Facial hyperhidrosis, also known as craniofacial hyperhidrosis, is excessive sweating of the face and scalp. It is the least common form of hyperhidrosis, which more often occurs in the hands, feet, and armpits. Facial hyperhidrosis is localized sweating of the face that occurs frequently without explanation. It usually happens at least once a week and can disrupt an individual’s normal activities.
There are two types of facial hyperhidrosis: primary and secondary. Primary hyperhidrosis is caused by emotional stimuli, such as stress or anxiety, and is thought to be genetic. Secondary hyperhidrosis is sweating as a side effect of other medical conditions, such as infections, neurological disorders, or overactive thyroid. It can also be a reaction to medication.
Sweating is the body’s way of regulating its temperature. When the temperature increases, the automatic nervous system sends a signal to the sweat glands to release sweat, a combination of mostly water and salt. Sweat is intended to cool off the skin’s surface; however, hyperhidrosis occurs when the sweat glands are stimulated even when the body’s temperature is normal.
The sweat gland system is comprised of eccrine and apocrine glands. Eccrine glands are located all over the body and release sweat directly onto the skin’s surface, while apocrine glands are located near areas with hair follicles, such as the face, armpits, and groin. Facial hyperhidrosis occurs when the apocrine glands are stimulated and release excessive amounts of sweat.
Facial hyperhidrosis can potentially cause physical and emotional complications. It can contribute to bacterial infections of the hairline caused by clogged hair follicles. If sweat glands become clogged, they are more susceptible to heat rash in humid weather.
Hyperhidrosis often interferes with an individual’s lifestyle. It can cause embarrassment or anxiety in social environments. Excessive facial sweating can prevent women from wearing makeup because it smears off due to the moisture. If untreated, it can even lead to depression.
The condition is typically diagnosed with a thermoregulatory sweat test. A doctor applies a yellow-green powder to the skin’s surface in a normal temperature room. If the powder is exposed to sweat, it will turn purple to indicate abnormal sweating. A doctor may also perform a medical examination and blood tests to determine if the cause is due to another medical condition.
Facial sweating caused by an underlying medical condition will generally subside when the other condition is treated. Sweating caused by anxiety or other emotional stimuli can be treated with anticholinergic medication that blocks the sweat gland stimulator, acetylcholine. Anticholinergic medications will usually affect the entire body and not just the face, and may cause side effects like dizziness, dry mouth, or constipation.
If facial sweating occurs in localized areas of the face, it can be treated with botulinum toxin injections. Botulinum toxin, or Botox, is a neuromuscular blocking agent that can prevent sweat gland stimulation in small areas of the face. Injections are not usually used if the sweating occurs all over the face and scalp. In cases of severe facial hyperhidrosis, sympathectomy surgery may be performed. Sympathectomy involves cutting the nerves of the sweating area to block sweat glands.