What is Focal Hyperhidrosis?

Also known as primary hyperhidrosis, focal hyperhidrosis means excessive sweating in specific sites of the body. It usually occurs in the affected person’s armpits, hands, feet, and face.

Individuals who experience this are usually healthy. They don’t have any medical condition or medication that could cause them to sweat more than what is normal.

But if profuse sweating affects larger parts of the body, then the case might be different. This case, called generalized hyperhidrosis, is usually a symptom of an underlying illness or is a side effect of a certain medication.

Types of Focal Hyperhidrosis

The types of focal hyperhidrosis are named based on the affected body parts.

Palmar hyperhidrosis affects the hands, while plantar hyperhidrosis affects the feet. If your sweating is concentrated in the armpits, it’s called axillary hyperhidrosis. Got uncontrollable sweating on your face? That’s craniofacial hyperhidrosis.

But in most cases, people who have excessive perspiration experience it in more than one area. Thus, having palmar-axillary hyperhidrosis or palmar-plantar hyperhidrosis is possible.

Signs and Symptoms

Too much sweating is the most visible sign of focal hyperhidrosis. You’ll see it through damp clothing and clammy or wet palms, soles, or face. Maceration of skin and infections may also occur due to chronic moisture.

It’s also important to note that the condition usually starts at early adolescence. Also, a family history of hyperhidrosis makes family members likely to have the same condition.

Sadly, most people who show symptoms don’t seek medical attention because of shame. Add to that the lack of awareness of available treatments.

Focal hyperhidrosis isn’t life-threatening. But it can burden a person for a lifetime if untreated.

For instance, sweating can affect your confidence and performance in school or work. Also, it can affect your attitude towards friendships and intimate relationships.

Diagnosis

Several tests can verify if one’s sweating is a case of focal hyperhidrosis.

To start, doctors should ask about the duration and frequency of your sweating and any medical conditions you may have. The following tests can help doctors rule out other possible causes and arrive at the correct diagnosis.

Iodine Starch Test

This two-step test involves applying an iodine solution on the affected areas followed by sprinkling starch on the same sites.

Starch reacts with iodine in the presence of sweat, leaving a purple residue. The areas that produce purple stains tell the doctors the specific sites where excessive sweating occurs.

It’s important that the area is clean and dry before doing this test.

Gravimetric Analysis

Gravimetric Analysis involves placing a weighed filter paper on the affected area and leaving it on for 60 seconds. After 60 seconds, the paper is removed and reweighed to measure how much sweat is absorbed.

Doctors can calculate the rate of sweating through this test. It’s important to use a high-precision scale when doing this analysis.

Thermoregulatory Sweat Test

This sweat test uses a moisture-sensitive powder and applies it on the skin.

The powder changes into a light orange color when mixed with sweat in room temperature. When in a heated room, the areas with hyperhidrosis tend to perspire and cause the powder color to change again. Excessive sweat on the powder will change the color into a dark purple.

With this, the test would be able to tell the severity of a person’s hyperhidrosis. It can also tell if the condition is a focal or generalized case.

Treatment of Focal Hyperhidrosis

Excessive perspiration is treatable. If you or someone you know is diagnosed with primary hyperhidrosis, below are some of the options a doctor might recommend.

Topical Agents

Antiperspirants with a high concentration of aluminum salts can manage moderate cases. Though you can buy antiperspirants over the counter, you can also ask for a stronger prescription antiperspirant from your doctor.

In case it doesn’t work, you can try topical drugs like QBREXZA, which is specifically used for the underarms. It’s a topical cloth pad containing 2.4% glycopyrronium—a type of anticholinergic that blocks the production of sweat.

A cloth pad is enough to treat both armpits daily. But be sure to talk to your doctor first before using any topical agent.

Botox Injections

If topical agents don’t work, injecting Botox might.

Botox injections block the nerves that trigger the sweat glands to perspire, thus stopping sweating. However, it is only a temporary solution that lasts for about 4-6 months. Patients usually need several injections to get favorable results.

Oral Medications

Doctors may also prescribe oral anticholinergic drugs. These drugs work by preventing the stimulation of sweat glands and disrupting perspiration.

But take note that since it’s an oral drug, its effects are systemic. It might reduce sweat not just in your target area but also in the rest of your body, putting you at risk for overheating.

Iontophoresis

Iontophoresis is a procedure that introduces ions to the target areas—usually the hands and feet—to help control sweating. The process involves submerging the affected parts in a bowl of water and letting electric current pass through the water.

Don’t worry—the procedure is painless. One round of treatment lasts from 20 to 30 minutes. Patients usually need two to four rounds before significant improvements happen.

miraDry

miraDry is the newest effective treatment for axillary hyperhidrosis. It involves the complete removal of underarm sweat glands, freeing you from your excessive sweating of the armpits permanently.

miraDry follows a three-step process consisting of numbing the underarms with anesthesia, marking the skin, and treating the area. Most people already get results just by undergoing one miraDry session.

It also works for removing hair and odor glands in the underarms, thus eliminating armpit odor as well.

Hyperhidrosis Surgery

If the less invasive options don’t work for you, your doctor might recommend a more invasive one.

ETS or Endoscopic Thoracic Sympathectomy surgery is usually a doctor’s last resort. It involves cutting the nerve fibers that carry messages to your sweat glands and cause sweating.

ETS surgery has 68-100% effectiveness for hyperhidrosis in the palms, underarms, and face. But it also has a side effect of compensatory sweating, where one part of your body starts sweating to compensate for the lack of sweat in the treated area of your body.

Although originally from Louisville, Kentucky, Dr. Masri has long outstanding ties to the South Florida medical community.

He completed his undergraduate and medical degrees in Indiana and Pennsylvania. After that, he underwent General Surgery residency at the Mount Sinai Medical Center of Greater Miami. This was followed by a Plastic and Reconstructive Surgery residency at The University of Miami/Jackson Memorial Hospital.

As a plastic surgeon, he focuses mainly on post-bariatric plastic surgery, abdominoplasty, breast surgeries, and lower body lifts.

He is also a certified practitioner of nonsurgical cosmetic procedures, like dermal fillers and Botox.

Just recently, he became one of Miami’s top miraDry practitioners, helping hyperhidrosis patients get rid of their excessive sweating problems using a permanent yet non-invasive procedure.