Sweating (Hyperhidrosis): Symptoms, Complaints, Signs

Hyperhidrosis (sweating) is:

• Local or focal, i.e., increased sweating in certain areas of the body (e.g., armpits, hands, feet).
• Generalized, i.e., increased sweating over the entire body (e.g., as night sweats). Generalized hyperhidrosis usually occurs as an accompanying symptom in the presence of an underlying disease.

Diagnostic criteria of primary focal hyperhidrosis (PFH):

• Positive family history
• Onset of symptomatology already in childhood or adolescence (< 25 years of age).
• Bilateral, symmetrical sweating at predilection sites (body regions where the disease occurs preferentially: armpits, palms of the hands, soles of the feet and forehead, rarely groin, anal crease, etc.)
• Temperature-independent, unpredictable and not voluntarily controllable occurrence.
• Episodes occurring at least once a week
• Sustaining sweating during sleep
• Impairment of daily activities

Warning signs (red flags)

Secondary generalized hyperhidrosis

• Medical history:
  • Consider tuberculosis in immigrants from Africa, Southeast Asia, and the Western Pacific region and in homeless persons (even if no fever is present).
  • Alcohol, drugs (nicotine, cocaine, heroin), intoxications.
• Night sweats → think of:
  • Infections such as AIDS, brucellosis, infectious mononucleosis (glandular fever), malaria, tuberculosis.
  • Cardiovascular diseases: Heart defects, heart failure, unstable angina pectoris (“chest tightness”; sudden pain in the heart area with inconstant symptoms).
  • Menopause (climacteric; menopause in women).
  • Neurological diseases we Parkinson’s disease, paraplegia, syringomyelia.
  • Psychiatric disease: depression, panic disorders, anxiety disorders.
  • Psychovegative diseases such as burnout, stress
  • Rheumatic diseases such as ankylosing spondylitis, rheumatoid arthritis or vasculitides (vascular inflammations)
  • Tumor diseases: Hodgkin’s disease, non-Hodgkin’s lymphoma, bronchial carcinoma (lung cancer), acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML); neuroblastoma (in infants).
• Cold sweat → think of: acute heart failure (cardiac insufficiency), myocardial infarction (heart attack) and shock.
• Weight loss → think of: malignant (malignant) process or hyperthyroidism (hyperthyroidism).
• Think of hypoglycemia (under-pregnancy). Typical signs of hypoglycemia are: Pallor, ravenous hunger, palpitations (palpitations), sweating, tachycardia (heartbeat too fast: > 100 beats per minute) and tremor (shaking).

Secondary regional and focal hyperhidrosis (etiology/causes).