The most obvious symptom of hyperhidrosis is excessive sweating.
We are not going to look at normal excessive sweating due to patients drinking too much and having clear urine, those who are very fit and exercise regularly, those who wear too many clothes or those who are sweating from anxiety related reasons. We are only going to consider true hyperhidrosis, patients with abnormal excessive hyperhidrosis.
Hyperhidrosis can be either generalised or localised. Almost everybody with primary, or true hyperhidrosis, has got localised hyperhidrosis in one or two areas. Those who have secondary hyperhidrosis, due to either a medical condition or something they are doing to themselves, usually have generalised hyperhidrosis. We will go through the symptoms of each in turn starting with the easier of the two, generalised hyperhidrosis.
Generalised hyperhidrosis is diagnosed when a patient sweats from all over the body. There may be areas of the body that sweat more than others, such as the armpits, feet or groins. These are often thought to sweat more than other areas as firstly there is a greater concentration of sweat glands in these areas and secondly, these are often areas where air does not readily flow. This might be due to two parts of the body being kept close together (such as the armpits) or due to clothing (such as feet being inside socks and shoes).
Often patients with generalised hyperhidrosis will complain about the sweating from the face and head or chest and back as well.
The common areas of localised hyperhidrosis are the armpits, hands, groins, feet and face/head.
- Armpits (axillary hyperhidrosis): most patients with localised hyperhidrosis find armpit sweating (axillary hyperhidrosis) the most upsetting of all. Symptoms from axillary hyperhidrosis involve water like sweat emerging from the skin in the hair bearing area and then either soaking through clothes or running down the sides of the torso. There is rarely a smell associated with this. Smelly sweat is called bromhidrosis rather than hyperhidrosis, although both can occur together.
- Hands (palmar hyperhidrosis): the symptoms of palmar hyperhidrosis are excessive sweating of the hands. Usually the water like sweat emerges from the palms, although it often merges from between the fingers and in the thumb web space. The water like sweat can often run off the hands and it can make picking up objects difficult as they frequently slip between the fingers and are dropped. Also, it can make writing on paper impossible
- Groin sweating: the symptoms of groin sweating are the emergence of watery type sweat from the hair bearing skin around the genitalia and upper legs which soaks into the into underwear. Due to the large number of apocrine sweat glands in the area, this would often also have a smell associated with it.
- Feet (plantar hyperhidrosis): symptoms of plantar hyperhidrosis are the emergence of watery sweat from the sole of the foot and from between the toes. A small amount may come from the top of the foot. When barefoot, this can cause people to slip on smooth surfaces. When wearing socks or shoes, the sweat can interact with the material to cause an odour.
- Face/head hyperhidrosis: hyperhidrosis of the face and head is seen when watery type of sweat emerges from the face in beads and usually runs down the sides of the face or the nose. This usually causes great embarrassment which worsens the condition due to a secondary psychological drive for sweating. In some patients it comes from within the hairline with sweat trickling out of the hair which can be very uncomfortable.