Secondary Hyperhidrosis
What is Secondary Hyperhidrosis?
Secondary hyperhidrosis is excessive sweating caused by an underlying medical condition or a side effect of a medication. This stands in contrast to primary hyperhidrosis, which is excessive sweating that is not incident to a medical condition or medication. In this post, I will list the most common causes of secondary hyperhidrosis, compare primary and secondary hyperhidrosis, and describe the treatment protocol for secondary hyperhidrosis.
Common Causes of Secondary Hyperhidrosis
As mentioned above, excessive sweating in secondary hyperhidrosis has a root cause, usually a medical condition or medication.
Common medical conditions associated with secondary hyperhidrosis include:
- Diabetes
- Hyperthyroidism
- Infections
- Menopause
- Heart disease
- Parkinson's Disease
- Certain cancers
Medications that can cause secondary hyperhidrosis include:
- Antidepressants, particularly SSRIs and SNRIs
- Antipyretics such as aspirin and acetaminophen
- Certain blood pressure medications
- Hormone therapy
Primary vs. Secondary Hyperhidrosis
Primary and secondary hyperhidrosis often have a very different clinical picture:
- Secondary hyperhidrosis often begins in adulthood; whereas, primary hyperhidrosis often appears before puberty
- Sweating in primary hyperhidrosis is often drastically reduced (or even stops) at night while sleeping
- People with secondary hyperhidrosis have generalized (all over the body) sweating; whereas, people with primary hyperhidrosis sweat in particular locations (though, unfortunately, some patients with primary hyperhidrosis sweat in so many locations, it is essentially generalized)
- There is no genetic component to secondary hyperhidrosis; whereas, primary hyperhidrosis tends to run in families
Treatment of Secondary Hyperhidrosis
If possible, the underlying cause of secondary hyperhidrosis should be addressed. For example, if a patient is sweating because they are hyperthyroid, taking a medication to treat the hyperthyroidism should be a very effective treatment. Similarly, if a patient is sweating because of a medication, stopping or changing (should be done only in consultation with your healthcare provider) that medication should resolve the symptoms.
Unfortunately, not all diseases can be treated, and some medications are medically necessary. In these cases, controlling the sweating itself is the best option. Sweat management is the same in both primary and secondary hyperhidrosis:
- Start with antiperspirants or methenamine cream, 13%
- Add an oral anticholinergic medication (e.g., glycopyrrolate)
- For underarms, hands, and feet, consider iontophoresis
- Botox injections
