Background

Sweating is a normal response to help cool the body especially after exertional activities and exercise. However, excessive sweating beyond what is normally required to regulate the body temperature, known as hyperhidrosis, can occur in some individuals and athletes. Roughly 1-3 percent of the U.S. population suffers from hyperhidrosis, and both men and women are equally affected. Despite this common occurrence, less than half of patients bring this condition up with their physicians.

There are two types of hyperhidrosis, primary and secondary. Primary hyperhidrosis is much more common (90%), with onset of symptoms before age 25. The cause is not well known, it could be that hyperactivity of nerves that stimulate the sweat glands is to blame. This can be triggered by emotional or physical stress. Secondary hyperhidrosis is typically caused by an underlying medical condition (e.g., heart failure, diabetes) or due to certain medications (e.g., anti-depressants, insulin).

Symptoms

People with hyperhidrosis experience visible and higher-than normal sweat production that can involve both sides of the body, including the armpits, palms, soles, face and scalp and groin. Symptoms typically will be present for longer than six months and will occur at least once per week. There is usually no occurrence during sleep. This excessive sweating negatively affects daily life and interferes with interpersonal relationships, work, self-esteem and overall emotional well-being.

Sports Medicine Evaluation and Treatment

A sports medicine physician will review your symptoms and medical history and medication usage to evaluate for secondary causes. They may also ask about your family history, as there may be a genetic predisposition to hyperhidrosis. The physician will also physically examine the areas of concern. Imaging tests and lab work are typically not necessary to make the diagnosis if primary hyperhidrosis is suspected.

Treatment of hyperhidrosis involves prescription topical medications initially such as 20% aluminum chloride (Drysol). This will initially be applied nightly, which stops the sweat glands from over-producing sweat. Over the counter medications such as “clinical strength” antiperspirants containing aluminum zirconium trichlorohydrate can also help. For hyperhidrosis on the hands and feet, iontophoresis (delivering drugs through a gradient) may be used. In some refractory cases, a prescription medication such as oxybutynin or glycopyrrolate can be used, or an injection of botulinum toxin is injected into the area of concern. There may be spontaneous improvement in hyperhidrosis later in life.

Return to Play

Although hyperhidrosis does not usually require any interruption of sports activity, without treatment it can be a source of emotional distress, distraction, and embarrassment for an athlete.

AMSSM Member Authors
Christina Giacomazzi, DO and Brian Liem, MD

References
1. McConaghy, John R, and Daniel Fosselman. n.d. “Hyperhidrosis: Management Options” 97 (1): 6.
2. Nawrocki, Shiri, and Jisun Cha. 2019. “The Etiology, Diagnosis, and Management of Hyperhidrosis: A Comprehensive Review.” Journal of the American Academy of Dermatology 81 (3): 657–66. https://doi.org/10.1016/j.jaad.2018.12.071.