What Is Primary Focal Hyperhidrosis?

Primary focal hyperhidrosis is the most common type of hyperhidrosis as it comprises 93% of all cases. Here is the information you need to know about what it is and how to manage it.
What Is Primary Focal Hyperhidrosis?

What is Primary Focal Hyperhidrosis?

Hyperhidrosis refers to the physiological issue of the body sweating in excess of what it needs to maintain thermoregulation. There are several types of hyperhidrosis but the two most common types are primary focal hyperhidrosis and secondary generalized hyperhidrosis. An estimated 2.8% of the US population has hyperhidrosis, making it quite common, and primary focal hyperhidrosis makes up 93% of the hyperhidrosis cases. Primary focal hyperhidrosis refers to excessive sweating in a specific area of the body that is not caused by other medical conditions or medications.[1]

Primary focal hyperhidrosis (PFH) has several characteristics that differentiate it from the other types of the condition. One of the most distinct features of PFH is that it typically begins in adolescents and lasts for a lifetime. The onset of the disease usually occurs between the ages of 14 and 25. There is some indication, however, that primary focal hyperhidrosis may get better with age, as most people over the age of 65 have significantly reduced symptoms. People with PFH experience excessive sweating on specific areas of their body which is why the term focal is used in the name. Sweating is most often experienced on the armpits, hands, feet, and face. Excessive sweating can occur on other areas of the body but it is unusual. The sweating that occurs with PFH is bilateral, meaning it occurs on both sides of the body, and it dissipates at night. People with the condition have at least one episode of excessive sweating per week, often daily, and the sweating is so severe that it impairs daily activities. While hyperhidrosis is not dangerous, it can have a negative impact on a person’s quality of life.[1]

What Causes It and Who Gets It?

Scientists are not entirely sure how people get primary focal hyperhidrosis is not completely understood. It is thought that hyperhidrosis is hereditary as it often appears to run in families. Researchers think that PFH is an autosomal dominant disorder, meaning that a child only needs to inherit the gene from one parent in order to get the condition. It is suspected that cases of PFH are often underreported due to embarrassment and social stigma. Unfortunately, many people who have hyperhidrosis also have anxiety due to the stress the condition adds to their lives. People between the ages of 14 and 25 with a family history of hyperhidrosis are at the highest risk of developing the disorder.[1]

The cause of hyperhidrosis, like other aspects of the condition, is not entirely known. The most popular theory posits that it is a result of an overactive sympathetic nervous system. The autonomic nervous system controls unconscious bodily functions like breathing, digestion, and heart rate. The sympathetic nervous system is a branch of the autonomic nervous system that is responsible for activating the “flight or flight” response when appropriate. Sweat glands are innervated by the sympathetic nervous system, so when it is overly excited, sweat glands become overactive and produce more sweat than they should. Most researchers tend to believe that hyperhidrosis occurs due to a problem somewhere in the nervous system but it will take more time and research to find a definitive answer.[2]

Treatment Options

Currently, there is no cure for hyperhidrosis. However, there are many effective options that people can use to manage their sweat. The treatment a patient receives depends on where their sweating is the worst. Here are the treatment options available for each body region affected by PFH:

  • Treatments for axillary (armpit) hyperhidrosis: Over-the-counter and prescription antiperspirants, botox injections, local permanent surgical procedures, Qbrexza, oral medications, or a surgery called endoscopic thoracic sympathectomy.
  • Treatments for sweaty hands: Antiperspirants, iontophoresis, oral medications, and botox injections. People with severe palmar (hand) hyperhidrosis can get a surgical procedure called endoscopic thoracic sympathectomy.
  • Treatments for sweaty feet: Antiperspirants, iontophoresis, oral medications, and botox injections. There is a similar procedure for plantar (foot) hyperhidrosis called endoscopic thoracic sympathectomy but can be risky and most doctors don’t recommend it.
  • Treatments for craniofacial hyperhidrosis: antiperspirants, oral medications, botox injections, or possibly, surgery. There are also some specific ways to stop excessive head and neck sweating.
  • Do you wonder if you have hyperhidrosis? Find out with this simple test.

    1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.
    2. Huddle, J. R. (2014). Hyperhidrosis: Causes, Treatment Options and Outcomes. New York, NY: Nova Science.
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