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Hyperhidrosis Types Diagnostic Test Treatment Options

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Last update 06/14/2023

Everyone sweats because your skin needs this to not dry out. But is your sweating to the extreme and causing you more to worry about? Hyperhidrosis Types.

Hyperhidrosis is a very common condition. Yet people are just too ashamed or embarrassed to discuss this skin problem. I guess, because we associate sweat as a bad thing.

However, have you ever imagined your skin without sweat? You would have your own Atacama Desert. I mean talk about dry skin.

There are two main categories to separate excessive sweating. This provides a better understanding for you and your skincare specialist in determining any possible underlying cause. Thus, an effective treatment plan can be created to support alleviating some of the uncomfortable symptoms.

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Hyperhidrosis Types

Primary Focal Hyperhidrosis (PFH)

The most common form Primary focal hyperhidrosis is the category of excessive sweating not due to a medical condition. It is also not a side effect of medications. This form is of primary origin. In short, excessive sweating is how the medical condition is referred to.

PFH happens on very specific locations of the body. The locations are called focal areas. And are typically “symmetric” which means that both the left and right sides of your body are affected the same.

The most common sweaty focal areas:

  • Hands (palmer)
  • Feet (plantar)
  • Underarms (axillary)
  • Face or head (craniofacial)
  • Beneath breast
  • Back (dorsum)
  • Groin (hexsel’s)

Furthermore, the majority of people with hyperhidrosis will have this condition on additional areas. For example, those with sweaty hands most likely will have sweaty feet.

Therefore, this type is typically discovered and diagnosed in childhood and mainly before adolescence. This is often the case with hyperhidrosis of the hands and feet. Interestingly, individuals will experience excessive sweating episodes at least once a week, but no excessive sweating occurs while sleeping.

Research has also shown that this type could be inherited and many family members could suffer from PFH as well. However, sadly because of embarrassment they never talk to each other about PFH.

Cause of Primary Focal Hyperhidrosis

The over production of sweat glands usually has a trigger like exercise and stress. But with those affected by PFH additional amounts of sweat go beyond what the body requires for thermoregulation.

For instance, around 30 to 50 percent of people with PF have a family history of sweating. And increased stimulation of the sympathetic nervous system at the central level is causing the excessive sweating. Primary Hyperhidrosis gets worse with puberty.

Secondary Generalized Hyperhidrosis (SGH)

This category of excessive sweating is due to another medical condition. It can also be a side effect from a medication. In other words, this is why it is referred to as secondary because it appears after something else.

Different from PFH, those with secondary will have sweating on larger or other locations of the body. These locations are called generalized areas. And another major difference is that those with SGH could have their sweating episodes while sleeping.

The sweating often has an abrupt beginning compared to another condition’s development. Further, SH commonly presents in those aged 25 and older.

Cause of Secondary Generalized Hyperhidrosis

Drugs/Medications known to cause hyperhidrosis as a side effect are provided in this list.

Diseases and conditions that could cause hyperhidrosis are available on this list.

These are a tool to aid in you getting started with your doctor visit.

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Secondary Focal Hyperhidrosis (SFH)

Secondary focalized hyperhidrosis can be due to neurological disorders and dermatologic syndromes. In other words, SFH often affects the whole body. However, if you’ve been injured, focal hyperhidrosis could result in that same region. The major cause with SFH is the result of injuries to the central nervous system.

Compensatory Hyperhidrosis

Following a severe injury compensatory hyperhidrosis can develop. Referring to its name, it’s compensating for the lack of sweat in certain areas. It is also known as reflex or rebound hyperhidrosis.

This includes:

  • Diabetic neuropathy
  • Ross syndrome
  • After endoscopic thoracic sympathectomy (ETS)


But if you have an injury affecting a large area of the sympathetic chain, anhidrosis (no sweating) could occur. This typically occurs in some areas below the injury site. However, if this is a significant area affected by anhidrosis, compensatory can develop in other locations.

Multifocal Hyperhidrosis

Multifocal hyperhidrosis is the name given for more than one location affected. One study found, over 81 percent of patients had three or more focal hyperhidrosis areas.

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Diagnosing Hyperhidrosis

Other than your physician doing a physical exam and listening to your history there are test to identify this condition. Your level of sweating can actually be measured in two different tests.

Starch Iodine Test

This test shows a chemical reaction that searches for the presence of starch or for iodine. The mixture of these two substances is intensely blue-black. Further, this test is utilized to detect hyperhidrosis.


Vapometer is a device that measures transepidermal water loss. So the amount of sweat that the hands, underarms, feet and scalp create is measured. In other words, this presents your doctor with a way to compare your sweat before and after treatment.

Hyperhidrosis Types Treatments

Treating your hyperhidrosis depends on the severity of your condition. Primary has several options for treatment available. This consists of home remedies as well as others that could require a doctor visit.

Changes to Diet

Latest research states switching to a vegetarian diet and dietary supplements can reduce the severity of excessive sweating.


These contain aluminum salt found over the counter or by prescription that are designed to block your sweat glands from perspiring.

Antiperspirants such as sprays, roll-ons or lotions can be applied at bedtime on dry skin and washed off in the morning.

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Drying Topical Creams

A topical cream can be used daily to dry the skin. This is commonly the first treatment. Included are aluminum chloride or aluminum chloride hexahydrate creams.

These are usually applied each night and covered to aid absorption. Aluminum topical creams are very effective. But, some individuals have reported uncomfortable side effects like burning and skin irritation.


These medications are known as systemic therapies. In other words, they affect the whole body. Anticholinergics can be either oral or topical. As a result, the medication deactivates your sweat glands.

For patients who sweat in multiple areas oral medications are a good choose. However, there are side effects, such as dry mouth and dry eyes.  Sometimes, after taking the prescription for a period the patient discovers they lose their effectiveness.


This treatment takes a series of administered Injections, to temporarily halt your nerves from telling the sweat glands to perspire. Injections are placed into areas where increased sweating occurs. As a result, a very reliable temporary reduction in sweating is observed. In short, it can last from 3 to 6 months.


The website states the treatment is considered safe and is FDA approved. It eliminates sweat and odor from the armpit area. Non-invasive electromagnetic energy is utilized and is very effective with permanent results.

Microwave Thermolysis

Microwave thermolysis directs energy at the sweat glands in the underarms. Thus, it destroys the sweat glands there. So, excessive sweating in the underarms stops right away.

Just two percent of your sweat glands in your body are found in this location. And destroying them in the underarm won’t affect how your body cools.

Your physician will numb the underarm area in preparation for this procedure. After that, your underarm skin is lifted into the device. Microwave energy is aimed at your sweat glands. Usually, this procedure lasts an hour with no incisions or cuts.


Iontophoresis is a non-invasive drug-free, needle free treatment option done in several visits. This applies a small (low voltage) electrical current through water to hands or feet.

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What is Endoscopic Thoracic Sympathectomy? (ETS)

ETS is a high-risk surgery done to treat hyperhidrosis. Physicians strongly discourage this because of its many side effects. As a result, those who have done ETS develop compensatory hyperhidrosis.

To sum up, these individuals are now sweating more in areas that had no sweating prior. Most importantly, if you are thinking about undergoing ETS, please research other non-invasive treatment options.

However, this surgery is a last resort after other methods have shown no improvement. The sympathetic nerve is cut with this procedure which is responsible for sweating.

A very select group of patients may consider this option. There is a risk that your body could compensate for the surgery by producing even more sweat.

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Behavioral Medicine

Those diagnosed with hyperhidrosis can experience more stress linked with excessive sweating. Furthermore, behavioral medicine techniques can give relief from stress, anxiety and additional negative emotions.

Behavioral medicine consultation is recommended to treat all patients with hyperhidrosis. To sum up, it improves emotional, social and occupational, academic activities in teens and adults with this condition.

Wrapping it up

Hyperhidrosis has two main types primary focal and secondary generalized. It is a common skin condition that is rarely spoken about. In other words, it causes much embarrassment and shame.

However, there are treatment options for this condition. So, it can be managed. Secondary is the result of another condition or medication, and this should be addressed first.


Mary is the founder of All About Our Skin. Former esthetician and CPC. Enjoys researching skincare and has been studying our skin for the past fifteen years.

Researching content:  SweatHelp, Two Types of Hyperhidrosis accessed 01/2023 Dermadry, What is Hyperhidrosis? accessed 01/2023 Dermatologic Surgery, Prevalence of Multifocal Primary Hyperhidrosis and Symptom Severity Over Time: Results of a Targeted Survey  accessed 01/2023  Pinnacle Dermatology, The Two Types of Hyperhidrosis  accessed 01/2023  American Academy of Dermatology Association, Hyperhidrosis: Diagnosis and Treatment  accessed 01/2023  verywell health, How Hyperhidrosis is Diagnosed  accessed 01/2023

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