The etiology, diagnosis, and management of hyperhidrosis: A comprehensive review: Etiology and clinical work-up

J Am Acad Dermatol. 2019 Sep;81(3):657-666. doi: 10.1016/j.jaad.2018.12.071. Epub 2019 Jan 31.


Hyperhidrosis (HH) is a dermatologic disorder defined by sweat production exceeding thermoregulatory needs. Clinically, HH is diagnosed when excess sweating creates significant emotional, physical, or social discomfort, causing a negative impact on the patient's quality of life. Existing data imply that this condition may affect at least 4.8% of the US population. The etiology of HH may stem from a complex autonomic nervous system dysfunction, resulting in neurogenic overactivity of otherwise normal eccrine sweat glands. Alternatively, HH may be a result of aberrant central control of emotions. This condition is categorized as primary or secondary HH. Approximately 93% of patients with HH have primary HH, of whom >90% have a typical focal and bilateral distribution affecting the axillae, palms, soles, and craniofacial areas. Secondary HH presents in a more generalized and asymmetric distribution and is generated by various underlying diseases or medications. Secondary causes of HH need to be excluded before diagnosing primary HH.

Keywords: apocrine sweat gland; apoeccrine sweat gland; autonomic nervous system; axillary sweating; eccrine sweat gland; emotional sweating; excessive sweating; facial sweating; hyperhidrosis; oversweating; palmar sweating; plantar sweating; primary hyperhidrosis; secondary hyperhidrosis; sweat overproduction; thermoregulatory sweating.

Publication types

  • Review

MeSH terms

  • Anti-Anxiety Agents / therapeutic use
  • Cognitive Behavioral Therapy
  • Diagnosis, Differential
  • Emotions / drug effects
  • Emotions / physiology*
  • Humans
  • Hyperhidrosis / diagnosis*
  • Hyperhidrosis / etiology
  • Hyperhidrosis / therapy
  • Patient Education as Topic
  • Quality of Life*
  • Sweat Glands / physiopathology*
  • Sweating / physiology*


  • Anti-Anxiety Agents