7th June 2025

Cause

The cause depends on whether it is primary or secondary hyperhidrosis.

• Primary
  • Complex over-reactivity or hyperexcitability of neurological circuits likely involving cortical, hypothalamic and autonomic nervous system interactions
  • Usually focal hyperhidrosis: palmoplantar, axillary or craniofacial
  • Positive family history
• Secondary hyperhidrosis
  • Systemic and neurological effects of organic conditions and their effect on thermoregulatory centres of hypothalamus
  • Generalised hyperhidrosis (more common):
    • Anxiety
    • Physiological (pregnancy, menopause)
    • Cardiovascular (heart failure, endocarditis)
    • Infections (acute/chronic viral or bacterial infections)
    • Malignancy (Hodgkin’s disease, myeloproliferative disorders)
    • Endocrine or metabolic (hyperthyroid, diabetes mellitus, diabetes insipidus, phaeochromocytoma, acromegaly, carcinoid syndrome, hyperpituitarism, obesity and gout)
    • Neurological (Parkinson’s disease, epilepsy, hypothalamic lesions)
    • Drugs (e.g. cholinesterase inhibitors, antidepressants, pilocarpine eye drops, propranolol, proton pump inhibitors, ciprofloxacin, aciclovir, esomeprazole, opioids)
    • Drug or alcohol misuse or withdrawal (cocaine, heroin)
  • Focal hyperhidrosis:
    • neurological (cerebrovascular disease, peripheral neuropathies, diabetic autonomic neuropathy, spinal cord lesions, complex regional pain syndrome)
    • intrathoracic lesions (mesothelioma, cervical rib)
    • Gustatory sweating, sweating caused by food or drink (diabetic neuropathy, preauricular herpes zoster, invasion of cervical sympathetic trunk by tumour, surgery/injury to parotid gland)
    • Compensatory hyperhidrosis (myelopathy, cerebrovascular disease, nerve trauma or post-surgery)
    • Others –Raynaud’s phenomenon, arteriovenous fistula, cold injury, rheumatoid arthritis, nail-patella syndrome  Image Source: Wikimedia Commons (2018). Hyperhidrosis Treatment, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/w/index.php?search=Hyperhidrosis_Treatment.jpg&title=Special:MediaSearch&type=image (Accessed 23 May 2025).