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Please note: This video is from the American Academy of Dermatology. This condition does not always require evaluation by a dermatologist. Please start with your child's primary care provider first, and we can refer you to a dermatologist if needed.
What is sweating excessively (hyperhidrosis)?
This is a condition where sweating is excessive, meaning there is more sweating than is needed to cool the body down.
The excessive sweating is not related to heat or exercise.
This may occur in one or more areas of the body.
The most common affected areas are the palms of the hand, armpits, and the feet.
This usually starts in early childhood or adolescence.
Kids with this condition sweat up to five times more than other kids.
There are two main types of hyperhidrosis, primary hyperhidrosis and secondary hyperhidrosis.
This affects 1% of people, and when it is primary hyperhidrosis, it doesn’t go away.
Images of sweating excessively (hyperhidrosis)
Image of excessive sweating of the palms of the hands
Image of excessive sweating of the armpits
Image of excessive sweating of the feet
What causes sweating excessively (hyperhidrosis)?
The causes of hyperhidrosis are broken into primary and secondary.
Primary hyperhidrosis occurs because the sweat glands are overactive causing them to produce more sweat than is needed to cool the body.
It is not known exactly why this happens.
If family members have it, your child may be more likely to have it.
Secondary hyperhidrosis is caused by other medical conditions, or it can be caused by some medications.
This type is more likely to cause sweating on different body parts or all over the entire body.
Some examples of medical conditions are:
Diabetes
Thyroid problems
Some cancers
Nervous system problems
Infections
Sleeping disorders
Some of the most common groups of medications are:
Antidepressants and antipsychotics (some examples: lexapro, prozac, zoloft, haloperidol, clozapine)
Pain relieving medications like opioids or non-steroidal anti-inflammatory medications (NSAIDS)
Medications used to treat infections (some examples: cephalexin, azithromycin, acyclovir).
Thyroid and diabetic medication (some examples: levothyroxine, insulin)
Oral steroids (some examples: prednisolone and prednisone)
What are the symptoms of sweating excessively (hyperhidrosis)?
The excessive sweating usually happens in one or more body parts.
The sweating is usually worse when it is warm, with exercise, and when your child is stressed.
The sweating doesn’t usually occur during sleep.
The hands and the feet are the most commonly affected areas, but sweat can happen anywhere or in multiple areas.
The sweating usually happens on both sides of the body.
The sweating often interferes with writing, holding objects, and using touch screens.
The sweating can interfere with playing sports and taking part in activities.
Your child may avoid shaking hands or holding an item like paper where the sweating is obvious.
Your child may be more likely to develop skin infections.
If your child has atopic dermatitis, it may make it worse.
The sweat can make feet and shoes smelly.
The sweat can affect your child’s confidence, limiting what they want to do with friends or classmates.
This can start to affect their mental health and mood, making them feel more nervous or sad.
Your child may feel embarrassed or ashamed.
Depending on where your child sweats, they may refuse to wear certain clothing if they have noticed it shows their sweat marks.
How is sweating excessively (hyperhidrosis) diagnosed?
Your child’s primary healthcare provider will talk to you and your child.
They will ask you and your child questions about your child’s symptoms.
You may be asked about your child’s mood and qualify of life.
They will need to know about all of the medications and supplements your child is taking including any over-the-counter medications.
Your child’s primary healthcare provider will examine your child.
The diagnosis can usually be made by talking to you and your child and examining your child.
For some causes of secondary hyperhidrosis, your child may need to be referred to a specialist.
How is sweating excessively (hyperhidrosis) prevented?
There is no way to prevent your child from having primary or secondary hyperhidrosis.
In the case of primary hyperhidrosis, this is a condition that was already developed in their sweat glands or body when they were born.
In the case of secondary hyperhidrosis, prevention will come once the cause of the hyperhidrosis is treated.
When possible avoid these known causes for sweating:
Eating spicy foods.
Caffeinated items like teas, coffees, chocolate and cocoa.
Avoid fabrics like polyester and nylon, as they tend to trap heat.
Instead choose loose fitting fabrics and cotton.
Avoid synthetic fabrics for sneakers.
Leather is more breathable option for athletic shoes.
How is excessive sweating (hyperhidrosis) treated?
Helpful lifestyle tips:
Make sure your child drinks lots of water since excessive sweating causes your child to lose hydration.
Use an over-the-counter antiperspirant. Make sure that the product is labeled as an antiperspirant, not just deodorant. Antiperspirants block the sweat glands whereas deodorants decrease odor but do not block the sweat pores. Aluminum is a common ingredient in antiperspirant.
You can use the antiperspirant in the armpits and on the hands, and anywhere on the body with excessive sweating. Avoid the face and genital area.
Have your child carry a set of clothing and socks so they can change if needed.
Look for water wicking socks, leather shoes when sneakers are needed, and have them wear loose fitting, cotton clothing when possible.
If feet or shoes are smelly they can use foot powders to help dry up the excess sweat.
Avoid foods that may make sweating worse, like caffeine and spicy foods.
Make sure they know you are happy to help them with any concerns about their mood.
Watch for effects on self-confidence, as this can be difficult for many kids to deal with and embarrassing.
Activities that may allow them to get exercise while feeling more comfortable are swimming, weight-lifting or resistance training (where age appropriate), speed walking, and martial arts.
Medical treatments include surgery and medications:
Medication options include:
Topical medicine like an antiperspirant (prescription example: Drysol and Xerac), as this will help minimize the sweating your child produces and can be used on different parts of the body.
Usually it is applied once per day at night.
Oral medications (prescriptions examples: Robinul, Ditropan) that help decrease the amount your child sweats.
Botox injections can be used to help decrease the sweating, but it does take a number of injections in the areas of the body that are affected.
Your child’s primary healthcare provider may refer your child to a dermatologist.
Surgical options:
Thoracoscopic sympathectomy is a minimally invasive procedure that helps reduce your child’s sweating.
This is usually only done if your child’s symptoms are not well controlled with the medications noted above.
This procedure is only performed if your child’s hands are involved, but the feet and armpits can be treated if they are involved too.
A specialist, such as a Dermatologist, may refer patients to a surgeon if the symptoms are not well controlled with medications.
When to contact CPCMG:
You think your child has hyperhidrosis.
Your child’s symptoms are not improving with treatment.
You have questions or concerns about your child.
You would like to have your child seen.
📚 References
This content was adapted from Children’s Hospital of Philadelphia, Riley Children’s Health, Medscape, Mayo Clinic, UpToDate, The American Academy of Pediatrics. Images from https://dermnetnz.org/topics/hyperhidrosis .
Written by TT DO, reviewed by JW MD, Patient Education Committee.