Table of ContentsView AllTable of ContentsSelf-Checks/At-Home TestingPhysical ExaminationLabs and TestsDifferential DiagnosisFrequently Asked QuestionsNext in Hyperhidrosis GuideWhat Are the Hyperhidrosis Treatment Options?
Table of ContentsView All
View All
Table of Contents
Self-Checks/At-Home Testing
Physical Examination
Labs and Tests
Differential Diagnosis
Frequently Asked Questions
Next in Hyperhidrosis Guide
Diagnosing hyperhidrosis may be a very complex, or it may be a simple process, depending on the underlying cause. For example, if a person is diagnosed with primary focal hyperhidrosis, the diagnostic criteria are relatively straight forward and simple. On the other hand, for those with secondary general hyperhidrosis, the underlying cause could be one of many different origins; in this instance, a variety of lab tests and diagnostic procedures may be needed. But either way, the initial appointment will involve a physical exam, medical history, and some basic tests to determine if a person has hyperhidrosis.
Verywell / Emily Roberts
There are questionnaires designed to help a person who is experiencing excessive sweating to determine whether the sweating is problematic, or simply normal sweating.Here are some sample questions for a self-check at home from the International Hyperhidrosis Society:
The answers to the questionnaire will provide a clue as to just how symptoms are impacting your daily life and activities. Your answers will be helpful for the healthcare provider in assessing how sweating affects your overall quality of life, daily activities, as well as your psychological and social well being. These questions may be part of the diagnostic assessment that will help your healthcare provider more accurately diagnose your condition. You can print out a copy of anonline worksheet, keep track of your answers, and take the worksheet with you when you visit the healthcare provider for an initial evaluation.
During the initial consultation, a healthcare provider will perform a physical exam and gather information on your health history. The exam will include taking a very close look at the areas of the body where excessive sweating occurs. If possible, a dermatologist or other healthcare provider may want to observe how severely sweating occurs. The diagnosing physician may look for stains on clothing to assess axillary (under the armpit) sweating. A sweat stain of less than 5 centimeters (approximately 2 inches) is considered normal. The bigger the sweat stains that can be measured, the more severe the hyperhidrosis condition is, ranging from mild to moderate or severe.
For diagnosingpalmar (on the hand) hyperhidrosis, your healthcare provider may evaluate the severity of moisture on your hands during the physical exam. Moisture without visible drops would indicate mild palmar sweating. Sweat that drips off the ends of the fingers indicates severe palmar sweating.
Diagnostic tests for hyperhidrosis focus on sweat tests. However, you can expect blood and urine tests to be performed to check your general health and screen for other health problems that might be secondary causes of hyperhidrosis.
Sweat Tests
Minor’s starch iodine test:This test is helpful in diagnosing hyperhidrosis, particularly for detecting focal hyperhidrosis. This test involves using an iodine solution which is applied to the skin and then starch powder is applied on top of the iodine. When the two substances are placed in an area of the skin, a violet color will appear. This allows that diagnosing physician to easily view and measure the area/s that sweating occurs. The absence of color may indicate that focal hyperhidrosis is not the correct diagnosis.
The Quantitative Sudomotor Axion Reflex Test (QSART):This diagnostic test is used to measure the nerves that control sweating. This test is conducted using mild electrical stimulation on the skin (called iontophoresis).
Gravimetry:Other tests that may be employed to measure the amount of sweat a person is experiencing including the use of gravimetry. Gravimetry involves using filter paper (that is weighed before the test) which is inserted under the armpit (or on other areas of the body, such as the palms of the hands) for a specific amount of time. Next, it is removed and then weighed again after each time interval from 60 seconds up to five minutes. The amount of sweat released at each time interval is measured and expressed as milligrams (mg)/time. A value of over 50 mg/min in the axillary (armpit) area, or more than 20 mg/min on the palms, indicates a diagnosis of hyperhidrosis.
According to a study published in the journalClinical Autonomic Research, gravimetry is “easy, reproducible and fast method of evaluation of sweating. The reference values are stable and can serve as a qualifying and follow-up tool for evaluation of the patients with PHH [primary hyperhidrosis].“
Other Tests
When the diagnosis of hyperhidrosis is secondary generalized hyperhidrosis, the diagnosing physician may need to perform several other tests to discover the primary (underlying) cause of sweating. This may involve urine, blood or other lab tests to diagnose medical conditions that could be causing hyperhidrosis.
Hyperhidrosis Diagnoses
There are several hyperhidrosis diagnoses that the healthcare provider may identify, these include:
Primary focal hyperhidrosis:The most common form of hyperhidrosis, involves sweating in one or more “focal” areas of the body, the most common areas that primary focal hyperhidrosis occurs is on the palms of the hands, under the arms and the soles of the feet.But, focal hyperhidrosis may also involve sweating of the face, head, or forehead. Primary focal hyperhidrosis, also referred to as focal hyperhidrosis, often begins during childhood.
Unspecified:Excessive sweating associated with an inability to define the underlying cause
Secondary focal hyperhidrosis:Secondary hyperhidrosis which is experienced in one or more focal areas (instead of being generalized throughout the body)
Other eccrine sweat disorders:Eccrine describes the body’s primary sweat glands; a diagnosis of other eccrine sweat disorders describes a sweating condition other than hyperhidrosis.
Depending on the area that sweating occurs, there are several names/diagnoses that further describe hyperhidrosis, these include:
Criteria for Primary Focal Hyperhidrosis
The diagnostic criteria (signs and symptoms that must be present to diagnosis a specific disease) for primary focal hyperhidrosis includes excessive sweating which occurs for six months or more in duration, along with four or more of the following:
These criteria clearly differentiate the difference between primary focal hyperhidrosis and secondary hyperhidrosis and are intended to help the physician provide the optimaltreatment.
The process of differentiating between two (or more) medical conditions that have the same or similar symptoms is called a differential diagnosis. There are several conditions that have the same signs and symptoms of hyperhidrosis. The body’s regulation of heat depends on its ability to sweat and cool the body off. In many situations, the sweat glands are overactive, such as when the external temperature climbs, during extreme stress, nervousness, exercise, and more. Sweating that occurs only during these situations is considered normal and would not be considered differential diagnoses, rather, associated medical conditions must exist, the most common include:
Endocrine Conditions
Neurologic Conditions
Neoplastic Conditions (Conditions Involving Tumors)
Infectious Disorders
Other medical conditions and underlying causes of hyperhidrosis include certain drugs, toxicity (from alcoholism or drug use) and more. Each of the above conditions causes secondary, generalized, diffuse sweating, except spinal cord injury and reflex sympathetic dystrophy, which involve sweating in focal areas.
Frequently Asked QuestionsNo, there is not a way to permanently cure hyperhidrosis. However, there are a number of effectivetreatmentstargeted to specific underlying causes of excessive sweating, includingiontophoresis,Botox, and oral anticholinergic medications.Adermatologistis best, particularly one who has experience in treating excessive sweating.Neurologistsand surgeons also are sometimes called upon to treat hyperhidrosis, depending on the underlying cause.It can be. Several neurological syndromes are associated with excessive sweating, includingParkinson’s disease,stroke, injuries to the spinal cord, and more. One clue hyperhidrosis may have a neurological cause is when it affects only one side of the body.
No, there is not a way to permanently cure hyperhidrosis. However, there are a number of effectivetreatmentstargeted to specific underlying causes of excessive sweating, includingiontophoresis,Botox, and oral anticholinergic medications.
Adermatologistis best, particularly one who has experience in treating excessive sweating.Neurologistsand surgeons also are sometimes called upon to treat hyperhidrosis, depending on the underlying cause.
It can be. Several neurological syndromes are associated with excessive sweating, includingParkinson’s disease,stroke, injuries to the spinal cord, and more. One clue hyperhidrosis may have a neurological cause is when it affects only one side of the body.
9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.International Hyperhidrosis Society.Diagnosing hyperhydrosis.Schlereth T, Dieterich M, Birklein F.Hyperhidrosis–causes and treatment of enhanced sweating.Dtsch Arztebl Int. 2009;106(3):32-7. doi:10.3238/arztebl.2009.0032Stefaniak TJ, Proczko M.Gravimetry in sweating assessment in primary hyperhidrosis and healthy individuals.Clin Auton Res. 2013;23(4):197-200. doi:10.1007/s10286-013-0201-2Kargi AB. PlantarSweating as an indicator of lower risk of compensatory sweating after thoracic sympathectomy.Thorac Cardiovasc Surg. 2017;65(6):479-483. doi:10.1055/s-0036-1579680Walling HW.Clinical differentiation of primary from secondary hyperhidrosis.J Am Acad Dermatol.2011;64(4):690-5. doi:10.1016/j.jaad.2010.03.013Romero FR, Haddad GR, Miot HA, Cataneo DC.Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects.An Bras Dermatol.2016;91(6):716-725. doi:10.1590/abd1806-4841.20165358American Academy of Dermatology.Hyperhidrosis: Diagnosis and treatment.International Hyperhidrosis Society.What type of doctor should I see for hyperhidrosis treatment?Merck Manual Professional Version.Hyperhidrosis.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.International Hyperhidrosis Society.Diagnosing hyperhydrosis.Schlereth T, Dieterich M, Birklein F.Hyperhidrosis–causes and treatment of enhanced sweating.Dtsch Arztebl Int. 2009;106(3):32-7. doi:10.3238/arztebl.2009.0032Stefaniak TJ, Proczko M.Gravimetry in sweating assessment in primary hyperhidrosis and healthy individuals.Clin Auton Res. 2013;23(4):197-200. doi:10.1007/s10286-013-0201-2Kargi AB. PlantarSweating as an indicator of lower risk of compensatory sweating after thoracic sympathectomy.Thorac Cardiovasc Surg. 2017;65(6):479-483. doi:10.1055/s-0036-1579680Walling HW.Clinical differentiation of primary from secondary hyperhidrosis.J Am Acad Dermatol.2011;64(4):690-5. doi:10.1016/j.jaad.2010.03.013Romero FR, Haddad GR, Miot HA, Cataneo DC.Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects.An Bras Dermatol.2016;91(6):716-725. doi:10.1590/abd1806-4841.20165358American Academy of Dermatology.Hyperhidrosis: Diagnosis and treatment.International Hyperhidrosis Society.What type of doctor should I see for hyperhidrosis treatment?Merck Manual Professional Version.Hyperhidrosis.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
International Hyperhidrosis Society.Diagnosing hyperhydrosis.Schlereth T, Dieterich M, Birklein F.Hyperhidrosis–causes and treatment of enhanced sweating.Dtsch Arztebl Int. 2009;106(3):32-7. doi:10.3238/arztebl.2009.0032Stefaniak TJ, Proczko M.Gravimetry in sweating assessment in primary hyperhidrosis and healthy individuals.Clin Auton Res. 2013;23(4):197-200. doi:10.1007/s10286-013-0201-2Kargi AB. PlantarSweating as an indicator of lower risk of compensatory sweating after thoracic sympathectomy.Thorac Cardiovasc Surg. 2017;65(6):479-483. doi:10.1055/s-0036-1579680Walling HW.Clinical differentiation of primary from secondary hyperhidrosis.J Am Acad Dermatol.2011;64(4):690-5. doi:10.1016/j.jaad.2010.03.013Romero FR, Haddad GR, Miot HA, Cataneo DC.Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects.An Bras Dermatol.2016;91(6):716-725. doi:10.1590/abd1806-4841.20165358American Academy of Dermatology.Hyperhidrosis: Diagnosis and treatment.International Hyperhidrosis Society.What type of doctor should I see for hyperhidrosis treatment?Merck Manual Professional Version.Hyperhidrosis.
International Hyperhidrosis Society.Diagnosing hyperhydrosis.
Schlereth T, Dieterich M, Birklein F.Hyperhidrosis–causes and treatment of enhanced sweating.Dtsch Arztebl Int. 2009;106(3):32-7. doi:10.3238/arztebl.2009.0032
Stefaniak TJ, Proczko M.Gravimetry in sweating assessment in primary hyperhidrosis and healthy individuals.Clin Auton Res. 2013;23(4):197-200. doi:10.1007/s10286-013-0201-2
Kargi AB. PlantarSweating as an indicator of lower risk of compensatory sweating after thoracic sympathectomy.Thorac Cardiovasc Surg. 2017;65(6):479-483. doi:10.1055/s-0036-1579680
Walling HW.Clinical differentiation of primary from secondary hyperhidrosis.J Am Acad Dermatol.2011;64(4):690-5. doi:10.1016/j.jaad.2010.03.013
Romero FR, Haddad GR, Miot HA, Cataneo DC.Palmar hyperhidrosis: clinical, pathophysiological, diagnostic and therapeutic aspects.An Bras Dermatol.2016;91(6):716-725. doi:10.1590/abd1806-4841.20165358
American Academy of Dermatology.Hyperhidrosis: Diagnosis and treatment.
International Hyperhidrosis Society.What type of doctor should I see for hyperhidrosis treatment?
Merck Manual Professional Version.Hyperhidrosis.
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