Hyperhidrosis

Diagnosis

Interview and Examination

It is important to thoroughly interview and examine each patient. Patient histories tend to have many of the same characteristics including:

• Condition starts sometime before the patient is 20 years old
• Sweating primarily affects palms of hands and soles of feet
• Sometimes other family members have it, sometimes not
• School papers get wet, social embarrassment and isolation can occur

It is important to find out what patients have done to treat their condition as many will have already tried some methods.

On exam there is usually a clamminess and even dripping of sweat droplets affecting the palms/soles that stops just above the wrists/ankles. The patients are usually not excessively anxious and the rest of their physical examination (including vital signs and neurology exam) is normal.

Blood and Urine Tests

With the medical history and exam, the next step is selected blood tests to rule out hyperthyroidism, diabetes, acromegaly and pheochromocytoma.

Thermoregulatory Sweat Test

Mayo Clinic in Minnesota documents the distribution of the excessive sweating via the Thermoregulatory Sweat Test. A moisture-sensitive indicator powder is applied on all skin areas and a color change from yellow-green to dark purple occurs in areas sweating excessively at room temperature. A digital photo documents this. Then the patient is exposed to sufficient heat and humidity in a sweat cabinet that causes sweating over the rest of the body surface. This is important, as occasionally a patient will have excessive sweating on other regions of the body caused by another condition that needs to be diagnosed and treated.

Patients who have essential hyperhidrosis tend to sweat even more in the palms in a warm environment whereas normal individuals tend not to sweat from the palms. These findings help physicians accurately diagnose the patient and define the severity of the condition to determine the most appropriate treatment.