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Why Do We Sweat?
Written by Katie Crissman
October 01 2020

We all sweat! It’s annoying, uncomfortable, and surprisingly, life saving. Here’s why we sweat and what it means for our bodies.

Why Do We Sweat?

From a light sweat due to a brisk walk on a pretty day, to getting completely drenched when playing sports, all of us sweat. Although we all sweat to varying degrees - all people perspire in order to maintain their body temperature, specifically to cool down. The fancy word for this is thermoregulation. So, the simple answer as to why people sweat is this: to control our body temperature.

Curious about how this works? Keep reading!

The Science Behind Sweat

Sweat and body temperature work together in a feedback loop that’s used to keep the body balanced and in a state of homeostasis. Homeostasis is the word that is used to describe how the body regulates itself; like how it maintains its temperature, regulates breathing and many other processes.

Wondering how sweating regulates body temperature? These questions can be answered with a quick dive into the anatomy of sweating. 

In all humans, the body is constantly producing heat via a series of reactions. This heat is a result of both chemical reactions and physical actions inside the body. From heart tissues expanding and contracting, to intestinal organs absorbing nutrients, heat is almost always produced as a by-product of the body’s actions. 

Since the human body does not rely on outside environmental conditions to regulate temperature, humans are classified as endotherms (commonly known as warm-blooded. Whereas ectothermic (cold-blooded) species rely on heat via solar energy to maintain their body temperatures, endothermic species produce sufficient heat to warm themselves on their own. But what if we, warm blooded humans, get too hot? 

There are three primary ways humans get rid of excess heat: dissipating heat through their breath, sending heat to the outer layers of the skin via blood flow, and producing sweat that evaporates from the skin. The first two methods happen constantly, but sweat is reserved for specific occasions.

Sweat is utilized when the body temperature rises slightly from its resting temperature. The normal body temperature is 98.6 degrees Fahrenheit, although a resting temperature often varies between 97.7-99.2 degrees Fahrenheit. Once your body hits a higher temperature the sweating process begins.

Sweat glands produce liquid sweat, and the sweat travels from the glands to the surface of the skin. Sweat is mostly made of water, and a few other things. When the sweat evaporates (because it is mostly water), the heat in the sweat leaves the body as well. This cools the body off with amazing efficiency!

More Sweat Questions?

Check out what your body loses when you sweat or learn more about conditions that cause stinky sweat, too much, or too little sweat.

If you’re glad your body can sweat (so you stay alive) but you’d like to sweat a little bit less check out these amazing antiperspirant options. They can reduce sweat at its source and make it a little more comfortable on those hot days! 

Sources
  1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Amsterdam: Elsevier Pub. Co., 2014. Retrieved from https://www.elsevier.com/books/hyperhidrosis-an-issue-of-dermatologic-clinics/pariser/978-0-323-32607-0>https://www.elsevier.com/books/hyperhidrosis-an-issue-of-dermatologic-clinics/pariser/978-0-323-32607-0
  2. Nordqvist, C. (2017, December 21). Hyperhidrosis: Symptoms, causes, diagnosis, and treatment. Retrieved May 14, 2018, from https://www.medicalnewstoday.com/articles/182130.php
  3. Kamudoni, P., Mueller, B., Halford, J., Schouveller, A., Stacey, B., & Salek, M. (2017, June 8). The impact of hyperhidrosis on patients' daily life and quality of life: A qualitative investigation. Retrieved May 21, 2018, from https://hqlo.biomedcentral.com/articles/10.1186/s12955-017-0693-x\
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Causes of Hyperhidrosis

How to Tell if I Have Hyperhidrosis

By Katie Crissman /

Are you dealing with excessive sweating? If you’re a super sweater, here's how you can tell whether your symptoms may be related to a condition called hyperhidrosis.

What is Hyperhidrosis?

Hyperhidrosis is a medical condition categorized by excessive sweating that isn’t related to temperature regulation. It affects roughly 3% of people and it’s very treatable.[1]

If you have hyperhidrosis then you may experience symptoms like: 

  • Sweating that specifically affects your hands, feet, underarms, face or groin.
  • You can’t find an environmental trigger for your sweat like heat.
  • Your sweat so much that it impacts your self confidence and interferes in your personal or work life.
  • You have to change clothes often due to sweat problems.[1]

You get the idea - hyperhidrosis causes sweating that’s disruptive and more or less constant. It’s important to know that there are two types of hyperhidrosis. They are called primary focal hyperhidrosis, and secondary generalized hyperhidrosis. In this article we are going to focus on the symptoms of primary focal hyperhidrosis.[1] 

However, if you have excessive sweating that doesn’t seem related to primary hyperhidrosis read our article on secondary generalized hyperhidrosis as it’s caused by underlying health conditions and it’s important to get them looked at. 

Back to primary hyperhidrosis! Here are some quick facts to know about the condition:

  • It’s categorized by profuse sweating in one or more specific areas of the body, the main areas affected are:
    • Hands
    • Feet 
    • Underarms 
    • Face
    • Groin
    • Breast
  • It typically starts in adolescence or during early adulthood. Sometimes kids can experience excessive hyperhidrosis as well.
  • It’s not a result of any other disease or disorder - the excessive sweating itself is the disorder.
  • Men are more likely to have it.
  • It tends to run in some families.
  • The sweating tends to be symmetrical on the body. For example, if your right hand sweats your left hand will too.
  • It’s treatable![1]

Factors to Consider When Self-Diagnosing Hyperhidrosis

If you can relate to our description of hyperhidrosis consider these factors when self diagnosing. The first thing to know is that you should consult a doctor! Specifically, a dermatologist who’s trained in dealing with hyperhidrosis. If you’re still interested in more information consider the following: 

1. Temperature and Weather

 

First and foremost, you should be cognizant of whether or not you sweat in response to high temperatures in your surrounding environment. Since sweat is produced primarily as a means to cool the body via thermoregulation, all people should sweat when the temperature is high. Typically, the higher the temperature, the more sweat produced to keep the body cool. However, the first sign of both primary and secondary hyperhidrosis is whether or not your body sweats even when the temperature is at a comfortable, or even cool, level. 

For those with hyperhidrosis, they have sweat glands that are overactive because they are receiving and reacting to too many signals from the spinal cord and brain. Due to the fact that these synaptic signals are sent regardless of temperature, gauging the temperature of the environment when sweating occurs is a strong indicator of potential hyperhidrosis.

2. Environmental Triggers

In addition to temperature, you should be aware of whether or not other environmental triggers are causing excessive sweating on a repeated basis. For example, situations that are anxiety producing like meeting new people, anticipating handshakes, preparing for major assignments or tests, and public speaking may prompt an individual’s hyperhidrosis to worsen. This is because hyperhidrosis and anxiety are closely related. 

When thinking of your own sweatiest moments, are they tied to a specific set of conditions? If so, you may have primary focal hyperhidrosis that is triggered by those specific conditions. 

However, an important distinction between hyperhidrosis and stress sweating related to anxiety must be made; just because someone sweats in a specific situation doesn’t mean they have hyperhidrosis. Most people will sweat a little before a business meeting, and many people find the idea of a public speech to be intimidating. 

The important distinction is to determine whether or not your body is producing sweat to aid with thermoregulation (i.e. keeping you cool and calm when you become a little worried before an event) or producing sweat at an excessive and uncontrollable rate. 

3. Timing of Your Sweat

The third factor to evaluate in order to tell if a person’s sweating is indicative of hyperhidrosis is the length of time a person has been experiencing excessive sweating. If you’ve been sweating excessively since adolescence or young adulthood it’s a sign you may have primary hyperhidrosis. If it just started suddenly later in life it’s less likely to be secondary hyperhidrosis. 

If you think you might have hyperhidrosis there are many ways to manage your sweat and there are several treatments you can try. A great starting place is finding a good antiperspirant - we recommend Carpe antiperspirant lotion. They have products tailored to each specific part of your body and their special formula is gentle on skin.

Are you still curious about whether you have hyperhidrosis? Take this quiz.

Sources
  1. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Amsterdam: Elsevier Pub. Co., 2014. Retrieved from https://www.elsevier.com/books/hyperhidrosis-an-issue-of-dermatologic-clinics/pariser/978-0-323-32607-0 
  2. Kamudoni, P., Mueller, B., Halford, J., Schouveller, A., Stacey, B., & Salek, M. (2017, June 8). The impact of hyperhidrosis on patients' daily life and quality of life: A qualitative investigation. Retrieved May 21, 2018, from https://hqlo.biomedcentral.com/articles/10.1186/s12955-017-0693-x
  3. MiraMar Labs, O'Shaughnessy, K., & Melkerson, M. (2011). 510(k) Summary. Division of Surgical, Orthopedic And Restorative Devices. Retrieved May 23, 2018, from https://www.accessdata.fda.gov/cdrh_docs/pdf10/K103014.pdf.
    Body Areas Affected by Hyperhidrosis

    Can Athlete’s Foot Cause Sweating?

    By JP Carter /

    The answer is “no” - Athlete’s foot does not make you sweat more, but it can make excessive sweating even more uncomfortable than it already was. Here is an in-depth look at what Athlete’s foot really is and how excessive sweating impacts it.

    Athlete’s foot, known scientifically as tinea pedis, is caused by a fungal infection (called dermatophytes) that affects the skin of the feet, especially the skin between the toes. The fungus causes skin to redden and crack and the affected areas are often flaky and itchy. Sometimes affected skin can also become inflamed. The fungus is able to infect a foot when it enters the top layer of the skin through small cracks or wounds. The infection can be passed on from person to person through direct contact or when someone steps on infected flakes of skin from another person. In order to grow and thrive, the fungus that causes Athlete’s foot needs a dark, moist environment and feet provide the perfect breeding ground due to those conditions. Furthermore, the skin of the feet contain large amounts of Keratin which the fungus feed on. There are certain risk factors that make it more likely for someone to develop Athlete’s foot, these include:

  1. Genetic predisposition (seems to affect some families more than others)
  2. History of allergies and eczema
  3. Excessively sweaty feet (history of hyperhidrosis)
  4. A weakened immune system
  5. Poor circulation in the legs
  6. Playing certain sports, particularly running and swimming[1]
  7. Athlete’s foot appears to be a very common problem as anywhere between 3% and 15% of the population are thought to struggle with it at any given time. It is not physically dangerous, but it typically won’t go away on it’s own. Therefore, it is important for people with the condition to seek treatment.[1] While no studies have shown that Athlete’s foot causes people to sweat more, it has been noted that excessive sweating of the feet makes the development of Athlete’s foot much more likely. This is especially true for people who suffer from a condition called primary focal hyperhidrosis.[2] Hyperhidrosis causes people to sweat excessively from specific parts of the body like the hands, feet, armpits, face, and head. It affects about 3% of the US population making hyperhidrosis quite common, like Athlete’s foot.[3] The reason so many people with hyperhidrosis develop Athlete’s foot is because the condition causes the feet to constantly produce sweat which promotes the exact environment fungus need to thrive.[2] Luckily, there are several effective ways to prevent Athlete’s foot and manage the symptoms of hyperhidrosis.

    How To Prevent Athlete’s Foot

    Preventing Athlete’s foot predominantly consists of specific types of self-care to keep feet dry and certain precautions to limit exposure to infectants. Often times, treating hyperhidrosis symptoms, which are how you stop foot sweat and its odor, can greatly reduce the likelihood of developing a fungal infection like Athlete’s foot. Here are some practical solutions you can use to make your feet a less habitable environment for the fungi that cause Athlete’s foot:

  8. Thoroughly drying feet after any activity that gets them wet. This includes activities like showering, bathing, swimming, or after sweating profusely while wearing shoes.
  9. Wearing breathable shoes that don’t constrict your feet.
  10. Not wearing the same pair of shoes two days in a row. It can be useful to have two pairs of shoes that you alternate each day.
  11. Taking shoes off and airing out feet as frequently as possible.[1]
  12. If you are suffering from hyperhidrosis and practical lifestyle changes are not enough to keep your feet dry, then you may want to consider other treatments for sweaty feet. These include treatment options like using over-the-counter topical treatments like antiperspirant to more invasive procedures like botox injections.[3] Due to the fact that hyperhidrosis treatments reduce the amount of moisture your feet are exposed to they can drastically reduce the likelihood that you will develop Athlete’s foot.[2]

    In addition to maintaining a dry pedal environment, it is also important for people to limit their exposure to the fungi that cause Athlete’s foot. Here are some tips to avoid contracting it:

  13. Wear your own flip flops when swimming, using communal showers, and using communal changing rooms.
  14. Do not share towels, shoes, and socks with other people.
  15. Wash all towels, bedding, and socks in hot water that is greater than 60 degrees C.
  16. Add antifungal laundry sanitizer if you wash your laundry at a lower temperature.[1]
  17. How to Treat Athlete’s Foot

    Due to the fact that Athlete’s foot is so common, even when practicing prevention procedures, people often develop the condition at some point in their lives. In most cases, Athlete’s foot can be treated with over-the-counter remedies that are available at local pharmacies. These treatments come in the form of creams, gels, or sprays that contain an active ingredient that stops fungal growth of kills off fungus completely. In rare cases, tablets can be prescribed for people who haven’t had success with over-the-counter treatment options. There are also natural remedies that people use, which include tea tree oil some herbal foot bath solutions, although there is not scientific evidence that they are effective.[1]

    Once you have treated Athlete’s foot it is important that you continue to use preventative care practices so that you don’t develop it again. If you do also happen to suffer from hyperhidrosis, then getting treatment for it should keep your feet more comfortable and prevent you from developing Athlete’s foot as easily. There are many effective treatment options and it is important to make sure that you are taking proper care of the skin on your feet.

    Sources
    1. Athlete's foot: Overview. (2015). Retrieved May 31, 2019, from https://www.ncbi.nlm.nih.gov/books/NBK279549/
    2. Common Complications of Hyperhidrosis. (n.d.). Retrieved May 31, 2019, from https://www.webmd.com/skin-problems-and-treatments/common-complications-of-hyperhidrosis
    3. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Philadelphia, PA: Elsevier.
    Causes of Hyperhidrosis

    Everything you need to to know about Hyperhidrosis (or Excessive Sweat)

    By Chris Reid /

    WHAT IS HYPERHIDROSIS?

    Hyperhidrosis, or excessive sweating, is basically when you sweat beyond comfort. People with hyperhidrosis just have overactive sweat glands. 

    The medical definition is sweat that is produced in excess of what is necessary for thermoregulation (the ability to maintain a healthy temperature.

    Sweating is a perfectly natural and necessary function the body uses to cool itself down. We need to sweat to live, however, with hyperhidrosis, you’ll sweat even when your body isn’t overheating.[1] 

    SIGNS YOU MAY HAVE HYPERHIDROSIS: 

    • When dressing, you take into account how your clothes will be affected by sweat and whether they will show sweat stains. 
    • You are always aware of your environment and whether or not you can influence the temperature. 
    • You've hesitated to shake someone's hand. 
    • You tailor your routine to take in account a need for reapplying your deodorant. 
    • You worry about taking off you shoes in front of others. 
    • You leave a sweat trail. 
    • Noticeable sweat even when you aren't working out or overheated. 

    WE DON'T JUST SWEAT UNDER THE ARMS: 

    All can be affected: 

    • Feet
    • Hands
    • Groin
    • Chest/Breasts
    • Thighs
    • Buttocks
    • Face
    • Scalp

    You could have sweat in just one of these areas, or like the lucky few experience full body excessive sweating. 

    Hands, feet, and underarms are the parts of the body that are most likely to be affected by hyperhidrosis.[3]

    People who suffer from hyperhidrosis have the same number and size of sweat glands as people who don’t have the condition. Their sweat glands are just overactive.[1]

    THERE ARE SOLUTIONS: 

    Good news, you don't have to live with uncomfortable sweat.

    SOME OPTIONS: 

    If you are interested in medical solutions, you can book an appointment with your dermatologist and learn how to manage hyperhidrosis with a dermatologist.[3]

    THERE ARE TWO MAIN FORMS OF HYPERHIDROSIS

    The vast majority of people will either have primary focal hyperhidrosis or secondary generalized hyperhidrosis

    Primary Focal Hyperhidrosis

    Primary Focal Hyperhidrosis (PFH) is by far the most common type, affecting up to 90 percent of people who have hyperhidrosis. 

    People with primary focal hyperhidrosis only sweat in particular areas like the hands, feet, armpits, face, and groin.

    Sweat will occur on both sides of the body in the same place and often in more than one area — like both hands and feet. [3]

    Symptoms usually begin in childhood or adolescence and tend to last for a person’s entire lifetime. There is evidence that primary focal hyperhidrosis is hereditary, meaning it often runs in families.[3]

    Secondary Generalized Hyperhidrosis

    While primary focal hyperhidrosis appears to be something you’re born with, secondary generalized hyperhidrosis (SGH) is a condition that shows up during adulthood. Think of SGH as an uninvited guest who arrives on your doorstep with no warning. [3]

    When someone has secondary hyperhidrosis the biggest problem isn’t the hyperhidrosis – it’s the disease or condition that might be causing it. [3]

    The source of this type of hyperhidrosis can also be a medication. Many common medications can cause hyperhidrosis as a side effect.[3]

    Unlike primary focal hyperhidrosis, the sweating from secondary hyperhidrosis tends to occur all over the body. This is a telltale sign of the condition.[3]

    Unlike primary hyperhidrosis, this condition doesn’t have to be permanent. If the instigating condition is found and treated, it can fix the hyperhidrosis. It may take a little work.[3]

    If you are concerned that your hyperhidrosis might have an underlying cause, schedule an appointment to talk to your doctor and find out.[3]

    THE IMPACTS OF HYPERHIDROSIS

    While hyperhidrosis isn’t particularly dangerous physically, it can be embarrassing.[3]

    Unfortunately, hyperhidrosis is more serious than just uncomfortable sweating.

    Up to a third of people who deal with excessive sweating from hyperhidrosis say that they are constantly bothered by their sweating.

    • 75% of respondents reported that hyperhidrosis negatively impacted their social, emotional, and mental health.[4] 
    •  Hyperhidrosis and anxiety often go hand in hand.[3] 

    HOW COMMON IS HYPERHIDROSIS?

    • 3% of the US population struggles with hyperhidrosis. In other countries the percentage of the population that has it is even higher.[3] 

    Because hyperhidrosis is such an embarrassing and overlooked condition, many individuals avoid reporting the issue to their doctor. This means that the number of people who have hyperhidrosis might even be higher than we currently think.[3]

    What Causes Hyperhidrosis?

    Doctors don’t truly understand what causes primary focal hyperhidrosis yet. One theory is that particular nerves that control the amount of sweat overreact or malfunction. That malfunction can cause the excessive sweating that can be life-changing for those who suffer from it.[7]

    Since hyperhidrosis affects so many people, researchers are now shifting into full gear to discover the causes of excessive sweating so they can develop better treatments. Future treatments and research for hyperhidrosis are being developed more rapidly than ever before.[3]

    What Conditions Can Cause Secondary Generalized Hyperhidrosis?

    Many diseases and medical conditions can cause hyperhidrosis. However, just because you have one of the conditions listed below this paragraph doesn’t mean you’ll develop hyperhidrosis.

    Here are some of the more common conditions that may be causing the hyperhidrosis you have developed as an adult.

    • A febrile illness
    • Menopause
    • Hyperthyroidism
    • Heart failure
    • Diabetes
    • Frostbite
    • Alcoholism - Alcohol can cause excessive sweating when someone is intoxicated, withdrawing, or in someone with an intolerance.
    • Gout
    • Lymphoma and some other cancers and tumors.
    • Obesity
    • Pregnancy
    • Parkinson’s disease
    • Rheumatoid arthritis
    • Stroke[3]

    There are also several types of common medications that cause hyperhidrosis as a side effect. So, if you are on medication and you begin experiencing new or increased amounts of sweating mention it to your doctor. Some of these medications include antidepressants, painkillers, blood pressure medications and many others.a [3]

    If you think you might have secondary generalized hyperhidrosis it is very important that you speak to a doctor. Many of the things that cause it can be resolved, and it could be a sign of a more serious problem. Don’t panic, but it is wise to look into the reason you are sweating more.

    What Are the Treatments for Primary Focal Hyperhidrosis?

    If you are diagnosed with primary focal hyperhidrosis, there are many things you can do.These are the existing treatments for hyperhidrosis, but new treatments are currently being explored by scientists:

    • Antiperspirants:There are many over-the-counter antiperspirants that can be very useful when trying to curb sweat. If a regular antiperspirant isn’t cutting it for you, ask your doctor to write a prescription for a stronger one. You can apply antiperspirant to places other than just your underarms. Use it on your hands, hairline, or feet as well. There are even antiperspirants for the face and groin that are made specifically for sensitive areas.
    • An Iontophoresis machine:This medical device sends low-voltage currents into a pan of water where your hands or feet are sitting. The electricity can lessen the activity of your sweat glands, at least for a while. However, it can take up to 10 sessions with the iontophoresis machine to deactivate your sweat glands. You may need to use this machine up to three times a week in the beginning and one treatment can take up to 40 minutes. Although iontophoresis as a treatment for palmar and plantar hyperhidrosis may give your hands and feet a much needed break, the iontophoresis machine is anything but convenient. Iontophoresis really does work, but patients have to be willing to keep up with a regular treatment regimen for it to work successfully.
    • Botox:If other treatments aren’t enough in your, you might need Botox injections. Botox can be particularly useful for axillary hyperhidrosis, but botox can also be a treatment for palmar and plantar hyperhidrosis. Botox can provide up to 6 months of reduced sweating. If you’re going to pursue this route, you should look for someone who is experienced at doing Botox injections in the underarms to ensure the right area is targeted.
    • Anticholinergics:A few oral medications can for hyperhidrosis can reduce the amount of sweat you produce by stopping your sweat glands from working. Most commonly patients are prescribed anticholinergics like glycopyrrolate or oxybutynin as a treatment for hyperhidrosis. These medications also have several side effects, including heart palpitations, blurry vision, and dry mouth.
    • ETS Surgery:An endoscopic thoracic sympathectomy (ETS) is a surgical treatment for primary focal hyperhidrosis. It is an operation where an individual actually has the nerve endings that transfer sensory information to the sweat glands destroyed. Since no known successful reversal of an ETS surgery has ever been recorded, this option isn’t usually on the table unless the other treatments have failed. As with any surgery, it can be risky. There is also a type of surgery called an endoscopic lumbar sympathectomy which is used to treat plantar hyperhidrosis, but this surgery can be very dangerous and is almost never recommended.[3]

    Defeating Hyperhidrosis

    Undoubtedly, hyperhidrosis can be a hard condition to cope with. Until recently, the lack of research into hyperhidrosis had made hyperhidrosis difficult to manage. Thankfully, however, new treatments and awareness has made hyperhidrosis much easier to handle. Keep trying treatments until you find what works for you and remember that you are not alone in suffering with this condition. It’s just a matter of figuring out what you can do to control your sweat instead of your sweat controlling you!

    Sources
      1. MedicineNet Medical Journal. (2016, May 13). Definition of Hyperhidrosis. Retrieved May 14, 2018, from https://www.medicinenet.com/script/main/art.asp?articlekey=16272
      2. Diaphoresis: What causes excessive sweating? (n.d.). Retrieved May 20, 2020, from https://www.medicalnewstoday.com/articles/321663#overview
      3. Pariser, D. M. (2014). Hyperhidrosis (4th ed., Vol. 32). Amsterdam: Elsevier Pub. Co., 2014. Retrieved from https://www.elsevier.com/books/hyperhidrosis-an-issue-of-dermatologic-clinics/pariser/978-0-323-32607-0
      4. Lenefsky, M., & Rice, Z. P. (2018). Hyperhidrosis and Its Impact on Those Living With It. AJMC. Retrieved from https://www.ajmc.com/journals/supplement/2018/hyperhidrosis-managed-markets-update-treatments/hyperhidrosis-and-its-impact--on-those-living-with-it

    Nordqvist, C. (2017, December 21). Hyperhidrosis: Symptoms, causes, diagnosis, and treatment. Retrieved May 14, 2018, from https://www.medicalnewstoday.com/articles/182130.php

    Doolittle, James, et al. “Hyperhidrosis: an Update on Prevalence and Severity in the United States.” Archives of Dermatological Research, vol. 308, no. 10, 2016, pp. 743–749., doi:10.1007/s00403-016-1697-9. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27744497/

    Huddle, J. R. (2014). Hyperhidrosis: Causes, Treatment Options and Outcomes. New York, NY: Nova Science. Retrieved from https://www.bookdepository.com/Hyperhidrosis-Janine-R-Huddle/9781633215160

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