Diagnostic Approach and Management of Excessive Sweating and Dry Mouth

Initial Evaluation and Diagnostic Considerations

Night sweats with fever and unexplained weight loss >10% are B symptoms that mandate evaluation for lymphoma, particularly Hodgkin's lymphoma which peaks in the 20-40 age group 1
Concurrent dry mouth with excessive sweating is an unusual combination that warrants investigation for autonomic dysfunction, medication effects, or systemic disease 2
The American College of Physicians recommends a complete blood count, ESR, and comprehensive metabolic panel to evaluate for underlying systemic conditions 1
The European Society of Medical Oncology suggests thyroid function tests (TSH, free T4) to exclude thyroid disease as a cause of hyperhidrosis 3

The American Dental Association recommends referral to dentistry for moderate to severe dry mouth to prevent dental caries 2
The National Institute of Dental and Craniofacial Research suggests using prescription-strength fluoride toothpaste to prevent dental caries in patients with dry mouth 4
The European Society of Medical Oncology recommends pilocarpine 5 mg orally three to four times daily for dry mouth from salivary gland hypofunction and Sjögren's syndrome 5
The American Academy of Dermatology suggests considering cevimeline as an alternative muscarinic agonist with potentially better tolerance profile than pilocarpine 5

The International Hyperhidrosis Society recommends topical aluminum chloride solution as initial treatment for most cases of primary focal hyperhidrosis, but this is not cited in the provided text, instead, the American College of Physicians suggests that systemic sialagogues (pilocarpine, cevimeline) used to treat dry mouth will worsen hyperhidrosis through their cholinergic effects 5
The American College of Rheumatology suggests considering rheumatology referral if symptoms persist despite management or if autoimmune disease is suspected 2