Hypohidrosis: is not sweating unhealthy?

There are plenty of inconveniences we would wish away if the world worked like that, but even some of the most inconvenient things serve some purpose. While we know sweaty palms aren’t great for first dates or business meetings, they also serve an important purpose.

There are actually two different types of glands involved in sweating. 

What we think of as exercise-induced sweat comes from eccrine sweat glands, which open directly onto the surface of the skin through our pores. We have the largest concentration of these on our palms and soles of our feet, but they are found all over the body. They release water, along with protein, sodium, and electrolytes.

Other glands, called apocrine glands, are linked with hair follicles and are found on specific parts of the body with hair, such as the armpits and groin. These glands release fatty acids, or natural oils, along with water when we sweat.

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Sweating serves a purpose—but that purpose differs from situation to situation. We talked to Dana Hunnes, Ph.D., RD, MPH, senior dietitian at Ronald Reagan UCLA Medical Center and an adjunct assistant professor at the UCLA Fielding School of Public Health, about sweating after eating. She explained that there’s a good reason you see spicy food in cultural cuisine in hotter parts of the world: sweat cools you down. Whether the sweat is caused by a rise in body temperature from that jog outside or a particularly fiery dinner, perspiration cools you as it evaporates off of your skin. This process tends to be more effective in situations involving dry, rather than humid, heat. 

But stress sweat, the bane of handshakes everywhere, also serves an important function. Dr. Steven Albrechta, MD, sports medicine physician at The Ohio State University Wexner Medical Center, underscores that this is your fight-or-flight system kicking into gear.

Back when stressful situations for humans involved the need to fight for survival, sweaty palms could increase your grip strength better than dry skin. Better grip strength could help you flee from a predator or hold a weapon to fight it off. But in the boardroom, it’s simply an annoyance because those stressful situations have nothing to do with our physical survival. The situation has changed, but our stress response has not.

Hypohidrosis, not sweating enough, can be dangerous for your physical health. (You may also see this referred to as anhidrosis. Anhidrosis is related but is the complete absence of sweat). Dr. Albrechta underscores that your body needs to release heat through sweating. If it cannot, you’re risking overheating, heat exhaustion, or heat stroke because sweating is a natural thermoregulatory response.

Although a separate condition, it’s worth noting that it’s also dangerous if you sweat normally but suddenly stop perspiring. Albrechta commonly sees this with athletes such as marathon runners. A sudden stop to your sweating may be a sign of hyponatremia, a condition in which your sodium levels plummet. Hyponatremia can result from only drinking pure water while vigorously working out instead of consuming something that contains both water and electrolytes.

If things have gotten severe enough that you stop sweating, end any activity you’re doing immediately and seek professional help from a healthcare practitioner.

But what about using treatments designed to cut down on sweating? Botox injections and aluminum-based antiperspirants decrease sweating, but they don’t eliminate it altogether. In one study, the sweat rate of most participants decreased by over 50%. Still, it took four applications of aluminum-based products to get this result (Swaile, 2012). Both antiperspirants and Botox injections are also typically used in one area of the body, which doesn’t interfere with your body’s ability to sweat in other areas.

Are these options safe?

Again, it’s important to remember that these localized treatments do not stop your body from sweating in other areas. That means the hyperhidrosis you’re experiencing in one area of your body may resolve. At the same time, you allow other areas of the body unaffected by this condition to continue sweating normally to regulate body temperature.

Localized Botox injections to cut down sweating in hyperhidrosis have been found to be safe and effective. The hyperhidrosis did not reoccur in patients in one study, and they had no adverse effects four months after the procedure (Naumann, 1998).

The biggest con to Botox noted by other researchers has been the cost, which may be prohibitive for some. Further research has been done to test the safety and efficacy of sweat gland removal compared to Botox. One study that pitted the treatments head-to-head found them equally effective and noted no adverse side effects with either treatment (Budamakuntla, 2017).

Although Internet rumors claim that antiperspirants with aluminum increase breast cancer risk, there’s no scientific evidence linking these products with breast cancer.

Past research that looked at the relationship between antiperspirant use and breast cancer is mixed, but these studies were done on all types of antiperspirants—not specifically on products containing aluminum (National Cancer Institute, 2016). And a review of research that looked at aluminum exposure found that the idea that using these products promotes breast cancer was unsupported by scientific data. However, the authors called for more research to be done (Klotz, 2017).

It’s understandable if you thought sweating was a process linked to the endocrine system since glands are involved. But sweating is actually a process of the nervous system. That’s why hypohidrosis generally comes from issues with the brain, spinal cord, or the sweat glands themselves. Nerve damage can also cause this absence of sweating (de Sylva, 1998).

Causes of hypohidrosis can fall into three buckets: dermatologic causes, neurological causes,  outside causes (like medication you’re on), and inherited conditions that don’t fall into these other buckets (Chia, 2012). 

Dermatologic causesDermatologic causes

It’s uncommon for skin disorders to be at the root of this condition. Still, psoriasis, scleroderma, ichthyosis, or exfoliative dermatitis may be the cause. Dermatologic disorders that affect the sweat glands, such as hypohidrotic ectodermal dysplasia or Ross syndrome, may also be at the root of these symptoms. Skin injuries such as burns and infections will also need to be ruled out (Chia, 2012).

Neurological causes

Conditions that affect the nerves, such as diabetic neuropathy (nerve damage caused by diabetes), Parkinson’s disease, and long-term alcoholism, can also be the cause. Nerves may have been damaged by an accident or a previous surgery (Chia, 2012).

Genetic causes

Connective tissue diseases, such as Sjögren syndrome, and inherited disorders that affect your metabolic system, such as Fabry disease, can be responsible for hypohidrosis or anhidrosis. But healthcare practitioners will likely rule out external causes first, like reviewing all the medication you’re taking (Chia, 2012). 

Although the cause of under sweating can't always be found, healthcare providers have multiple tests they use to get to the root issue. 

If a dermatologic disorder is suspected, your healthcare provider will take a skin biopsy. They can also identify underlying neurological issues through a quantitative sudomotor axon reflex test (QSART). A QSART uses mild electrical stimulation on the skin to stimulate sweat glands to assess nervous system response. They may also perform a sweat test, in which a patient is covered with a powder that changes color in the presence of sweat. The patient is placed in a chamber that will raise their body temperature that makes most people sweat. In some cases, an MRI may be used to uncover any neurological issues in the brain that may be causing the absence of sweat.

They’ll likely also ask what medicines you’re taking (Chia, 2012). Although it’s much less common, certain medications can also cause hypohidrosis. Drugs called anticholinergic agents block the action of certain neurotransmitters in the body and can cause this condition. These medications help prevent involuntary muscle movements and can alter certain bodily functions. Drugs that help with bladder control, for example, fall into this category of medication. But antihistamines and some antidepressants can also cause hypohidrosis (Cheshire, 2008).

The most significant sign of hypohidrosis is, of course, an absence or a minimal amount of sweat—even in situations that typically cause perspiration, such as hot temperatures and exercise. Overall, this causes heat intolerance due to the inability to regulate body temperature through sweat.

Other symptoms are related to increased body temperature, including fever, flushing, and feeling overly hot even in the absence of a fever. People with hypohidrosis may also experience dizziness and muscle cramps. Left untreated, hypohidrosis can also cause life-threatening, heat-related illnesses, such as heatstroke and hyperthermia.

Hypohidrosis cannot always be treated. If caused by an underlying condition, it needs to be treated or managed. But you can also manage the effects of hypohidrosis by avoiding situations involving high temperatures and applying water directly to the skin to simulate sweat. Water applied topically in this way in hot weather will still cool the body as it evaporates and may help people with hypohidrosis avoid overheating and heatstroke.

Similarly, it’s not always possible to stop medications that cause hypohidrosis. Your healthcare practitioner may work with you to lessen the dose of the medication or switch to an alternative when possible (Cheshire, 2008). Even if your medication is causing hypohidrosis, it’s essential to work with your healthcare provider to find a solution rather than stopping your medicines on your own. Abruptly discontinuing medication can be dangerous.

Sweating is an important function for the body. If you find yourself not sweating, even when temperatures are hot or when exerting yourself, see your healthcare provider. 

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Current version

February 24, 2021

Written by

Linnea Zielinski

Fact checked by

Mike Bohl, MD, MPH, ALM

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About the medical reviewer

Mike Bohl, MD, MPH, ALM

Dr. Mike is a licensed physician and a former Director, Medical Content & Education at Ro.