Hyperhidrosis is defined as the overproduction of sweat, in excess of what can be evaporated and what is typically needed for normal, physiological thermoregulation (1,2). Hyperhidrosis can be primary or secondary. Primary hyperhidrosis is by definition idiopathic in nature. Secondary hyperhidrosis can be generalized or localized. There are many causes of secondary hyperhidrosis and each patient should be evaluated with a complete history of these causes a diagnosis of primary hyperhidrosis is given. Secondary causes of hyperhidrosis are generally related to systemic conditions, the most common being endocrine abnormalities. Other common causes of secondary hyperhidrosis include febrile illness, neurological disorders, spinal cord injury, and diabetes. Table 1 gives a complete list of additional causes. In this chapter, we focus our attention on primary idiopathic hyperhidrosis. In most cases, primary hyperhidrosis is seen in its localized form, yet cases of generalized primary hyperhidrosis are also reported. Primary localized hyperhidrosis most commonly occurs symmetrically in the axillae, palms, and/or soles and is usually absent during sleep (2-4).
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