الفهرس 
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Abstract
Hyperhidrosis is a condition in which sweat production exceeds that which is needed for thermoregulation and can affect the hands, feet, axilla, face back, groin and legs. It is a disabling condition that affects , both children and adults , with an incidence rate of 0.6% to 1% and onset usually during childhood or adolescence. Although not a dangerous condition hyperhidrosis can cause social and occupational impairment and emotional distress and facilitate the development of secondary morbidity .
Hyperhidrosis is classified as either primary, also known as idiopathic, or secondary. The clinical presentation may be either focal or generalized. Primary hyperhidrosis most often presents as focal hyperhidrosis localized most commonly to the axillae, palms, feet or face. Secondary hyperhidrosis is usually generalized, however it can present in a localized, focal pattern .
Primary Focal hyperhidrosis affects males and females equally, females are more likely to seek medical attention for their symptoms. Nearly two thirds of individuals with focal hyperhidrosis do not consult their physician regarding their condition, presumably due to either social embarrassment or a lack of awareness that they are suffering from a treatable medical condition. As a result the majority of individuals suffering from hyperhidrosis are undiagnosed and untreated .
Primary focal hyperhidrosis most commonly affects individuals aged 25-
64 years. The average age of onset is 25 years, but it varies depending on the body area affected ,Palmar hyperhidrosis tends to begin in childhood and early adolescence, while axillary hyperhidrosis tends to have a post pubertal onset.
The exact cause of focal hyperhidrosis is unknown, although sympathetic over stimulation of normal eccrine glands is the most likely etiology.
Interestingly, studies have shown an association between the sympathetic hyperactivity seen in hyperhidrosis with other autonomic disorders such as cardiac hyperexcitability .
There is likely also a heritable component to this neurogenic overactivity, as 30 – 50% of patients have a positive family history ,The inheritance of focal hyperhidrosis is thought to be autosomal dominant with variable penetrance and expressivity. Based on calculations of allelic probability a child born to aparent with palmar hyperhidrosis has a 25% chance of also developing the disorder.
Secondary(Generalized) hyperhidrosis can occur at any age, at any time throughout the day and can be controlled or even eliminated by treating the underlying etiology.Generalized hyperhidrosis usually occurs as a result of an underlying condition , such as chronic infection, malignancy, neurological abnormalities, spinal cord injury, cerebrovascular accident, endocrine disorders,
medication.
Physicians and patients often fail to recognize that primary hyperhidrosis is a relatively common and treatable medical condition. A complete history should be taken and a physical examination should be performed .Patient history should be focuss on location of excessive sweating, duration of the presentation, associated symptoms or comorbidities, family history, age of onset and any specific triggers allows one to differentiate primary from secondary hyperhidrosis .
The physical examination will be guided by any suggestion of secondary hyperhidrosis and will also attempt to confirm the distribution of disease.
Laboratory tests are uncommonly required if there is no suggestions of a secondary disorder on review of systems and the pattern is typical.