Hyperhidrosis

Hyperhidrosis (Excessive Sweating)

Hyperhidrosis is excessive sweating that is out of proportion to heat or exercise. It can affect the underarms (axillary), palms, soles, scalp, or face. Hyperhidrosis often interferes with work, school, social life, and confidence.

Sweating is a normal, physiological response by the body’s thermoregulatory system. In hyperhidrosis, this response is amplified intensely, even in air-conditioned environments.

What is hyperhidrosis?

Hyperhidrosis is a medical condition where sweat glands produce more sweat than the body needs for temperature regulation. It commonly presents as:

  • Visible soaking through clothing (underarms)
  • Wet palms that affect handshakes, writing, sports
  • Slippery soles causing foot discomfort and shoe damage


Clinically, hyperhidrosis is broadly classified into:

  • Primary focal hyperhidrosis: focal, usually symmetrical sweating with no underlying medical cause (most common) 
  • Secondary hyperhidrosis: sweating due to another condition or medication, often more generalised or associated with systemic symptoms 
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Why does hyperhidrosis occur?

Primary focal hyperhidrosis (most common)

This form is thought to be driven by overactivity of sympathetic (cholinergic) signalling to otherwise normal eccrine sweat glands. This means that the sweat glands are too reactive to triggers, and produce excess swat. 

What hyperhidrosis looks like:

  • Focal sweating of underarms, palms, soles, face/scalp
  • Often bilateral and symmetric
  • Often minimal during sleep 


Secondary Hyperhidrosis


Here, the body is sweating as a symptom  due to a medical cause e.g., endocrine causes, infection, medications. Evaluation focuses on pattern, timing (including night sweats), and accompanying symptoms.

Risk factors and triggers of hyperhidrosis

Common triggers in Singapore include:

 

  • Heat, humidity, and emotional stress
  • Occlusive clothing, tight footwear, prolonged glove use
  • Caffeine, alcohol, spicy foods (variable sensitivity)
  • Anxiety around sweating 


Risk factors for secondary hyperhidrosis include:

 

  • New onset sweating in adulthood
  • Generalised sweating or night sweats
  • Medication changes or systemic symptoms

Categorisation

 

By cause

  • Primary focal vs secondary 


By location

  • Axillary (underarm), palmar (hands), plantar (feet), craniofacial (face/scalp), or generalised 


By severity and impact

A commonly used tool is the Hyperhidrosis Disease Severity Scale (HDSS)—a simple 4-point scale that correlates with quality-of-life impact and sweat measurements.

 

Signs and symptoms


You may have hyperhidrosis if you notice:

  • Sweating that is frequent, visible, and interferes with daily activities
  • Sweat dripping from hands and/or feet or soaking through clothing
  • Skin irritation, eczema flares, or recurrent infections in affected areas (because moisture alters the skin barrier)


For primary focal hyperhidrosis, commonly cited clinical features include focal involvement bilateral symmetry, reduced sweating during sleep, and meaningful daily-life impairment.

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FAQs

How can hyperhidrosis be treated?

Treatment is tailored to anatomical region, severity lifestyle needs, and tolerance.  Treatment options include:

1) Antiperspirants Often includes aluminium chloride formulations to reduce sweat output.

  • Works best with correct technique and skin-barrier support. 


2) Topical prescription therapies

  • Dermatology-led treatment may include topical agents that reduce sweat signalling 


3) Iontophoresis

  • A non-surgical approach using electrical current through water to reduce sweating—commonly used for hands and feet.

 

4) Botulinum toxin injections (highly effective for focal areas)

Botulinum toxin reduces sweating by blocking the nerve signals that stimulate sweat glands. Dermatologists use it for underarms, hands, feet, and sometimes the face. Results often begin within 7–10 days, and the effect commonly lasts months.

5) Oral medications

Oral anticholinergic medications can reduce sweating but must be prescribed carefully due to side effects (e.g., dry mouth, blurry vision). 

6) Device-based and procedural options 

Some in-clinic options aim to reduce sweat gland function more durably. 

7) Surgery 

Procedures like sympathectomy are reserved for specific situations due to potential complications, including compensatory sweating.

Why choose Dr Rachel Ho and The Skin Longevity Clinic for hyperhidrosis treatment?

At The Skin Longevity Clinic, hyperhidrosis is treated as a medical condition with real quality-of-life impact.

What patients can expect:

  • Structured diagnosis: distinguishing primary vs secondary hyperhidrosis and using tools like HDSS to quantify impact 
  • Evidence-based planning: a stepwise approach aligned to clinical guidance and medical best practices 
  • Skin longevity focus: reducing sweat while protecting barrier function, minimising irritation, and preventing secondary skin problems


Dr Rachel Ho’s public-facing work emphasises clear, evidence-based explanations well suited to conditions like hyperhidrosis where understanding the biology improves adherence and outcomes.

Doctor Rachel’s Takeaway

Hyperhidrosis is common—and treatable. The most important steps are:

  1. Identify the type 
  2. Measure impact (HDSS helps guide intensity of treatment)
  3. Use targeted therapy based on body area and severity
  4. Support the skin barrier so the skin stays resilient in Singapore’s humidity 

If sweating is interfering with your daily life, a personalised, medical plan can meaningfully improve comfort, confidence, and long-term skin health.