Excessive Sweating and Heat Intolerance

Abstract

Excessive sweating or hyperhidrosis refers to sweating that is in excess of that required for thermoregulation, and can be generalized or focal. Commonly involved focal sites include the axillae, soles and palms, forehead, and groin, in that order. Hyperhidrosis can be precipitated by certain situations, and by the intake of certain foods, drinks, and medications. Endocrine causes of hyperhidrosis include hyperthyroidism and growth hormone excess, pheochromocytoma, paraganglioma, carcinoid, premature ovarian insufficiency, and hypoglycemia. However, there are many other causes of excessive sweating, such as obesity, autonomic dysfunction, lymphomas, leukemia, tuberculosis, sleep disorders, and certain infections and medications. Heat intolerance refers to a greater perception of and inability to tolerate (higher) temperatures well tolerated by others in the same environment and is a feature of hyperthyroidism and certain other conditions. A thorough history and physical examination can help narrow down the work-up that is required, which may include blood tests, imaging studies, and other specialized tests. Management includes avoiding the precipitating event, treating the underlying condition, the use of antiperspirants (particularly with aluminum chloride), the use of local and oral anticholinergics, injections of botulinum A toxin, and surgery.