of generalised sweating. They may sweat everywhere for no apparent reason; this is called primarily hyperhidrosis. However, it is important to exclude disorders that may cause or worsen this condition. Secondary hyperhidrosis is associated with disorders including-
- Thyroid disease
- Carcinoid syndrome
- Lymphomas & malignancy
- Drugs can also worsen or cause excessive sweating: the most common drugs include antidepressants
- Energy drinks & caffeine may worsen all forms of sweating
Patients who have generalised hyperhidrosis should see a GP for review. Your doctor may order tests or refer you to a physician for more investigations.
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Who should you see for generalised sweating?
Secondary generalised sweating is exceedingly rare, but it is important to rule out causes. Most patients say they sweat everywhere, but in reality, sweat more in areas like the hands, feet & armpits. Distinguishing primary essentially sweating in these areas compared to generalised secondary hyperhidrosis is important.
Your first port of call is your General Practitioner, your doctor can rule out the most common causes of secondary sweating such as drugs, infections, thyroid disease, & diabetes. More complicated cases can be investigated by a general physician. They may arrange special testing including urine & metabolic screens, chest X rays & CT scans. Medical dermatologists are also well versed in the diagnosis, management & treatment of generalised HH.
Disclaimer: I am a procedural dermatologist; I do not treat or investigate generalised sweating. A medical dermatologist can guide you.
What is the most effective way to treat sweating?
The fastest & most cost effective method to treat generalized sweating is to pop a tablet. These tablets are anticholinergics & include propantheline bromide & oxybutynin. Your GP can prescribe this medication. Side effects include dry mouth, constipation, weight gain, blurred vision & sedation.
Other tablets that can help include glycopyrrolate, clonidine, gabapentin & propranolol.
Can excessive sweating be controlled with diet?
In some cases, a dietician can be of benefit. This is especially so for patients who have underlying diabetes or who may be overweight. Eating a well-balanced diet, with minimal caffeine intake can decrease sweating. For more information on diet & sweating, visit sweathelp.org
Davin’s Viewpoint on General Hyperhidrosis
If you sweat everywhere, it’s called generalised hyperhidrosis. Most patients say they sweat in all places, but in reality, they sweat more in places such as the hands, feet, face, & armpits. Secondary generalised hyperhidrosis is exceedingly rare however investigations are mandatory, based upon clinical history.
How I approach excessive sweating in many places is simple. I treat them according to their importance. Most patients choose to get their hands treated first; others prefer armpits. Listening to where patients prioritise their treatments is important. In widespread sweating, a combination of treatments will yield the best results, for example one patient may require iontophoresis for the hands & feet, & Botox treatments for excessive underarm sweating, whilst another patient maybe well controlled with compounded glycopyrrolate wipes for the face. Individualizing treatments is the key for best outcomes.
Disclaimer: For generalized sweating please consult a physician for investigations & first line management. Try simple measures described elsewhere before consideration of Botox for excessive sweating.
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