7th June 2025

Diagnosis

Diagnosis is based on the cause of hyperhidrosis; for primary, history and physical examination are enough. Investigations may be required to confirm or exclude secondary causes.

Diagnostic criteria for primary focal hyperhidrosis

• Occurs in at least one of the following locations: axillae, palms, soles or craniofacial region AND
• Lasted 6 months AND 
• No apparent cause AND 
• At least two of the following:
  • Bilateral and relatively symmetrical
  • Impairs daily activities
  • At least one episode per week
  • Onset before 25 years of age 
  • Positive family history 
  • Cessation of local sweating when sleeping 
• If symptoms less than 6 months or onset after 25 years, can be primary focal hyperhidrosis if other criteria are met, but clinically should exclude any underlying causes

Tests to consider for secondary hyperhidrosis depend on the clinical scenario

• Urine analysis for substance abuse 
• Urine evaluation for metanephrines, catecholamines and 5-hydroxyindoleacetic acid
• Bloods – FBC, ESR, CRP, U+E, LFT, TFT, HIV, TB
• Blood film for malarial parasites, if indicated
• Chest X-ray 
• ECG 
• CT scanning – thyroid, pituitary, diabetic, infectious, neoplastic disorders, as well as phaeochromocytoma and carcinoid tumours