In all humans, sweating is an automatic process. In some people, however, natural perspiration is excessive, leading to a condition known as hyperhidrosis. Hyperhidrosis (hi-pur-hi-DROE-sis) is abnormally excessive sweating that's not necessarily related to heat or exercise.

Hyperhidrosis, also known as polyhidrosis or sudorrhea, is a condition characterized by excessive sweating. The sweating can affect just one specific area or the whole body. You may sweat so much that it soaks through your clothes or drips off your hands.

Besides disrupting normal daily activities, this type of heavy sweating can cause social anxiety and embarrassment.

Although not life-threatening, it can be uncomfortable and cause embarrassment and psychological trauma. Sweating is embarrassing, it stains clothes, ruins romance, and complicates business and social interactions.

Severe cases can have serious practical consequences as well, making it hard for people who suffer from it to hold a pen, grip a car steering wheel, or shake hands.

What is Hyperhidrosis?

The excessive sweating associated with hyperhidrosis is normally most active in the hands, feet, armpits, and the groin because of their relatively high concentration of sweat glands.

  • Focal hyperhidrosis: When the excessive sweating is localized. For example, palmoplantar hyperhidrosis is excessive sweating of the palms and soles.

  • Generalized hyperhidrosis: Excessive sweating affects the entire body.

Hyperhidrosis may be present from birth or might develop later in life.

Hyperhidrosis may be present from birth or might develop later in life.

However, most cases of excessive sweating tend to start during a person’s teenage years. The condition can be due to an underlying health condition, or have no apparent cause:

  • Primary idiopathic hyperhidrosis: “Idiopathic” means “of unknown cause.” In the majority of cases, the hyperhidrosis is localized.

  • Secondary hyperhidrosis: The person sweats too much because of an underlying health condition, such as obesity, gout, menopause, a tumor, mercury poisoning, diabetes mellitus, or hyperthyroidism (overactive thyroid gland).

For some, hyperhidrosis symptoms are so severe that it becomes embarrassing, causing discomfort and anxiety. The patient’s career choices, free time activities, personal relationships, self-image, and emotional well-being may be affected.

Fortunately, there are several options which can treat symptoms effectively. The biggest challenge in treating hyperhidrosis is the significant number of people who do not seek medical advice, either due to embarrassment or because they do not know that effective treatment exists.


Hyperhidrosis is defined as sweating that disrupts normal activities.

Episodes of excessive sweating occur at least once a week for no clear reason and have an effect on social life or daily activities.

Signs and symptoms of hyperhidrosis may include:

  • Clammy or wet palms of the hands

  • Clammy or wet soles of the feet

  • Frequent sweating

  • Noticeable sweating that soaks through clothing

People with hyperhidrosis might experience the following:

  • Irritating and painful skin problems, such as fungal or bacterial infections

  • Worrying about having stained clothing

  • Reluctant to make physical contact

  • Self-conscious

  • Socially withdrawn, sometimes leading to depression

  • Select employment where physical contact or human interaction is not a job requirement

  • Spend a large amount of time each day dealing with sweat, such as changing clothes, wiping, placing napkins or pads under the arms, washing, wearing bulky, or dark clothes

  • Worry more than other people about body odor

Experts are not certain why, but excessive sweating during sleep is not common for people with primary hyperhidrosis (the type not linked to any underlying medical condition).


The causes of primary hyperhidrosis are not well-understood; on the other hand, secondary hyperhidrosis has a long list of known causes.

Causes of primary hyperhidrosis

People used to think that primary hyperhidrosis was linked to the patient’s mental and emotional state, that the condition was psychological and only affected stressed, anxious, or nervous individuals.

However, recent research has demonstrated that individuals with primary hyperhidrosis are no more prone to feelings of anxiety, nervousness, or emotional stress than the rest of the population when exposed to the same triggers.

In fact, it is the other way round – the emotional and mental feelings experienced by many patients with hyperhidrosis are because of the excessive sweating.

Studies have also shown that certain genes play a role in hyperhidrosis, making it look more likely that it could be inherited. The majority of patients with primary hyperhidrosis have a sibling or parent with the condition.

Causes of secondary hyperhidrosis

· Spinal cord injury

· Alcohol abuse

· Anxiety

· Diabetes

· Gout

· Heart disease

· Hyperthyroidism – an overactive thyroid gland

· Obesity

· Parkinson’s disease

· Pregnancy

· Respiratory failure

· Shingles

· Some cancers, such as Hodgkin’s disease

· Some infections – HIV, malaria, TB (tuberculosis)

· Some medications, including some antidepressants, anticholinesterases (for Alzheimer’s disease), pilocarpine (for glaucoma), propranolol (for high blood pressure)

· Substance abuse


Initially, a doctor may try to rule out any underlying conditions, such as an overactive thyroid (hyperthyroidism) or low blood sugar (hypoglycemia) by ordering blood and urine tests.

Patients will be asked about the patterns of their sweating – which parts of the body are affected, how often sweating episodes occur, and whether sweating occurs during sleep.

The patient may be asked a series of questions, or have to fill in a questionnaire about the impact of excessive sweating; questions may include:

· Do you carry anything around to deal with episodes of excessive sweating, such as napkins, antiperspirants, towels, or pads?

· Does hyperhidrosis affect your behavior or mental state when you are in public?

· Has hyperhidrosis had any effect on your employment?

· Have you ever lost a friend due to hyperhidrosis?

· How often do you change your clothing?

· How often do you wash or have a shower/bath?

· How often do you think about excessive sweating?


If hyperhidrosis is not treated, it can lead to complications.

· Nail infections: Especially toenail infections.

· Warts: Skin growths caused by the HPV (human papillomavirus).

· Bacterial infections: Especially around hair follicles and between the toes.

· Heat rash (prickly heat, miliaria): An itchy, red skin rash that often causes a stinging or prickling sensation. Heat rash develops when sweat ducts become blocked and perspiration is trapped under the skin.

· Psychological impact: Excessive sweating can affect the patient’s self-confidence, job, and relationships. Some individuals may become anxious, emotionally stressed, socially withdrawn, and even depressed.

On average, a person with hyperhidrosis seeks medical help after living with the condition for 9 years.

It is important to spread the word that the symptoms of excessive sweating can be effectively treated.

Do I have wet hands?

· Provoked by emotional stress, hot weather conditions

· Continuous sweating

· Sweating without an apparent reason

· Sweating stops during sleep

· Sweating not provoked by exercise


There are multiple types of surgical solutions, but we recommend the "NO SWEAT" Technique.

The results are usually instantaneous and the patient can leave the hospital on the same day with warm and dry hands. The overall success rate is close to 100%.

Sweaty palms, armpits and even face can be permanently treated by a procedure known as Transaxillary Video-Assisted Thoracoscopic Sympathicotomy (ETB/ETS). This procedure is performed under general anaesthesia and two 5mm incisions are made on each side of the chest to allow access into the chest cavities.

With the aid of a camera mounted on the thoracoscope, the sympathicotonic chains are visualized and clipped using titanium clips at the level of the second and third thoracic vertebra.

Some other surgical methods include:

  • Transthoracic (large open chest incision)

  • Transaxillary (through the armpits with a open incision) | PREFERRED

  • Anterior transthoracic (through the front of the chest with a large incision).

The sympathetic nerve can either be removed OR clamped.

The clamp procedure is called an Endoscopic Transthoracic Sympathetic Blockade (ETB) with Metallic Clips. It is also referred to as an Endoscopic Transthoracic Sympathectomy - Clip (ETS-C). The terms ETB and ETS-C are interchangeable and mean the same.