what is secondary hyperhidrosis?
This form of hyperhidrosis occurs secondary to an underlying body state, medical condition or the side effect of a medication. It nearly always begins in adulthood, long after the usual age of onset for primary hyperhidrosis. Secondary hyperhidrosis is sometimes called diaphoresis. With a few exceptions secondary hyperhidrosis affects the whole body and is often also called generalised hyperhidrosis.
Nearly everyone will have experienced short episodes of sweating and an increased body temperature with an acute infection such as the flu, Covid or other viral infection. Such episodes are short lived and subside as the infection clears. Changing physiological states of the body can cause sweating including pregnancy, menopause and obesity. Large intakes of caffeine or alcohol can also lead to episodes of sweating.
Nearly everyone will have experienced short episodes of sweating and an increased body temperature with an acute infection such as the flu, Covid or other viral infection. Such episodes are short lived and subside as the infection clears. Changing physiological states of the body can cause sweating including pregnancy, menopause and obesity. Large intakes of caffeine or alcohol can also lead to episodes of sweating.
night sweats
Night sweating is not a feature of primary hyperhidrosis. The causes of night sweating or sweating while asleep include the menopause, severe anxiety and/or stress, hyperthyroidism, alcohol or drug misuse or withdrawal, hypoglycaemia (diabetics), some prescribed medications and infections.
Infections causing night sweating include tuberculosis (TB), HIV and endocarditis as well as other acute infections. If there are no other symptoms other than night sweats it is very important to get checked out as a serious infection could be the cause and sweating might be the only symptom. Sadly, tuberculosis in the UK is continuing to rise after falling in the 1980s, rising again in the first decade of the 21st century then falling during the second decade.
Infections causing night sweating include tuberculosis (TB), HIV and endocarditis as well as other acute infections. If there are no other symptoms other than night sweats it is very important to get checked out as a serious infection could be the cause and sweating might be the only symptom. Sadly, tuberculosis in the UK is continuing to rise after falling in the 1980s, rising again in the first decade of the 21st century then falling during the second decade.
other causes of secondary hyperhidrosis
There is a very long list of diseases and medical conditions that can cause secondary hyperhidrosis. To help diagnose hyperhidrosis (and the cause of many other conditions) many clinicians use the surgical sieve to provide a list of possible causes as shown below.
Physiologic
Pregnancy, menopause, obesity.
Iatrogenic
Drugs (prescribed or illicit), surgery.
Infection
Acute viral or bacterial infections, tuberculosis, HIV, endocarditis.
Endocrine
Diabetes, hyperthyroidism.
Trauma
Amputees, spinal cord injury.
Neurological
Parkinson's disease, peripheral neuropathy, stroke.
Neoplastic
Lymphoma, leukaemia.
Immunologic
Rheumatoid arthritis, lupus.
Cardiovascular
Heart failure.
Psychiatric
Social anxiety disorder, stress, anxiety & depression.
If there is no obvious cause of your sweating many of the commonly known conditions that can lead to secondary hyperhidrosis can be identified by some simple routine blood tests to check your full blood count, sugar levels and your liver, kidney and thyroid functions.
secondary hyperhidrosis due to medications
The number of medications that can cause sweating as a side effect is large. If you suspect one of the medications that you are taking might be responsible for your sweating DO NOT stop taking it. Discuss with your GP or hospital specialist to see if there is an alternative medication with the same action that could be prescribed instead.
We have had increasing numbers of people contact us with sweating symptoms who are taking antidepressant drugs in the selective serotonin reuptake inhibitor (SSRI) and serotonin & serotonin-norepinephrine(noradrenaline) reuptake inhibitor (SNRI) classes. Sweating is a known side effect of these medications in as many as 1 in 10 (10%) of those taking them. The SNRI venlafaxine seems to be particularly prone to this side effect. This is possibly because it increases the amount of noradrenaline available in the body which is the chemical which stimulates the sympathetic nervous system. If you are experiencing sweating taking one of these drugs it is worth discussing with your doctor about trying an alternative drug in the same group to see if that reduces your symptoms.
We have had increasing numbers of people contact us with sweating symptoms who are taking antidepressant drugs in the selective serotonin reuptake inhibitor (SSRI) and serotonin & serotonin-norepinephrine(noradrenaline) reuptake inhibitor (SNRI) classes. Sweating is a known side effect of these medications in as many as 1 in 10 (10%) of those taking them. The SNRI venlafaxine seems to be particularly prone to this side effect. This is possibly because it increases the amount of noradrenaline available in the body which is the chemical which stimulates the sympathetic nervous system. If you are experiencing sweating taking one of these drugs it is worth discussing with your doctor about trying an alternative drug in the same group to see if that reduces your symptoms.
Gustatory sweating
Gustatory sweating is a further form of hyperhidrosis of the head, neck and sometimes chest that occurs when some patients eat any type of food, smells food or even thinks about food. It can be a manifestation of autonomic neuropathy in diabetes mellitus.
Another form, Frey’s syndrome, can occur after parotidectomy surgery (removal of the parotid salivary gland) when the parasympathetic fibres of the auriculotemporal nerve normally responsible for salivation begin to innervate the eccrine sweat glands of the overlying skin.
Another form, Frey’s syndrome, can occur after parotidectomy surgery (removal of the parotid salivary gland) when the parasympathetic fibres of the auriculotemporal nerve normally responsible for salivation begin to innervate the eccrine sweat glands of the overlying skin.
amputees
Hyperhidrosis affecting the residual limb in amputees is common. The cause is a combination of the sweat glands in the area compensating for the ones that have been lost and the lack of evaporation of the sweat beneath the prosthesis. This localised area of excessive sweating is thought to contribute to many of the other problems amputees experience such as recurring infections, dermatitis and blisters.
Unlike many other parts of the body, there is no agreed treatment strategy of hyperhidrosis for amputees but based upon feedback from patients, doctors and the scientific literature the treatments to try are largely similar to how other skin sites are managed:
· Strong antiperspirants are the first-line treatment for all patients with hyperhidrosis. The skin at the amputation site can be sensitive and some antiperspirants can irritate the skin badly.
· Iontophoresis is possible using specially designed electrodes/baths that the residual limb can be placed into. There are ready made devices available from some companies and we have had electrodes made for the purpose as illustrated in the pictures below. A thin cotton stocking must be placed over the skin that is immersed in the water to prevent inadvertent contact of the skin with the metal electrode. If you are interested in this and would like further information please contact us [link to contact].
· Botulinum toxin can be used and targeted at the area(s) of skin worst affected. However, the injections can be very painful for some which is made worse when the anatomy is distorted especially after traumatic loss of the limb. As with use in other body areas the effects are relatively short-lasting and require repeat injections after three to six months. Other treatments can and have been used including medications and local surgery but these do require the specialist care of a dermatologist or other healthcare professional trained and experienced in treating amputees and prescribing such therapies.
Unlike many other parts of the body, there is no agreed treatment strategy of hyperhidrosis for amputees but based upon feedback from patients, doctors and the scientific literature the treatments to try are largely similar to how other skin sites are managed:
· Strong antiperspirants are the first-line treatment for all patients with hyperhidrosis. The skin at the amputation site can be sensitive and some antiperspirants can irritate the skin badly.
· Iontophoresis is possible using specially designed electrodes/baths that the residual limb can be placed into. There are ready made devices available from some companies and we have had electrodes made for the purpose as illustrated in the pictures below. A thin cotton stocking must be placed over the skin that is immersed in the water to prevent inadvertent contact of the skin with the metal electrode. If you are interested in this and would like further information please contact us [link to contact].
· Botulinum toxin can be used and targeted at the area(s) of skin worst affected. However, the injections can be very painful for some which is made worse when the anatomy is distorted especially after traumatic loss of the limb. As with use in other body areas the effects are relatively short-lasting and require repeat injections after three to six months. Other treatments can and have been used including medications and local surgery but these do require the specialist care of a dermatologist or other healthcare professional trained and experienced in treating amputees and prescribing such therapies.
