Excessive face and head sweating: Causes and more

Hyperhidrosis means too much (hyper) sweating (hidrosis). It occurs when someone sweats when they do not need or to or it does not make sense to. It is fairly common, impacting an estimated 1–3 people per 100 people. The purpose of sweat is to cool down the body. In hyperhidrosis, sweating occurs even when there is no need to cool the body.

There are two types of hyperhidrosis: primary focal hyperhidrosis and secondary hyperhidrosis.

Primary focal hyperhidrosis is the most common type of hyperhidrosis. It occurs when excessive or extreme sweating is not related to another medical condition or medication use. When the cause of hyperhidrosis is medication or a medical condition, it is called secondary hyperhidrosis.

When hyperhidrosis impacts the head, scalp, and face, it is called craniofacial hyperhidrosis. It may also affect the:

• palms of the hands
• soles of the feet
• chest
• groin
• armpits

There is no precise definition of excessive sweating. That said, people with craniofacial hyperhidrosis tend to experience sweating on the face, head, or scalp that:

• occurs for no apparent reason, such as heat, exercise, or anxiety
• causes dripping or soaking
• smells different than the usual underarm sweat
• may impact only one or two body regions, while the rest of the body stays cool
• causes someone to be embarrassed and therefore avoid physical contact or being around others
• interferes with everyday activities, such as working, exercising, or driving
• causes someone to have to change their clothes or bathe more than normal
• may reduce self-esteem and cause someone to become overly self-conscious
• may interfere with personal relationships
• occurs at least once per week
• may be worse first thing in the morning

Hyperhidrosis can impact anyone and occur at any age, but people with primary hyperhidrosis tend to experience symptoms as children or after reaching puberty.

Primary hyperhidrosis tends to cause excessive sweating that impacts both sides of the body equally. It also tends to affect one or two body regions while the rest of the body stays cool. Symptoms of primary hyperhidrosis may improve with age.

People with secondary hyperhidrosis tend to experience symptoms throughout the entire body, and symptoms can begin at any age. Symptoms also tend to develop suddenly. Secondary hyperhidrosis may also cause excessive night sweats.

People with craniofacial hyperhidrosis may be more sensitive to and embarrassed by their symptoms compared to other types of hyperhidrosis because it is hard to hide. The face also plays an important role in how most people present and express themselves.

Sweating is usually controlled by brain signals sent along sympathetic nerves to sweat glands in the skin. Sympathetic nerves are part of the autonomic nervous system, which controls many body functions, including sweating.

When someone’s body temperature increases, the brain sends signals to initiate sweating to help release internal heat and cool the body. Sweating may also occur in response to emotions such as embarrassment or anxiety.

The cause of primary hyperhidrosis remains unknown.

Hyperhidrosis seems to impact the eccrine sweat glands, or water-producing sweat glands, rather than the apocrine, oil-producing glands. It may occur when the brain sends signals to cool the body when it is not necessary.

Genetic factors may play a role in primary hyperhidrosis. About 33% of people with hyperhidrosis have a family member with the same condition.

In some instances, there is no apparent cause for secondary hyperhidrosis. However, secondary hyperhidrosis may occur due to:

• infections
• diabetes
• menopause or after pregnancy
• overactive thyroid gland (hyperthyroidism)
• low blood sugar (hyperglycemia)
• obesity
• gout
• tumors
• fluoxetine and other similar antidepressant medications
• propranolol, pilocarpine, and bethanechol
• Parkinson’s disease
• drug or alcohol use, or withdrawal from drugs or alcohol
• injury, such as head trauma
• frostbite
• blood cell or bone marrow disorders, such as Hodgkin lymphoma
• certain rare inherited conditions
• irritation or diseases that impact the sympathetic nerves

To diagnose hyperhidrosis, a doctor will ask someone about their symptoms and examine affected areas. They may also run a sweat test, which involves covering affected areas of the skin with a powder that turns purple when wet.

A doctor may then run a series of blood and urine tests and potentially imaging tests to check for other causes of excessive sweating. They will also review the medications and supplements someone is taking to determine whether they may be causing the excessive sweating.

If no other cause can be determined, a doctor is likely to diagnose primary hyperhidrosis. If a doctor finds a cause, the diagnosis will be secondary hyperhidrosis.

A range of factors may trigger symptoms of hyperhidrosis. These factors are typically those that would increase body temperature or the risk of sweating.

Common triggers include:

• warm weather
• alcohol
• spicy foods
• anxiety
• wearing tight, thick, or restrictive clothing
• exercise
• hot sauces or spicy condiments
• curry and cumin
• caffeine
• monosodium glutamate (MSG)

There are a few at-home remedies that may help reduce symptoms of hyperhidrosis or make them more manageable. Common tips include:

• avoiding warm weather or places
• wearing loose, thin, or lightweight clothes
• wearing lighter colors, such as white, rather than darker clothing that shows sweat easier
• using an antiperspirant rather than deodorant
• wearing clothes made out of natural fibers instead of synthetic fibers
• keeping towels or a cloth made of moisture-absorbing or wicking materials close by to dab the face or head
• wearing sweatbands
• carrying a personal fan to cool the face and head
• treating anxiety using stress-reducing techniques or cognitive behavioral therapy (CBT)
• using unscented facial powder
• staying hydrated
• keeping the hair up, away from the face and neck

If at-home remedies do not reduce symptoms or make them manageable, other treatments may be used, including:

• topical glycopyrrolate
• Botox (botulinum toxin) injections (effects typically last 2–6 months)
• prescription cloth wipes coated in glycopyrronium tosylate
• prescription-strength antiperspirant, such as those containing aluminum chloride, which blocks sweat glands
• beta-blockers and benzodiazepines that block physical symptoms of anxiety and embarrassment
• anticholinergics and antimuscarinic medications that block acetylcholine, a chemical in the nervous system that helps activate sweat glands
• iontophoresis, a procedure where doctors treat the affected area by passing a weak electrical current through water or a moistened pad (not common for use on the face)

Surgery

In rare or extreme cases when symptoms do not respond to any other treatment, surgery may be required. Potential surgical procedures include:

Endoscopic thoracic sympathectomy

This is the most commonly used surgical treatment for hyperhidrosis. It involves cutting or clipping the nerves responsible for triggering sweating in the impacted area through very small incisions. This stops the nerves from being able to signal sweat glands to sweat. It may cause gustatory sweating, or sweating in the neck and face after eating, or excessive sweating elsewhere.

Removal or destruction of sweat glands

In this procedure, sweat glands surrounding the impacted area are physically cut or scraped away. Electromagnetic radiation may also be used to destroy sweat glands. It is mostly done when armpits are involved.

Sweating of the face and head is normal. However, excessive sweating (hyperhidrosis) of these areas can be uncomfortable and challenging.

At-home and therapeutic interventions can often help people manage or reduce symptoms of hyperhidrosis.

People should contact a doctor about excessive or unexplained sweating, especially if it develops fairly suddenly or after starting to take a medication.

People should also contact a doctor about night sweats or sweating that causes excessive embarrassment, reduced self-esteem, social withdrawal, or interference with daily activities.