Hyperhidrosis is a common presenting complaint, and typical distributions include palms/soles, axillae, face, and other regional foci.

For secondary hyperhidrosis, treatment involves the identification and elimination of underlying causative factors. Common medication culprits would include cholinesterase inhibitors, selective serotonin reuptake inhibitors, opioids and tricyclic antidepressants. Basic labs including thyroid function studies should be performed, and if guided by the review of symptoms, may also include a workup for metabolic by-products suggestive of a carcinoid tumor or a pheochromocytoma (urinary 5-HIAA, and 24 h urinary catecholamines and metanephrines, respectively). If the patient is female, LH/FSH studies could suggest the onset of menopause. A routine chest x-ray may reveal adenopathy or an intrathoracic mass suggestive of a lymphoma. Additional cancer workup should, again, be suggested by the review of systems. Age-appropriate malignancy screening such as colonoscopy and mammography should also be up to date.

In a typical case of an otherwise young, healthy individual, as outlined above, the most likely diagnosis is primary focal hyperhidrosis, which we term idiopathic but may involve a decreased response threshold to emotional and chemical stimuli.

Conventional treatment options would follow the algorithm below:

An integrative approach to treatment would likely include many of the above measures, but would also touch on the mind-body component of the condition: