10 Minute consultation: Hyperhidrosis
A 26 year old woman presents with excessive sweating, which she says embarrasses her socially and at work. Sometimes her hands literally drip with sweat, making work involving writing difficult. Concerned to conceal her excessive axillary sweating, she is self conscious and particular about her clothing. She asks what help you can give her.
Location - Explore and identify the exact locations of the sweating. Possibilities include excessive facial flushing and sweating and axillary, palmar, groin, and plantar hyperhidrosis.
Severity - How disabling is the problem? Explore the effects on her emotional wellbeing and daily social life.
Exclude physiological and psychological causes - Consider other causes, such as hypoglycaemia or hyperthyroidism, although usually these will be obvious. Might there be an anxiety state?
Explanation and advice - Reassure her that sweating is a normal phenomenon. Explain that the evaporation of water from the skin takes heat away from the body and is essential for temperature control and that sweating is controlled by the sympathetic nervous system. It is important that she drink plenty of fluids and consider boosting salt intake, as fluid loss can be substantial.