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3 July 2024

Hyperhidrosis and skin infections. Is there a Link?

Are individuals with excessive sweating more predisposed to skin infections? While it is suspected that this might be the case, an increased prevalence of skin infections in HH has not conclusively been shown. However, a Danish study* of over 400 diagnosed hyperhidrosis individuals demonstrated that they are more likely to use antibiotics and topical antifungals. In fact, individuals with hyperhidrosis were 33% more likely to use antibiotics than the the population without hyperhidrosis. The likelihood increases to 43% with respect to topical antifungals. While this doesn’t show a direct increase in skin infections, it does suggest a clinically relevant association between hyperhidrosis and skin infections.

And so, what is the rationale behind this greater propensity to be at risk to skin infections. Here are some plausible reasons:

• Moisture and Friction: Excessive sweating creates a moist environment on the skin, which can promote the growth of bacteria and fungi. This is especially true in areas where skin folds rub together, creating ideal conditions for infections to develop.

• Compromised Skin Barrier: Continuous exposure to moisture and friction can compromise the skin's natural barrier function. Intact skin serves as a protective barrier against pathogens, but constant moisture and friction can weaken this barrier, making it easier for bacteria and fungi to invade and cause infections.

Helping Create Dryer Lifestyles

• Bacterial and Fungal Growth: Sweat itself is generally sterile, but when it remains on the skin for extended periods, it can mix with bacteria and create an environment conducive to bacterial overgrowth. This can lead to conditions like erythrasma or bacterial folliculitis. Similarly, fungal infections such as athlete's foot (tinea pedis) can thrive in warm, moist environments.

• Skin Conditions Exacerbated by Sweating: In individuals with pre-existing skin conditions like eczema or psoriasis, excessive sweating can exacerbate these conditions. The combination of sweat and friction can lead to flare-ups, skin irritation, and potentially secondary infections.

• Hygiene Challenges: Managing hygiene effectively becomes crucial in efforts to minimize the risk of infections. Regular cleansing, drying thoroughly after sweating, and using appropriate treatments can help reduce moisture and maintain skin health.

In summary, while hyperhidrosis itself is primarily a functional disorder of sweat glands, the associated excessive sweating can create conditions on the skin that increase susceptibility to bacterial and fungal infections. Proper hygiene practices and managing sweating effectively are essential in reducing the risk of skin infections in individuals with hyperhidrosis.

* Henning, M.A.S., et. al., J Dermatolog Treat. 2022 Jun;33(4):2263-2269

Excessive sweating can "wear away" the skin's natural barrier function thus creating an environment more prone to infectious organisms.