What questions should be asked in the history of a 14-year-old female patient presenting with hyperhidrosis in a dermatology clinic?

History Questions for 14-Year-Old Female with Hyperhidrosis

Begin by determining whether this is primary focal hyperhidrosis versus secondary generalized hyperhidrosis, as this distinction fundamentally changes your diagnostic and therapeutic approach.

Essential Diagnostic Questions to Distinguish Primary vs Secondary Hyperhidrosis

Pattern and Distribution of Sweating

• Ask: "Where exactly do you sweat excessively? Show me the specific areas." Primary hyperhidrosis affects focal, bilateral areas (axillae, palms, soles, craniofacial regions), while secondary hyperhidrosis presents with generalized, asymmetric distribution 1
• Ask: "Is the sweating the same on both sides of your body, or is one side worse?" Bilateral and symmetric sweating suggests primary hyperhidrosis 1
• Ask: "Do you sweat during sleep?" Sweating during sleep suggests secondary hyperhidrosis, as primary hyperhidrosis typically does not occur during sleep 1, 2

Timing and Onset

• Ask: "When did the excessive sweating first start?" Primary hyperhidrosis typically begins between ages 14-25 years, making this patient's age consistent with primary disease 3
• Ask: "Did the sweating start suddenly or gradually?" Sudden onset may suggest secondary causes 1
• Ask: "Has the sweating gotten worse, better, or stayed the same since it started?" Progressive worsening may indicate an underlying systemic condition 1

Triggers and Exacerbating Factors

• Ask: "What makes your sweating worse? Does it happen with stress, anxiety, heat, exercise, or certain foods like spicy foods or caffeine?" Primary hyperhidrosis is often triggered by emotional stress and heat 4, 2
• Ask: "Does the sweating happen randomly throughout the day, or only in specific situations?" Random, unprovoked sweating may suggest secondary causes 1

Screening for Secondary Causes Using the "SCREeN" Approach

The American Academy of Dermatology recommends systematically screening for underlying conditions 4:

Sleep Disorders

• Ask: "Do you have trouble sleeping? Do you snore loudly or wake up gasping for air?" Sleep apnea can cause secondary hyperhidrosis 4

Cardiovascular Conditions

• Ask: "Do you ever have chest pain, rapid heartbeat, or feel like your heart is racing?" Cardiac conditions may present with sweating 4

Renal Disease

• Ask: "Have you noticed any changes in your urination? Swelling in your legs or face?" Kidney disease can cause secondary hyperhidrosis 4

Endocrine Disorders

• Ask: "Have you noticed weight changes, feeling very hot or cold, increased thirst or urination, or changes in your menstrual periods?" Screen for hyperthyroidism, diabetes, and pheochromocytoma 4, 1
• Ask specifically: "When did you start your periods? Are they regular?" Given her age and sex, assess for hormonal influences and polycystic ovarian syndrome, which is associated with hidradenitis suppurativa in adolescent females 5

Neurological Conditions

• Ask: "Have you had any headaches, dizziness, weakness, numbness, or tingling?" Neurological disorders can cause autonomic dysfunction leading to hyperhidrosis 4, 1

Medication and Substance History

• Ask: "Are you taking any medications, including over-the-counter drugs, supplements, or birth control?" Many medications can cause secondary hyperhidrosis 1
• Ask: "Do you use tobacco, alcohol, or any recreational drugs?" Substance use can trigger sweating 1

Family History

• Ask: "Does anyone in your family have excessive sweating problems?" Primary hyperhidrosis often has a genetic component 1, 3

Impact on Quality of Life

• Ask: "How does the sweating affect your daily life? Does it interfere with school, sports, social activities, or relationships?" This establishes disease severity and treatment urgency 2, 3, 6
• Ask: "Do you avoid certain activities or clothing because of the sweating?" Quantifies functional impairment 6
• Ask: "On a scale of 0-10, how much does the sweating bother you emotionally?" Assesses psychological impact 6

Associated Dermatologic Conditions

• Ask: "Do you have any painful bumps, boils, or draining lesions in your armpits, groin, under your breasts, or buttocks?" Screen for hidradenitis suppurativa, which has increased prevalence in adolescent females and is associated with polycystic ovarian syndrome 5
• Ask: "Do you have acne on your face, chest, or back?" Acne can coexist with hidradenitis suppurativa 5

Psychosocial Screening

• Ask: "How have you been feeling emotionally? Have you felt sad, anxious, or worried more than usual?" Depression and anxiety are common comorbidities with chronic dermatologic conditions 5
• Ask: "Have you ever had thoughts of hurting yourself?" Screen for suicidality, particularly important in chronic skin conditions 5

Red Flags Requiring Immediate Investigation

• Fever, night sweats, or unintentional weight loss (suggests malignancy or infection) 1
• Unilateral sweating (suggests neurological pathology) 1
• New-onset generalized sweating in an adolescent (suggests secondary cause) 1
• Associated symptoms like palpitations, tremor, heat intolerance (suggests hyperthyroidism) 4, 1