Differential Diagnosis for Hyperhydrosis

The following is a differential diagnosis for hyperhydrosis, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis

  • Primary Hyperhidrosis: This is the most common cause of hyperhidrosis, characterized by excessive sweating without an identifiable cause, often affecting the palms, soles, and axillae. It typically starts in childhood or adolescence and can be familial.

• Other Likely Diagnoses

  • Secondary Hyperhidrosis due to Medications: Certain medications, such as antidepressants, antipyretics, and hypoglycemic agents, can cause hyperhidrosis as a side effect.
  • Hyperthyroidism: An overactive thyroid gland can lead to increased sweating among other symptoms like weight loss, palpitations, and heat intolerance.
  • Menopause: Hormonal changes during menopause can lead to hot flashes and excessive sweating.
  • Anxiety Disorders: Conditions like generalized anxiety disorder or panic disorder can cause excessive sweating due to the body's stress response.

• Do Not Miss Diagnoses

  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hyperhidrosis along with hypertension, palpitations, and headaches. Missing this diagnosis can be fatal.
  • Hypoglycemia: Low blood sugar can cause sweating, confusion, and shakiness. In diabetic patients or those with other metabolic disorders, recognizing and treating hypoglycemia promptly is crucial.
  • Lymphoma: Some types of lymphoma can present with night sweats, which is a significant symptom that warrants further investigation.

• Rare Diagnoses

  • Frey's Syndrome: A rare condition that typically develops after trauma or surgery to the parotid gland, leading to gustatory sweating (sweating in response to the sight, smell, or taste of food).
  • Generalized Dyshidrotic Eczema: A skin condition characterized by small, itchy blisters on the hands or feet, which can be accompanied by excessive sweating.
  • Congenital Syndromes: Certain rare genetic syndromes, such as Fabry disease or Riley-Day syndrome, can include hyperhidrosis among their symptoms.