How to deal with hyperhidrosis or hyperhydrosis

Hyperhidrosis, or excessive sweating, is a common disorder which produces a lot of unhappiness. An estimated 2%-3% of Americans suffer from excessive sweating of the underarms (axillary hyperhidrosis) or of the palms and soles of the feet (palmoplantar hyperhidrosis). Underarm problems tend to start in late adolescence, while palm and sole sweating often begins earlier, around age 13 (on the average). Untreated, these problems may continue throughout life.

Sweating is embarrassing, it stains clothes, ruins romance, and complicates business and social interactions. Severe cases can have serious practical consequences as well, making it hard for people who suffer from it to hold a pen, grip a car steering wheel, or shake hands.

What Causes Hyperhidrosis?

Although neurologic, endocrine, infectious, and other systemic diseases can sometimes cause hyperhidrosis, most cases occur in people who are otherwise healthy. Heat and emotions may trigger hyperhidrosis in some, but many who suffer from hyperhidrosis sweat nearly all their waking hours, regardless of their mood or the weather.

What is the Treatment for Hyperhidrosis?

Through a systematic evaluation of causes and triggers of hyperhidrosis, followed by a judicious, stepwise approach to treatment, many people with this annoying disorder can sometimes achieve good results and improved quality of life.

The approach to treating excessive sweating generally proceeds as follows:

  • Over-the-counter antiperspirants containing a low dose of metal salt (usually aluminum) are usually tried first because they are readily available. Antiperspirants containing aluminum chloride (for example Certain Dri) may be more effective when other antiperspirants have failed.
  • Prescription strength antiperspirants, which contain aluminum chloride hexahydrate.
  • Iontophoresis, a device which passes ionized tap water through the skin using direct electricity.
  • Oral medications, Anticholinergics reduce sweating.
  • Botox (botulinum toxin)-A, has been approved in the U.S. by the FDA for treating excessive axillary (underarm) sweating.
  • miraDry. This technique uses microwave energy to permanently kill sweat glands.
  • Lasers. Lasers can target and kill the underarm sweat glands.
  • Surgery. A procedure called thoracic sympathectomy may be considered as a last resort.

Aluminum Chloride Hexahydrate and Excessive Sweating

When regular antiperspirants fail to treat excessive sweating, most doctors start by recommending aluminum chloride hexahydrate (Drysol), a prescription-strength version of aluminum chloride. It is applied just before bedtime 2 to 3 nights in a row, then roughly once a week thereafter to maintain improvement. Use as directed by your doctor.This treatment works reasonably well for many patients whose problem is excessive underarm sweating, but it is not satisfactory for most of those with palm and sole sweating.

The main side effect of Drysol is irritation, which can sometimes, but not always, be overcome by making sure the skin is dry before application and letting the medicine dry completely afterwards. Also, reducing the frequency of use or applying anti-inflammatory drugs, such as lotions containing a corticosteroid may help.

Iontophoresis for Excessive Sweating

Iontophoresis was introduced over 50 years ago as a treatment for excessive sweating. Its exact mechanism of action is still unclear, although it probably works by temporarily blocking the sweat duct. The procedure uses water to conduct an electric current to the skin a few times each week, for about 10-20 minutes per session, followed by a maintenance program of treatments at 1- to 3-week intervals, depending on the patient’s response. Iontophoresis treatments are not painful.

Patients may purchase devices for this treatment through a doctor’s prescription. Medical insurers sometimes cover the cost.

Oral Drugs for Excessive Sweating

Oral anticholinergic drugs such as glycopyrrolate (Robinul) are not commonly used for excessive sweating, because in order to work they often produce side effects like dry mouth, blurred vision, and urinary retention. Oral medication is typically reserved for people who have tried first-line treatments without success.

Botox and Excessive Sweating

Botulinum toxin A (Botox), a nerve toxin that can temporarily paralyze muscle, is often in the news as a cosmetic treatment for wrinkles. But it has actually been used in many areas of medicine for some time, such as in the treatment of muscle spasms and certain types of headaches. Its latest medical niche is the treatment of excessive underarm sweating.

A small amount of Botox is injected with a very fine needle into roughly 25 to 20 spots in each armpit. This may produce up to 14 months of relief from sweating. The injections are uncomfortable, but use of a very small injection needle makes them tolerable.

Now that this treatment has received FDA approval for hyperhidrosis, many health insurers are providing coverage for the injections and the Botox itself after other treatments have failed.

Currently, the FDA has not approved Botox for sweating of the palms and soles of the feet, though some physicians are administering it as an off-label use, reportedly with success. Palm injections cause more pain, requiring nerve blocks to numb the hands in order to make the injections comfortable. Skilled practitioners have used Botox for the head and face, as well.

miraDry and Lasers

Microwave energy

miraDry is a treatment that was FDA approved in 2011 for the treatment of excessive underarm sweating. It is a noninvasive treatment using electromagnetic energy that targets heat on sweat glands, destroying them. Local anesthesia is used and the skin is cooled during this hour-long procedure. It can be repeated 2-3 times for optimal effect.

Lasers can focus heat a narrow beam of heat to destroy underarm sweat glands and can be done faster with a faster recovery.

Surgery for Excessive Sweating

Thoracic sympathectomy is surgical interruption of the sympathetic nerves responsible for sweating. Sympathectomy is an operation intended to destroy part of the nerve supply to the sweat glands in the skin. The surgeon inserts a special endoscopic instrument into the chest between two ribs just below the armpit. Sympathectomy is both effective and risky. Even with newer endoscopic techniques, the complications can include excessive sweating in other parts of the body and lung and nerve problems. As many of these complications are serious and not reversible, this option is rarely used, and then only as a last resort.

It’s normal to sweat if you get hot or do exercise, but you may be sweating excessively if you’re sweating when your body does not need to cool down.

Excessive sweating can happen for no obvious reason, because of another condition you may have or as a side effect of a medicine you’re taking.

Things you can do to help with excessive sweating

wear loose-fitting clothes to minimise signs of sweating

wear socks that absorb moisture and change your socks at least twice a day if possible

wear leather shoes and try to wear different shoes day to day

do not wear tight clothes or synthetic fabrics – for example, nylon

do not wear enclosed boots or sports shoes that may cause your feet to sweat more

do not do things that might make your sweating worse – for example, drinking alcohol or eating spicy food

A pharmacist can help with excessive sweating

You can see a pharmacist about excessive sweating. You can buy things without a prescription, such as:

  • stronger antiperspirants instead of deodorant
  • armpit or sweat shields to protect your clothing
  • foot powders for sweaty feet
  • soap substitutes that are more gentle on your skin

Non-urgent advice: See a GP if you're sweating excessively and:

  • things you can do yourself are not helping
  • it’s lasted for at least 6 months
  • it stops you from getting on with your daily activities
  • it happens at least once a week
  • it happens at night (you’re having night sweats)
  • you have a family history of excessive sweating
  • you’re taking medicine for another condition

The GP may refer you for tests if they think another condition may be causing your sweating.

Coronavirus (COVID-19) update: how to contact a GP

It's still important to get help from a GP if you need it. To contact your GP surgery:

  • visit their website
  • use the NHS App
  • call them

Treating severe excessive sweating

If there’s no obvious cause for your sweating, and nothing seems to be helping, then you may be referred to a specialist (dermatologist).

They may recommend other treatments that you can try, such as:

  • taking tablets that reduce sweating
  • treating the areas with a weak electric current passed through water or on a wet pad (iontophoresis)
  • having botox injections for sweating under the armpits (this may not be available on the NHS)
  • surgery – for example, removal of the sweat glands

Visit Hyperhidrosis UK for more information on available treatments.

If your sweating is caused by another condition, any treatment you may need will depend on what’s causing it.

Page last reviewed: 11 January 2021
Next review due: 10 January 2024

From treatment options to lifestyle tips, these pointers can help you get your excessive sweating under control.

How to deal with hyperhidrosis or hyperhydrosis

How to deal with hyperhidrosis or hyperhydrosis

Maybe you wear multiple layers of clothing in hopes of sopping up sweat. Or you sweat enough to stain a jacket. Or maybe even you notice your pants are wet because there’s enough to drip down your chest.

All these are complaints of people who have hyperhidrosis, a condition in which the body’s cooling centers are turned up so high that they sweat to an extreme — sometimes up to 5 times more than normal, according to the International Hyperhidrosis Society (IHHS). The condition affects an estimated 365 million people worldwide, and types of the condition vary depending on where the sweating is happening. Most often, the sweating occurs in underarms, feet, hands, and the face or the head, notes the IHHS.

“Patients who have hyperhidrosis talk about how it affects their confidence and ability to perform well. They’re always worried about people finding out they have it,” says Dee Anna Glaser, MD, professor of dermatology at Saint Louis University in Missouri, and president of the IHHS.

And that includes hiding it from doctors, too. “Many people are so embarrassed they keep it to themselves instead of seeking medical attention,” says A. Yasmine Kirkorian, MD, assistant professor of dermatology and pediatrics at Children’s National Health System and George Washington University School of Medicine in Washington, DC. But the truth is, you really can find help by talking to a board-certified dermatologist with knowledge of excessive sweating. (The IHHS’s website, SweatHelp.org, has a handy physician finder tool).

Once actively treating the condition, you may notice issues, like irritation from topical products or side effects from medication. But the good news is that there are so many different options, you can work with your doctor to find a solution. Here, nine great ones:

1. Swipe on an Antiperspirant to Help Block Excessive Sweating

“These are a great first step for treating excessive sweating,” says Dr. Kirkorian. Antiperspirants contain physical sweat blockers, like aluminum chloride, which plug up sweat glands, and “extra strength” or “clinical strength” over-the-counter options are effective, she says. Pro tip: Swipe it on at night for the best results, as this is when sweat glands are less active. You may also use it again in the morning with deodorant or on its own. To better lock in its effects, try using a hair dryer on the warm setting and applying heat to the application areas.

2. Ask Your Doctor About Popping a Pill for Hyperhidrosis

Oral medicines, like anticholinergics, can be used off-label for hyperhidrosis, the IHHS points out. But these do carry risks. For one, adults older than age 65 need to tread with caution, as some research suggests an association between long-term use of these drugs and dementia, according to a study published in March 2015 in the journal JAMA Internal Medicine. Even healthy folks need to consider potential side effects, namely that they may cause constipation, blurred vision, dry mouth, and increased heart rate, previous research has noted.

3. Consider Botox as a Possible Way to Stop Sweating So Much

Don’t just think of injections of Botox (onabotulinumtoxinA) as wrinkle fighters for your face — this drug has a whole host of medical uses, and is approved by the U.S. Food and Drug Administration (FDA) in people ages 18 and older for treating armpit hyperhidrosis. Per the IHHS, the natural protein in Botox helps disrupt and block the chemical that triggers sweat glands, effectively helping to stop you from sweating in the injected area. The website notes 20 countries or more have approved this treatment for underarm sweating, and the approach may reduce sweating by upwards of 87 percent and for as long as 14 months.

“Botox can be a good option for patients who don’t respond to or can’t tolerate topical or oral sweating medication,” says Kirkorian. The downside is that the injections, which go directly into the armpit and may be needed every three to six months for sustained dryness, can be painful. But your doctor can use topical numbing creams, ice, or vibration to minimize discomfort, she says.

4. Help Manage Excessive Sweating With miraDry

Noninvasive and FDA-cleared, miraDry is a device that uses microwave technology to permanently destroy sweat glands, says Dr. Glaser, who was involved in the clinical trials for this approach. “It’s appealing for working professionals or other people who don’t want to worry about applying something or taking medication,” she says. The downside is that it’s not covered by insurance, but it may be cost-effective in the long run. The majority of patients require one treatment, she says.

5. Wipe Away the Perspiration With an FDA-Approved Treatment

If you don’t want to take oral medication, a topical treatment called Qbrexza comes in wipes, and was approved by the FDA in October 2018 for underarm sweating. “The wipes contain glycopyrronium tosylate, which is similar to a medicine that has been used orally for a long time to reduce sweating,” says Kirkorian. She also notes that it’s approved for people ages 9 and older, making it a great option for kids and adolescents.

6. Shop for Dark Clothes Made With Moisture-Wicking Fabrics

If you’re dealing with underarm sweating, opt for sweat-wicking fabrics. (Performance clothing geared toward fitness often features these fabrics.) You’ll want to avoid cotton, and instead opt for fibers such as polyester, nylon, and polypropylene, notes Macy’s. Dark colors will hide perspiration better than lighter ones. And to help minimize foot sweating, breathable shoes are a must, says Glaser.

7. Plan Ahead for Sweaty Moments That You Can Predict

Stress can certainly trigger sweating, but just as important as managing stress when it arrives is coming up with an action plan for times it’s most likely to happen. For example, if you deal with sweaty palms, the stress of a job interview — knowing you’ll be shaking hands — can be enough to prompt perspiration, says Glaser. In that instance, learning to reliably wipe off sweat discretely “can give someone confidence back, rendering the trigger a less potent stress releaser,” she says.

8. Try to Change Your Lifestyle, but Have Reasonable Expectations

You can try to pinpoint common triggers (some find that eating spicy food or drinking caffeine may do it) and make appropriate changes. But know that “patients with hyperhidrosis cannot control sweating,” says Kirkorian. That should give you the assurance you need to seek out help and work with a dermatologist to find relief.

9. Think About Other Possible Causes of Hyperhidrosis

If you experience excessive sweating that begins later in life, is all over your body, or involves night sweats where you wake up drenched, talk to your healthcare provider, says Glaser. These may be signs that a medical condition — including heart disease or lung disease, certain cancers, or a hormonal imbalance — may be causing you to sweat too much.

Many people who sweat excessively do not realize that they have a treatable medical condition called hyperhidrosis. The following tips from board-certified dermatologists can help you gain control.

Many people who sweat excessively do not realize that they have a treatable medical condition. The following tips can help you gain control.

See a board-certified dermatologist for a diagnosis. A dermatologist is one of the few doctors who receives training in the diagnosis and treatment of hyperhidrosis. A dermatologist can tell you what type of hyperhidrosis you have and recommend appropriate treatment.

  • Do any of your blood relatives have excessive sweating?
  • Do you sweat a lot while sleeping?
  • When did you first notice the excessive sweating?
  • Do you avoid certain activities or social situations because of your sweating?
  • How often do you sweat excessively?
  • Does anything seem to trigger your sweating?
  • Make sure you are using an antiperspirant rather than a deodorant. Antiperspirants can reduce sweating. Deodorants mask or stop body odor, but allow you to sweat.
  • Apply antiperspirant to dry skin before going to bed.

Keep a sweat journal. For many people who sweat excessively, certain situations trigger their sweating. Learning whether you have triggers is important. This knowledge can tell you when you need more help controlling the sweating. You also may find that you can avoid some triggers.

  • Monosodium glutamate (MSG)
  • Caffeine (chocolate, coffee, tea)
  • Hot sauce
  • Spices such as curry or cumin
  • Alcohol
  • Wear sandals when you can.
  • Wear shoes made of a natural material like leather. This allows air to circulate.
  • Slip off your shoes when you can.
  • Avoid wearing the same shoes 2 days in a row. You want the shoes to dry completely before you wear them again.
  • Wear socks that wick moisture away from your skin. Cotton socks do not wick moisture away. If socks can wick moisture away, it will say so on the packaging.
  • Change socks daily or more often if the socks are wet.
  • Wash socks before you wear them again.
  • Apply antiperspirant to your feet before you go to bed, and wash it off when you wake up. Do this for 3 to 4 nights in a row. Then apply it once a week.

More resources

References
Hornberger J, Grimes K, Naumann M, et al. “Recognition, diagnosis, and treatment of primary focal hyperhidrosis.” J Am Acad Dermatol. 2004;51:274-86.

Miller J, Hurley H. “Diseases of the eccrine and apocrine sweat glands.” In: Bolgna J, Jorizzo J, Rapini R, et al. editors. Dermatology. 2nd ed. Spain, Elsevier Limited. 2008. p. 531-8.

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without prior written permission.

Hyperhidrosis is excessive sweating. Everyone sweats when they’re hot, exercising, or feeling stress. But people who have hyperhidrosis sweat most of the time and sweat heavily without the usual triggers.

Symptoms of hyperhidrosis

If you have hyperhidrosis, you may sweat all over your body. Or you may sweat mainly on your hands, feet, armpits, face, and genital area. Your clothes may be soaked with sweat. Your skin may become white and wrinkled or red and irritated from the moisture.

Dampness from the sweat is accompanied by odor. Sweat by itself doesn’t usually have an odor. But once it is on your skin, bacteria and other germs begin to break it down. This causes it to smell.

Hyperhidrosis can have an unpleasant effect on your life. You may feel awkward and uncomfortable in social situations. You may be self-conscious because of dampness and odor. You may also be afraid to touch or shake hands with people or raise your arm to reach for something. You may feel embarrassed about being in public, spending time with your friends, and going to work or school. These are very normal reactions to having hyperhidrosis.

Should I see my doctor?

Too often, people suffer with hyperhidrosis without seeking help. Perhaps you may think it is silly or embarrassing. But hyperhidrosis can have a negative impact on your life. It can cause social isolation, depression, and anxiety. Plus, it can be a sign of a serious health problem. You are wise to seek your doctor’s advice. Contact your doctor if:

If you suffer from excessive sweating, you may feel like you’ve tried everything. You may have lost hope. Even if you feel this way, please take some time to read through our information about all the treatments currently available for treating hyperhidrosis. We think you’ll leave feeling optimistic again. Please understand that we do not intend to replace the advice of a medical professional, but rather to provide information to support your quest for excessive sweating relief.

In addition to medical treatments, there are many high-tech products on the market to help you manage excessive sweating symptoms and the day-to-day hassles that excessive sweating causes. Many of the best products in this arena are featured in our Fan Faves section where we’ve got great prices on both new sweat-busting products as well as reliable products we’ve loved for years. And by shopping here, you help support our work, too.

As for medical treatments, here’s a brief overview (click through to specific treatment pages for more details):

Treatments such as antiperspirants and iontophoresis have been improved and we now know how to make them more effective.

More recent treatments, like miraDry, Botox injections, and lasers have started giving relief to those who never thought they’d find it. (A webinar about miraDry for underarms is available.)

The newest addition is Qbrexza®, a topical anticholinergic medication self-applied at home using a medicated wipe (or “cloth”).

Additionally, healthcare providers and their patients are experimenting with combinations of treatments and getting good results. This is especially true with oral medications. Due to side effects, oral medications are not always a practical, long-term, single solution. Their better use may be, instead, in combination with other treatments, and new formulations can make them easier to take for more people.

Underarm surgeries, such as liposuction, for excessive underarm sweating are being refined, but less invasive treatments should still be considered first.

ETS surgery, although heavily advertised, is reserved for only certain severe cases of palmar hyperhidrosis (excessive sweating of the palms) that have not responded to any other treatment options or to combinations of treatments. Before considering ETS treatment, physicians and their patients must fully consider and discuss the real risks of permanent damage and severe side effects including compensatory sweating. When ETS is used to treat focal hyperhidrosis areas besides the palms, there appears to be reduced benefit and greater risk.

Everyone’s experience with this condition is different. So please be patient, explore all your options, explore combinations of options, adjust techniques, and work with your doctor to find the best treatments for your individual situation. Keep in mind, also, that research is still being conducted and new treatments, and new ways of using the current treatments, are being worked on. Subscribe to our News Blog, and you’ll be among the first to know about the latest developments.

Hyperhidrosis is a medical condition in which a person sweats excessively and unpredictably. People with hyperhidrosis may sweat even when the temperature is cool or when they are at rest.

Causes

Sweating helps the body stay cool. In most cases, it is perfectly natural. People sweat more in warm temperatures, when they exercise, or in response to situations that make them nervous, angry, embarrassed, or afraid.

Excessive sweating occurs without such triggers. People with hyperhidrosis appear to have overactive sweat glands. The uncontrollable sweating can lead to significant discomfort, both physical and emotional.

When excessive sweating affects the hands, feet, and armpits, it is called focal hyperhidrosis. In most cases, no cause can be found. It seems to run in families.

Sweating that is not caused by another disease is called primary hyperhidrosis.

If the sweating occurs as a result of another medical condition, it is called secondary hyperhidrosis. The sweating may be all over the body (generalized) or it may be in one area (focal). Conditions that cause secondary hyperhidrosis include:

  • Acromegaly
  • Anxiety conditions
  • Cancer
  • Carcinoid syndrome
  • Certain medicines and substances of abuse
  • Glucose control disorders
  • Heart disease, such as heart attack
  • Lung disease
  • Menopause (adrenal gland tumor)
  • Spinal cord injury
  • Stroke
  • Tuberculosis or other infections

Symptoms

The primary symptom of hyperhidrosis is wetness.

Exams and Tests

Visible signs of sweating may be noted during a visit with a health care provider. Tests may also be used to diagnose excessive sweating, including:

  • Starch-iodine test — An iodine solution is applied to the sweaty area. After it dries, starch is sprinkled on the area. The starch-iodine combination turns a dark blue to black color wherever there is excess sweat.
  • Paper test — Special paper is placed on the affected area to absorb the sweat and then weighed. The heavier it weighs, the more sweat has accumulated.
  • Blood tests — These may be ordered if thyroid problems or other medical conditions are suspected.
  • Imaging tests may be ordered if a tumor is suspected.

You may also be asked details about your sweating, such as:

  • Location — Does it occur on your face, palms, or armpits, or all over the body?
  • Time pattern — Does it occur at night? Did it begin suddenly?
  • Triggers — Does the sweating occur when you are reminded of something that upsets you (such as a traumatic event)?
  • Other symptoms — Weight loss, pounding heartbeat, cold or clammy hands, fever, lack of appetite.

Treatment

A wide range of common treatments for hyperhidrosis includes:

  • Antiperspirants — Excessive sweating may be controlled with strong antiperspirants, which plug the sweat ducts. Products containing 10% to 20% aluminum chloride hexahydrate are the first line of treatment for underarm sweating. Some people may be prescribed a product containing a higher dose of aluminum chloride, which is applied nightly onto the affected areas. Antiperspirants can cause skin irritation, and large doses of aluminum chloride can damage clothing. Note: Deodorants do not prevent sweating but are helpful in reducing body odor.
  • Medicines — Use of some medicines may prevent stimulation of sweat glands. These are prescribed for certain types of hyperhidrosis such as excessive sweating of the face. Medicines can have side effects and are not right for everyone.
  • Iontophoresis — This procedure uses electricity to temporarily turn off the sweat gland. It is most effective for sweating of the hands and feet. The hands or feet are placed into water, and then a gentle current of electricity is passed through it. The electricity is gradually increased until the person feels a light tingling sensation. The therapy lasts about 10 to 30 minutes and requires several sessions. Side effects, although rare, include skin cracking and blisters.
  • Botulinum toxin — Botulinum toxin is used to treat severe underarm, palmar, and plantar sweating. This condition is called primary axillary hyperhidrosis. Botulinum toxin injected into the underarm temporarily blocks the nerves that stimulate sweating. Side effects include injection-site pain and flu-like symptoms. Botulinum toxin used for sweating of the palms can cause mild, but temporary weakness and intense pain.
  • Endoscopic thoracic sympathectomy (ETS) — In severe cases, a minimally invasive surgical procedure called sympathectomy may be recommended when other treatments do not work. The procedure cuts a nerve, turning off the signal that tells the body to sweat excessively. It is usually done on people whose palms sweat much more heavily than normal. It may also be used to treat extreme sweating of the face. ETS does not work as well for those with excessive armpit sweating.
  • Underarm surgery — This is surgery to remove the sweat glands in the armpits. Methods used include laser, curettage (scraping), excision (cutting), or liposuction. These procedures are done using local anesthesia.

Outlook (Prognosis)

With treatment, hyperhidrosis can be managed. Your provider can discuss treatment options with you.

When to Contact a Medical Professional

Call your provider if you have sweating:

  • That is prolonged, excessive, and unexplained.
  • With or followed by chest pain or pressure.
  • With weight loss.
  • That occurs mostly during sleep.
  • With fever, weight loss, chest pain, shortness of breath, or a rapid, pounding heartbeat. These symptoms may be a sign of an underlying disease, such as overactive thyroid.

Alternative Names

Sweating – excessive; Perspiration – excessive; Diaphoresis

References

James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Diseases of the skin appendages. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews’ Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 33.

Langtry JAA. Hyperhidrosis. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson IH, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 109.

Miller JL. Diseases of the eccrine and apocrine sweat glands. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 39.

Excessive sweating is when the body releases too much fluid from the sweat glands. It’s also called hyperhidrosis. It’s often an ongoing (chronic) condition. Sweating is a normal process. It helps manage body temperature and other processes of the body. But excessive sweating is more than is needed to do this. Excessive sweating can affect the entire body, but it usually occurs in the palms, soles, armpits, or groin area. The symptoms can start when you’re a child and continue into adulthood.

What causes excessive sweating?

In most cases, the cause isn’t known. It may be caused by thyroid problems, low blood sugar, nervous system disorders, medicines, or other problems. This is known as secondary hyperhidrosis. In some cases, the cause of hyperhidrosis can be serious.

Who is at risk for excessive sweating?

A person is more at risk for excessive sweating if they have any of the below:

  • Thyroid problems
  • Low blood sugar problems
  • A nervous system disorder
  • Medicine that can cause sweating

What are the symptoms of excessive sweating?

Symptoms can occur a bit differently in each person. The main symptom of hyperhidrosis is heavy sweating that:

  • Can cause problems with daily activities, work, and social events
  • Happens during the day but not at night
  • May happen with no physical activity
  • Is not affected by temperature

The sweating occurs most often in any or all of these areas:

  • Bottoms of the feet
  • Palms
  • Underarms

In some cases, it may also occur in these areas:

  • Face
  • Groin
  • Scalp
  • Under the breasts

Areas that produce excessive sweat usually appear pink or white. In severe cases, the skin may appear cracked, scaly, and soft, especially on the feet. You may also have odor caused by bacteria and yeast on the wet skin.

The symptoms of excessive sweating can be like other health conditions. Make sure to see your healthcare provider for a diagnosis.

How is excessive sweating diagnosed?

Your healthcare provider will ask about your symptoms and medical history. Your provider will give you a physical exam. You may also have tests, such as a blood test to check for thyroid problems.

How is excessive sweating treated?

Treatment will depend on your symptoms, your age, and your general health. It will also depend on how severe the condition is. Treatment may include:

  • Antiperspirant. An antiperspirant that has 10% to 15% aluminum chloride can block sweat glands and help stop sweating. It comes in creams, sticks, gels, and sprays. You can buy antiperspirant at a drugstore. Or your healthcare provider may give you a stronger prescription antiperspirant that has 20% aluminum chloride. Antiperspirant should be applied to dry skin at night before bed. It needs to be applied every night for a week or 2, and then once or twice a week or as needed. This can irritate the skin for some people. This medicine is not used on the face.
  • Anticholinergic medicine. This medicine can be taken by mouth to help reduce sweating. Possible side effects can include blurry vision, dry mouth, dry eyes, and constipation. A version for the skin (topical) has recently become available.
  • Botulinum toxin. This medicine is injected into the areas with sweat glands. It can help prevent sweat glands from working normally for a few months. You’ll need to get injections every few months. It can be painful and costly.
  • Iontophoresis. This treatment uses electricity to block sweat glands. Moist pads are put on the skin, or your hands or feet are placed in shallow water. Chemicals may be added to the water. An electrical current is sent through fluid. The process is done several times a week until sweating is reduced, and then once a week or as advised.
  • Surgery. In severe cases, surgery can be done to remove your sweat glands. Or surgery can be done to cut the nerves that send signals to the sweat glands. Either of these types of surgery can stop sweat permanently. But it can lead to compensatory hyperhidrosis. This means you will start sweating from another part of your body.
  • Treating another health condition or changing a medicine. A health condition or a medicine can cause secondary hyperhidrosis. If that’s the case, excessive sweating can be managed by treating the health condition or by changing a medicine. Your healthcare provider will talk with you about these options if you have secondary hyperhidrosis.

Talk with your healthcare provider about the risks, benefits, and possible side effects of all treatments.

What are possible complications of excessive sweating?

You may have skin problems in the areas where you sweat. The skin may become moist, pale, swollen, and soft enough to rub away easily. This is known as skin maceration. It can lead to loss of skin, pain, and skin infection. You can help prevent this problem by treating your hyperhidrosis and keeping your skin dry as much as possible.

Living with excessive sweating

Hyperhidrosis may be caused by or made worse by emotional stress and heat. It can also cause problems with work and social life. You may have stains on your clothes and not want to shake hands with people. It can be upsetting to cope with the problems of excess sweat. Talk with your healthcare provider about:

Excessive sweating is common and can affect the whole body or certain areas. Sometimes it gets better with age but there are things you can do and treatments that can help.

It's normal to sweat if you get hot or do exercise. But you may be sweating excessively if you're sweating when your body does not need to cool down.

Excessive sweating can happen for no clear reason. It could be because of another condition you may have or as a side effect of a medicine you're taking.

It can happen during the menopause. This type of sweating is known as a hot flush.

Things you can do to help with excessive sweating

wear loose-fitting clothes to minimise signs of sweating

wear socks that absorb moisture and change your socks at least twice a day if possible

wear leather shoes and try to wear different shoes day to day

do not wear tight clothes or synthetic fabrics – for example, nylon

do not wear enclosed boots or sports shoes that may cause your feet to sweat more

do not do things that might make your sweating worse – for example, drinking alcohol or eating spicy food

A pharmacist can help with excessive sweating

You can ask a pharmacist about excessive sweating. You can buy things without a prescription, such as:

  • stronger antiperspirants instead of deodorant
  • armpit or sweat shields to protect your clothing
  • foot powders for sweaty feet
  • soap substitutes that are more gentle on your skin

Non-urgent advice: Talk to your GP if you're sweating excessively and:

  • things you can do yourself are not helping
  • it's lasted for at least 6 months
  • it stops you from getting on with your daily activities
  • it happens at least once a week
  • it happens at night (you're having night sweats)
  • you have a family history of excessive sweating
  • you're taking medicine for another condition

Your GP may refer you for tests if they think another condition may be causing your sweating.

Treating severe excessive sweating

You may be referred to a skin specialist (dermatologist) if there's no clear cause and nothing seems to be helping.

They may recommend other treatments that you can try, such as:

  • taking tablets that reduce sweating
  • treating the areas with a weak electric current passed through water or on a wet pad (iontophoresis)
  • having Botox injections for sweating under the armpits
  • surgery – for example, removal of the sweat glands

If your sweating is caused by another condition, any treatment you may need will depend on what's causing it.

Hyperhidrosis is excessive sweating that occurs on the:

What is hyperhidrosis?

The body uses sweat as a form of temperature control, in order to cool itself. Hyperhidrosis is excessive sweating, which means sweating more than normal.

People with hyperhidrosis report feelings of social isolation and withdrawal from others in order to avoid touching others. This includes dating, business activities (where shaking hands is commonplace) and other activities for fear of body odor and damp clothing.

People with hyperhidrosis don’t have more sweat glands than other people. Rather, the nerve that controls sweating—the sympathetic nerve—is oversensitive and causes the overproduction of sweat.

Who gets hyperhidrosis?

There are two types of hyperhidrosis (excessive sweating): primary hyperhidrosis and secondary hyperhidrosis.

Primary hyperhidrosis is usually inherited, which means one of your family members may have had it. Primary hyperhidrosis begins in childhood and worsens with puberty, especially in women.

Secondary hyperhidrosis is caused by some other condition or behavior. Some of these might include:

Medications that may cause sweating

Spinal cord injury

Some cancers are known to cause night sweats, so if you only sweat at night, see your doctor as soon as possible to rule out a serious disease.

Hyperhidrosis Symptoms

Depending where on your body you experience hyperhidrosis will determine your symptoms. Typically, symptoms include:

Excess sweat on your palms, hands, underarms, face and trunk (body)

Some patients may experience extreme flushing on their faces

Hyperhidrosis Diagnosis

Our doctors diagnose hyperhidrosis by doing a physical examination and listening to a patient’s history. We can also measure the level of sweating in two different ways:

Starch Iodine Test: This is a test that turns the sweat brown and is used to detect excessive sweating (hyperhidrosis)

Vapometer: This device measures transepidermal water loss and measures the amount of sweat that the hands, underarms, feet and scalp make. Measuring the amount of sweat gives your doctor an objective way to compare the amount of sweat before and after treatment.

Hyperhidrosis Treatment

There are different treatments for hyperhidrosis, depending on the severity of the condition. These include:

Medications

Drying Topical Creams

Daily topical creams that dry the skin are usually the first introduced treatment. Aluminum chloride or aluminum chloride hexahydrate are the most common of these creams.

Applied daily, usually at night, and then covered to encourage absorption, these creams can be very effective. However, some people find that they have uncomfortable side effects, including burning and skin reactions.

Oral Medications

Oral medications are known as systemic therapies, meaning they affect your entire body. These medications are called anticholinergics, which mean they cause a drying reaction in the body. These oral medications can be a good option for patients who sweat in multiple locations. There are some side effects, like dry mouth and dry eyes. Sometimes, after using these medications for a while, patients find these medications lose their effectiveness.

Dietary Changes

New research suggests changes in diet, such as adopting a vegetarian diet, and dietary supplements may reduce the severity of hyperhidrosis.

Botulinum Toxin

This treatment involves administering injections into affected areas. These injections cause a very reliable temporary decrease in sweating, typically lasting from three to six months.

Microwave thermolysis of sweat glands

This treatment directs energy at the sweat glands in the underarm. By destroying the sweat glands in the underarm, excessive sweating in that area stops immediately. Only 2% of the sweat glands in the body are located in the underarm area, so destroying them in this area does not affect the body’s ability to cool.

Before the procedure, your doctor will numb the underarm area. Then your underarm skin is lifted into the system and microwave energy is directed to the sweat glands. The procedure typically takes an hour and involves no incisions or cuts.

Surgery

Sympathectomy is often used as a last resort for treating hyperhidrosis after other methods have shown no effect. This procedure involves cutting the sympathetic nerve, which is the nerve that controls the sweat reaction.

Behavioral Medicine

Patients diagnosed with hyperhidrosis may experience increased stress associated with excessive sweating. Although topical and oral medications are the first steps of treatment for the physical symptoms of hyperhidrosis, behavior medicine techniques may provide relief from stress, anxiety and other negative emotional reactions which can be experienced with this condition. Behavior medicine consultation is recommended for all patients to improve emotional, social and occupational/academic functioning in youth and adults with hyperhidrosis.

The Johns Hopkins Center for Sweat Disorders

The Johns Hopkins Center for Sweat Disorders provides a holistic approach to treating hyperhidrosis and other dysautonomia conditions through innovative genetic research and multiple treatment options for patients to restore their confidence.

Hyperhidrosis is a condition that causes excessive sweating. Although it is not dangerous, it can affect a person’s confidence level and inconvenience normal activities. Treatments available at the University of Michigan often lead to very quick and effective correction of hyperhidrosis. At the University of Michigan, patients with hyperhidrosis are cared for by specialists from thoracic (chest) surgery, dermatology and neurology who create a treatment plan that fits individual needs.

Hyperhidrosis Causes

When your body temperature is high, nerves in your body will trigger your sweat glands to help cool you down. You may also sweat when nervous. With hyperhidrosis, these same nerves are triggering sweat even when it is not needed. Many patients will experience sweating in the hands, armpits, and feet, and sometimes in the groin, buttocks or other areas of the body.

Hyperhidrosis often appears during puberty. There are two types of hyperhidrosis: primary hyperhidrosis and secondary hyperhidrosis. Primary hyperhidrosis has no known cause and is not related to any other medical condition. Meanwhile, secondary hyperhidrosis may be caused by other factors such as medications, diabetes or abnormal blood sugar level, hyperthyroidism, heart problems, or other diseases.

Hyperhidrosis Treatment

Some patients may respond well to a non-surgical therapy. Most often, one or more of these options are tried before surgery is recommended. Your physician will work with you to discuss all potential therapies and identify the most effective care plans.

  • Topical lotion that is applied to symptomatic areas multiple times a day to reduce sweating may be recommended. Its effectiveness varies greatly and patients sometimes experience side effects of like cracked or chapped skin.
  • Oral medication that stops activity in the nerves responsible for starting sweating may be recommended. These medicines, anti-cholinergic drugs, may also cause side effects including dry mouth and eyes and digestive issues.
  • Iontophoresis is an ionic transfer technique given by dermatologists that sends low levels of electric current to symptomatic areas. To start, patients will receive an application a day for several weeks. If it is effective, they will have less frequent maintenance treatments.
  • Thoracoscopic sympathectomy, allows a thoracic surgeon to directly target the nerves that lead to the sweating symptoms of hyperhidrosis when it effects the hands and armpits. Our thoracic surgeons use the latest minimally invasive or robotic techniques . Most patients will notice immediate results. Our thoracic surgeons have performed more than 200 procedures with a high success rate. As will be discussed in your clinic visit, while the surgery can be effective for sweating in the hands and armpits, it is important to understand some potential side effects before considering surgery. Compensatory hyperhidrosis, or sweating in other areas of the body such as the abdomen or back, can occur in up to 30-50% of patients. There is also a 1% risk of Horner’s Syndrome, which can result in a slightly drooping eyelid and small pupil on one side of the face. Watch as Dr. Rishindra Reddy describes the surgery in our Sympathectomy video.

Most patients will need a referral to be treated for hyperhidrosis. You can speak with your primary care physician or call one of our clinics listed under the Locations tab in the right sidebar for assistance.

How to deal with hyperhidrosis or hyperhydrosis

Cool weather is a time to bundle up and stay cozy. But if you’re sweating through your winter layers, you might not be in the seasonal spirit. Those with hyperhidrosis experience excessive sweating all year, so this condition can be particularly challenging in the winter. This guide will help you stay dry, so you can enjoy your favorite sweaters.

Identifying and Treating Hyperhidrosis

What Is Hyperhidrosis?

Hyperhidrosis is a condition that causes excessive sweating. If you experience hyperhidrosis, you might sweat in cool weather or when you’re sitting still. This condition most often affects the underarms, face, hands, and feet.

Hyperhidrosis doesn’t always have a clear cause, but people often experience excessive sweating because their eccrine sweat glands are always active. This may be linked to an underlying condition like thyroid issues, diabetes, and nervous system disorders. Hyperhidrosis may also be genetic.

If you sweat excessively without a clear cause, book an appointment with your doctor. They can provide a diagnosis and look into an underlying condition as a root cause. If you already have a hyperhidrosis diagnosis, a dermatologist can recommend excessive sweating treatment to keep you comfortable this winter.

How Can You Manage Excessive Sweating in the Winter?

Hyperhidrosis can cause you to sweat through your clothes, even in the winter. You might also notice that your palms and feet are sweaty when you’re otherwise feeling chilly. While sweating like this can be uncomfortable and embarrassing, there are options for relief. A dermatologist can recommend a number of hyperhidrosis treatment options, including:

  • Prescription Antiperspirants: Over-the-counter antiperspirants are often not effective for those with hyperhydrosis. In this case, your dermatologist may recommend a prescription antiperspirant as the first step in treatment. You can generally use these products on the underarms, hands, feet, and other affected areas.
  • Topical Treatments: Dermatologists may recommend prescription creams that contain glycopyrrolate as treatment for excessive sweating on the head and face.
  • Thermal Treatment: Through this type of treatment, a dermatologist would target the sweat glands using a hand-held thermal device. Some people will experience results in as little as one session.
  • Medications: Certain oral medications can block the nerves that cause sweating. These work by preventing the nerves from communicating with each other.
  • Botox Injections: Botox can be an effective treatment for excessive sweating in the underarms. You will likely need to return for a series of injections, since it can take four to six months to notice results.
  • Surgery: If alternative treatments aren’t effective, your dermatologist may recommend surgery. The surgical procedure would likely involve either removing the sweat glands or the associated nerves.

Keep in mind that you may need to try a number of treatments to control your hyperhidrosis, especially in severe cases. Be sure to track your symptoms and see your dermatologist regularly. They will ensure that your treatments are working for you.

If you want to stay ahead of excessive sweating this Winter, contact the skin experts at Pacific Dermatology Specialists. We offer a number of medical and surgical treatments to treat hyperhidrosis. Our licensed dermatologists will recommend a targeted treatment based on your needs. With locations in Seal Beach, CA and the surrounding area, we look forward to working with you.

healthdirect Australia is a free service where you can talk to a nurse or doctor who can help you know what to do.

Excessive or uncontrollable sweating, also known as hyperhidrosis, can be very distressing and embarrassing, but it’s quite common. Treatments can help lessen the impact of excessive sweating on your life.

What is excessive sweating?

As many as 3 in every 100 Australians have excessive sweating, meaning they sweat a lot for no apparent reason, such as being hot or doing physical activity. If you have this condition, you might sweat so much it soaks through your clothes.

There are 2 types of excessive sweating:

  • Focal hyperhidrosis: excessive sweating in certain areas of the body, usually the armpits, hands, feet or face.
  • Generalised hyperhidrosis: excessive sweating that affects the entire body, usually due to an underlying medical problem.

What causes excessive sweating?

Sweating normally happens when the nervous system triggers the sweat glands to produce fluid to cool the body. This can happen in response to the temperature, physical activity or stress.

Sometimes, the nerves become overactive and trigger the sweat glands even without heat or physical activity. This type of hyperhidrosis often runs in families. It can be worse if you are nervous or stressed.

Excessive sweating can also be caused by a medical condition such as:

Some medicines can also cause excessive sweating.

Symptoms and diagnosis of excessive sweating

Excessive sweating in itself doesn’t affect your health. But many people with this condition find it can make them unhappy, depressed and embarrassed. It can affect people’s social lives, work, relationships and level of confidence. It can also can lead to complications such as skin conditions like tinea and eczema, and physical discomfort.

To diagnose hyperhidrosis, your doctor will examine you and may do some tests to rule out a medical cause of your excessive sweating.

How is excessive sweating treated?

Most people with excessive sweating don’t realise they can get help, but possible treatments include:

  • Therapy:psychotherapy, behaviour therapy and relaxation techniques to help you reduce anxiety and improve your quality of life.
  • Medicines: including antiperspirants, nerve-blocking medicines, antidepressants or botox (this works by reducing the amount of sweat produced by sweat glands when injected around the glands).
  • Iontophoresis: a mild electrical current is delivered through water to areas of affected skin.
  • Surgery: as a last resort, your doctor may recommend surgery to remove the sweat glands or sever the nerves.

Looking after yourself

If you suffer from excessive sweating, it’s important to keep the affected areas as clean and dry as possible. You could use absorbent pads to stop the sweat from soaking through your clothes.

Make sure you carry a spare set of clothes and choose natural fibres such as silk or cotton that allow your skin to breathe. It is important to drink plenty of water to replace fluid lost when you sweat.

If the sweating affects your palms, wearing gloves may help you with day-to-day tasks. If it affects your feet, take your shoes and socks off to air your feet when you can.

If you are upset or embarrassed, it can help to talk to a counsellor or social worker.

Not sure what to do next?

If you or someone you know are concerned about excessive sweating, try healthdirect’s online Symptom Checker and get advice on when to seek professional help.

The Symptom Checker guides you to the next appropriate healthcare steps, whether it’s self care, talking to a health professional, going to a hospital or calling triple zero (000).

Working up a sweat on hot, muggy days or while exercising is only natural and, in fact, healthy. Sweating is the body’s way of cooling down. But sometimes, the body sweats too much, which is the case for people who have a medical condition called hyperhidrosis.

In people with hyperhidrosis, the body’s 2 to 4 million sweat glands are overactive, causing profuse perspiration at times when others would sweat lightly (if at all). They sweat a lot even when weather or physical activity don’t warrant it. If this is the case for you or a loved one, you might consider talking to a dermatologist about it because there are treatments that can help.

If you find yourself staining your shirts on a daily basis, feeling embarrassed to give a handshake because of dripping palms, sweating in the midst of a winter blizzard or coming home to a puddle of sweat in your sneakers, it may be the time to speak with a board- certified dermatologist for an evaluation. Sometimes the condition is caused by medications or a medical condition, but most of the time there is no underlying cause.

At Yale Medicine Dermatology, we understand that hyperhidrosis can interfere with your day-to-day life and cause embarrassment. We do a thorough evaluation to determine if there is a cause of sweating and then customize a treatment regimen that fits your lifestyle.

What is hyperhidrosis?

People who sweat excessively find that their perspiration gets in the way of their daily lives. Besides the obvious social stigma and discomfort hyperhidrosis causes, people with this condition may also get skin infections caused by fungi and yeast in places the skin gets too wet, too often.

Though we know that excessive sweating is triggered by overactivity of the sympathetic nervous system, it’s unusual that a cause can be identified. Sometimes, however, hyperhidrosis can be caused by disorders of the thyroid, menopause or certain medications. The condition affects about 3% of Americans.

There are two types of hyperhidrosis:

Primary hyperhidrosis: Often, people who have this condition sweat excessively from only one or two parts of the body, not all over. Their feet, hands, underarms, foreheads, palms or scalps may get sopped (embarrassingly so), while the rest of their bodies sweat normally. This condition is not associated with a systemic disorder.

Secondary hyperhidrosis: This type of hyperhidrosis can happen in one or two locations on the body, or it can affect the entire body. It results from some medications or from a medical condition. Here are some conditions commonly associated with secondary hyperhidrosis:

  • Overactive thyroid
  • Diabetes
  • Menopause
  • Head injuries
  • Spinal cord injuries
  • Obesity
  • Tumors

Is odor an issue with hyperhidrosis?

There is some good news associated with the condition: Most people don’t have body odor issue from their hyperhidrosis. Even so, you may want to take steps to be sure that you don’t get body odor (bromhidrosis) associated with your excessive sweating. Here are some things you can do:

  • Bathe daily with an antibacterial soap.
  • Change socks and shoes often.
  • Use an antiperspirant or deodorant under the arms.
  • Apply shoe spray for foot odor.
  • Decrease your intake of certain foods like garlic, asparagus and curry that can contribute to body odor.

Do the antiperspirants or deodorants used to treat excessive sweating cause breast cancer?

While there has been research on the topic, there is no conclusive evidence at this time that regular use of these products is associated with breast cancer development, according to an article in the journal Epidemiology.

There are many natural and clinical-strength formulas to try, and it’s really a matter of personal preference. So find what works best for you.

How is hyperhidrosis diagnosed?

Your dermatologist will take a medical history, and ask questions about your sweating patterns. Sometimes bloodwork is needed to determine if there’s an underlying medical cause for hyperhidrosis.

Who gets hyperhidrosis?

People of all ages can experience excessive sweating. Dermatologists note that:

  • Hyperhidrosis tends to run in families.
  • Some medical conditions (like menopause) may cause sweating.
  • Certain medications can cause excessive sweating.
  • The problem occurs despite the climate.
  • More people probably have hyperhidrosis than are diagnosed.

What are the treatments for hyperhidrosis?

If wearing an antiperspirant to stop wetness isn’t working well enough to control your sweating problem, there are several treatments available:

  • Prescription strength antiperspirants: Your doctor may recommend applying these products overnight and/or under a layer of plastic wrap. This improves their efficacy by helping the formula to penetrate into the skin, where the sweat glands are located.
  • Medications: Your doctor may prescribe medications that help prevent the sweat glands from releasing sweat. This may not be an option for people who live, work or exercise in areas with high temperatures (because sweating cools the body) or who have certain medical conditions. New medications are in the pipeline, too, (from Brickell BioTech and Dermira) that may offer solutions in the future for patients with hyperhidrosis.
  • Iontophoresis: This device works by temporarily turning off the sweat glands via delivery of a low-voltage current to the nerves, while you soak your hands or feet in a shallow pan of water. Follow your dermatologist’s advice on how often to do the treatment.
  • Botulinum toxin injections (like Botox):Botox injections are FDA-approved for use in the armpit area for people with hyperhidrosis. Given by a dermatologist, the injections are effective for several months after treatment. They work by blocking the release of a chemicals that cause sweating to occur.

Surgery, though not performed at Yale, is another option for hyperhidrosis.

Why is Yale Medicine dermatology unique in its ability to treat hyperhidrosis?

Yale Medicine dermatologists understand the sensitivity associated with seeing a doctor for hyperhidrosis.

“Hyperhidrosis is common, and probably even more than currently realized because many patients don’t mention the issue. This is often either due to embarrassment, self-consciousness or a lack of knowledge that treatment options exist or which physicians might offer them,” says Yale Medicine dermatologist Sara Perkins, MD. “Anyone concerned about their level of perspiration, is wiping sweat from their forehead regardless of temperature or activity level, or avoids raising their arms or shaking hands because of obvious moisture should see a dermatologist to discuss management options. For many patients, finally addressing the issue can be life-changing.”

Hyperhidrosis is a condition characterized by excessive sweating in amounts greater than what is needed to regulate our body temperature. In most cases, the condition occurs for no apparent reason and is called primary hyperhidrosis. Primary hyperhidrosis usually affects only certain parts of the body, so it is also referred to as primary focal hyperhidrosis. The areas that are most commonly affected by primary focal hyperhidrosis are the palms of the hands, the axillae (armpits), and the feet. Primary focal hyperhidrosis affects 1 to 3 percent of the U.S. population. Males and females are affected equally, and in the majority of patients the condition starts during childhood or adolescence.

Hyperhidrosis can also occur as a result of several medical conditions, including hyperthyroidism and hypertension, in which case it is called secondary hyperhidrosis. Before starting any treatment for hyperhidrosis, all medical conditions that can lead to excessive sweating must be ruled out.

Signs and symptoms of hyperhidrosis

Patients with primary focal hyperhidrosis have constant excessive sweating in the affected areas, regardless of the environmental temperature and the emotional situation. Generally the excessive sweating only stops during sleeping hours and worsens in warm environments and stressful situations. In most patients, more than one area of the body is affected, hands and feet being the most common combination.

Most patients notice the excessive sweating for the first time when the moist palms begin to interfere with school and social activities. Excessive sweating in the hands can severely affect the ability to write, hold papers, use touch-screens, manipulate objects, and perform routine daily activities. It can also cause social embarrassment and impair the patient’s social interactions, which can lead to negative psychological and psychosocial consequences.

Testing and diagnosis of hyperhidrosis

After ruling out all potential causes of secondary hyperhidrosis, the diagnosis of primary focal hyperhidrosis is made by physical exam and a detailed evaluation of the patient’s signs and symptoms. No special diagnostic tests or imaging studies are required. The diagnosis is usually made by the patient’s pediatrician or dermatologist.

Treatment for hyperhidrosis

Hyperhidrosis can be treated non-surgically or with a surgical procedure. At Children’s Hospital of Philadelphia we are committed to treating the patient, not just the condition. Your child’s dermatologist, primary care physician and surgeon will work together to make sure that all hyperhidrosis treatment options are explored.

Patients who don’t have success with non-surgical options will be carefully screened through a comprehensive interview, a detailed self-assessment questionnaire, and a psychological evaluation to ensure that they are good candidates for surgery. Children (and their families) who are appropriate candidates for hyperhidrosis surgery will have an in-depth discussion with the surgeon about the risks and benefits of the operation. After the operation your child will be followed on a regular basis in the surgery clinic.

Non-surgical treatment of hyperhidrosis

Our expert pediatric dermatologists, led by Dr. Albert C. Yan, offer the full spectrum of non-surgical treatment options for hyperhidrosis.

  • Topical agents: Hyperhidrosis can be treated with the application of antiperspirants that prevent sweating by mechanically blocking the sweat glands. The topical agents most commonly used in the treatment of hyperhidrosis are Drysol® (20 percent aluminum chloride) and Xerac® (6.25 percent aluminum tetrachloride). These products are applied to the affected area once a day, usually at night.
  • Oral medications: The medications used to treat hyperhidrosis are called anticholinergic agents and work by blocking the innervation of the sweat glands. The most commonly used are Robinul® (glycopyrrolate) and Ditropan® (oxybutynin). These medications have a variety of side effects that include dry mouth, blurred vision and urinary retention.
  • Iontophoresis: This is a type of low-voltage electrical therapy. The affected areas are submerged in water to which an electrical current is applied. The electrolytes of the water accumulate on the surface of the skin, blocking the sweat glands. Iontophoresis is done on a daily basis, and each session is 20 to 30 minutes long. This treatment requires a significant time commitment.
  • Botox®: The botulinum toxin decreases the amount of sweating by inhibiting the release of acetylcholine from the nerves that stimulate the sweat glands. This treatment requires multiple skin injections to the affected areas and needs to be repeated every 3 to 9 months.

Other therapies such as lasers, herbal medicines, microwave energy, and high-intensity ultrasound are not standard options in pediatrics and their efficacy has not been scientifically proven. To learn more about the non-surgical options available to treat hyperhidrosis, contact the Dermatology Section.

When patients do not respond to non-surgical alternatives, we offer a surgical treatment option.

Surgery for hyperhidrosis

alt=”Illustration shows two incisions made in a hyperhidrosis surgery procedure called thoracoscopic sympathectomy” width=”320″ height=”180″ />Illustration of thoracoscopic sympathectomy Patients with primary hyperhidrosis have the option of undergoing a surgical procedure called thoracoscopic sympathectomy. The operation is also known as endoscopic thoracic sympathectomy or minimally invasive thoracic sympathectomy.

Dr. Pablo Laje, a pediatric general surgeon at The Children’s Hospital of Philadelphia, offers surgery to children and teenagers who have primary focal hyperhidrosis of the hands, alone or in combination with armpits and/or feet. Patients whose hands are not involved are not candidates for the operation. Learn more about surgery for hyperhidrosis.

Whether your child’s doctor has recommended surgery or you are seeking help, our team is available to answer any questions you may have about the procedure.

To learn more about surgery for hyperhidrosis or to refer a patient, contact the Division of Pediatric General, Thoracic and Fetal Surgery or email us with any questions.

If your child is undergoing a surgical procedure at The Children’s Hospital of Philadelphia, we have a variety of resources available that can help you and your family prepare for the experience. Check out our Guide to Your Child’s Surgery to learn more about having surgery at CHOP.

The diagnosis and treatment of excessive sweating depends on the type of hyperhidrosis and the area affected:

  • Most patients with generalized idiopathic hyperhidrosis (which affects large areas of the body) can be treated with oral medications.
  • Those with secondary generalized hyperhidrosis (caused by a medical condition) should be evaluated by a dermatologist.
  • A number of treatment methods are used to treat primary focal hyperhidrosis, which occurs on specific areas of the body, including the hands, feet, armpits and face. These treatments are described below.

Many patients should try conservative therapies (medications or topical agents) first before considering surgery. Your doctor will determine what is the best treatment method for you based on the type of hyperhidrosis you suffer from, your age, and your general medical condition.

Some of these methods are covered by health insurance plans, some are not. Check with your individual policy and/or carrier to understand what benefits you are entitled to receive.

Treatment Options

Oral Medications

There are no medications for the specific treatment of primary hyperhidrosis. However, the condition can be treated with some success with systemic anticholinergics.

  • Ditropan ® (generic name: oxybutynin) is one that has been the most promising, but some patients cannot tolerate the dry mouth and drowsiness associated with it. Other side effects include dilated pupils, constipation, urinary retention and heart palpitations.
  • Robinul ® (generic name: glycopyrrolate) is sometimes effective but may cause dry mouth, dry throat, dilated pupils, constipation, urinary retention and heart palpitations.
  • Beta-blockers (Inderal) have systemic anti-sympathetic effects that are helpful in decreasing the body’s sympathetic response. They’ve been useful in some cases of stress-related hyperhidrosis. They also decrease palpitation and tremors and are mostly useful when taken two hours before a stressful situation.
  • Anti-depressants (Zoloft ® ) and anti-anxiety medications (Xanax) can be effective. Depression doesn’t cause hyperhidrosis, but hyperhidrosis can cause depression.
  • Probanthine ® (generic name: propantheline bromide), which is often used to treat high blood pressure and some arrhythmias, causes a systemic decrease in sympathetic response. It should only be administered after a patient undergoes a thorough physical examination.

Topical Treatments

  • Glutaraldehyde applied two to four days a week is effective in treating palm sweating (plantar hyperhidrosis). But it can cause severe browning of the skin and stain clothing. It may also be expensive.
  • Topical agents containing aluminum chloride (hexahydrate) with ethyl alcohol (Drysol, CertainDri, Maxim, Odaban and Driclor) are the most widely used for patients with mild to moderate armpit sweating (axillary hyperhidrosis). They contain a much higher concentration of aluminum chloride than what is used in regular antiperspirants. Patients apply the medication to the affected areas of the skin and leave it on for six hours at night for about one week. The medication obstructs the sweat gland pores. Axillary irritation can occur. Short-term results are satisfactory, but the medication doesn’t have long-term results.

ETS Surgery

Endoscopic thoracic sympathectomy (ETS) is a minimally invasive surgical procedure used to treat hyperhidrosis. It’s the most successful treatment for excessive sweating of the hands, as well as an effective option for patients who have excessive armpit sweating or facial sweating/blushing. Learn more about ETS surgery for hyperhidrosis.

Botox

Botox injections work best for armpit sweating (axillary hyperhidrosis), but not palm sweating, facial hyperhidrosis or facial blushing. Botox is derived from Botulinum Toxin Type A. The toxin is highly deadly, but Botox is manufactured under strict laboratory conditions. Botox blocks the neurotransmission from the sympathetic nerves to the skin to the sweat glands and reduces excessive sweating in the areas where it has been injected by a dermatologist. This treatment lasts only between four to six months, so treatments must be repeated.

Iontophoresis

This treatment involves placing the hands or feet (whichever area is affected) in two pails of water that contain a conductor. A device (brand names Drionic ® , Idrostar, MD-1A) applies a low electric current to the feet. As the current passes through each hand or foot, minerals in the water clog the sweat glands, limiting the amount of sweat released. Each session lasts 20 minutes and is repeated four to six times a week. Frequent treatments are necessary. Some people have experienced good results with this treatment, while others see no effect.

Sweat Gland Removal Surgery

Very severe armpit sweating (axillary hyperhidrosis) may need to be treated with permanent surgical removal of the sweat glands by a plastic surgeon. Either a traditional surgical procedure, or a minimally invasive one called suction curettage, which is a modified form of liposuction, may be used.

Suction curettage is an outpatient procedure during which a plastic surgeon removes the sweat glands using quick suction and scraping (curettage). The surgery takes about 60 to 90 minutes, and patients return home later that day. Some patients return to work the next day. More than 95 percent of patients report less discomfort and permanent dryness. Patients may experience scarring or compensatory sweating (excessive sweating of back, torso and legs) after having this type of sweat gland removal surgery.

Louise Dunford receives funding from The UK Dermatology Clinical Trials Network.

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Most people sweat when they exercise or the weather is hot. But some people sweat far more than this. Hyperhidrosis – excessive sweating – can be a devastating condition that has a huge impact on quality of life, and even prevent those who have it from carrying out everyday tasks. For some it has affected their relationships. Others are so embarrassed by their sweating that they feel unable to leave their house.

Sweating is a normal physiological process that helps the body to regulate its temperature. When we get too hot or exercise, sweat evaporates from the skin and has a cooling effect. People often also notice they sweat when they are anxious or are in a situation that makes them nervous. But for the roughly 3% of people who have hyperhidrosis, sweating can be almost constant.

The most common areas of the body affected by hyperhidrosis are hands, feet, underarms, face, and head, although other areas can be affected too. Some people with hyperhidrosis sweat all over, rather than in just some parts of the body. People with hyperhidrosis often sweat in situations where other people don’t, for example, when the weather is cold.

It is not known what causes hyperhidrosis, although it is thought that the nerves that usually make us sweat become over-active. Hyperhidrosis often starts in childhood or adolescence, but can start at any time during life. There is probably a genetic element as well, as there is often a family history in people who have excessive sweating of the hands.

How to deal with hyperhidrosis or hyperhydrosis

Few answers

Without a clear understanding of what causes hyperhidrosis, it is more challenging to find effective treatments. That is why colleagues and I have been researching the condition. We asked people with hyperhidrosis and healthcare professionals who treat them what questions they would like research to answer. We had 268 people come forward to suggest nearly 600 research questions.

We found that hyperhidrosis has a wide range of severity. At the mild end of the spectrum, the effects may be minimal – a small inconvenience or minor embarrassment. But as severity increases, the impact on quality of life becomes much more substantial. And the condition can have a huge impact on quality of life, affecting people’s career choices and leading to social isolation. For example, some people have such sweaty hands that it makes it difficult to hold a pen or use a keyboard.

People with hyperhidrosis often have anxiety in work situations such as job interviews or meetings where they might be expected to shake hands. Their social life can also be affected, with many people feeling embarrassed by their sweating, and some people have avoided forming intimate relationships due to this. Some people have to change their clothes several times.

How to deal with hyperhidrosis or hyperhydrosis

Many people with hyperhidrosis don’t seek medical help due to the stigma of the condition. They may not even know it is a medical condition at all. Those that do often report difficulties in being taken seriously, lack of access to specialists, and treatment being considered a low priority.

Available treatment

There are a number of treatments available for hyperhidrosis, which depend upon the area of the body affected. Temporary treatments include:

  • Strong anti-perspirants containing aluminium chloride
  • Iontophoresis, where the affected areas are placed in water and a low voltage electrical current passed through it
  • Botox, which works by blocking a chemical at the nerve endings, so it can’t activate the sweat glands
  • Oral medications, called anti-cholinergics, which also work by blocking the nerve endings, throughout the body

But these are all temporary, and do not work for everyone. The anti-perspirants can cause skin irritation, and oral medication blocks nerve endings throughout the body, so can cause side effects such as a dry mouth and problems urinating. Botox and iontophoresis, meanwhile, need to be repeated regularly and can be expensive.

How to deal with hyperhidrosis or hyperhydrosis

There are also some more permanent solutions available. Some sufferers have had surgery to remove or destroy sweat glands in a localised area (such as the armpits) or endoscopic thoracic sympathectomy (ETS), where the nerves that control sweating are cut. ETS is effective in reducing the sweating of the areas intended, but can lead to very serious side effects such as damage to nerves or organs. Most patients end up with some level of sweating in other areas (compensatory sweating) and this can be worse than the original problem, so this surgery is generally only used as a last resort. A newer permanent treatment uses electromagnetic energy to destroy sweat glands.

Despite being a common skin condition, hyperhidrosis is not widely known about, and research is very poorly funded. Raising awareness is key if people are to feel comfortable enough to come forward to ask for help and advice.

How to deal with hyperhidrosis or hyperhydrosis

No one enjoys sweating but it is oftentimes an unavoidable occurrence. Sweating is a necessary bodily function; our bodies naturally sweat to prevent us from overheating and to release toxins from the body. However, there are some instances in which sweating or excessive sweating should be given some concern. Keep reading to learn more about hyperhidrosis, an excessive sweating neurological disorder that can cause negative side effects.

What Is Hyperhidrosis and What Causes It?

Hyperhidrosis is a condition characterized by excessive sweating in either the whole body or a specific area. This condition is not detrimental to one’s health, but it can be uncomfortable, inconvenient, and cause psychological trauma. Hyperhidrosis can be present from birth or onset later in life. Focal hyperhidrosis refers to localized excessive sweating, typically sweating of the palms and soles of the feet , whereas Generalized hyperhidrosis occurs across the entire body.

This condition can be due to an underlying health issue or can have no evident cause, affecting approximately 2.8% of Americans. Primary idiopathic hyperhidrosis is excessive sweating with an unknown cause. This kind of hyperhidrosis is typically localized. Treatment of primary idiopathic hyperhidrosis tends to be more difficult as there is no pre-existing issue to narrow down options. Secondary hyperhidrosis is when a person sweats too much as a result of another health condition like gout, obesity, menopause, diabetes, or cancer.

What Are Side Effects of Hyperhidrosis?

Hyperhidrosis is a condition that causes excessive sweating , which is the obvious main side-effect. However, there are several lesser-known, more challenging-to-detect symptoms that people suffer from. Excessive sweating throughout the day is the most obvious symptom and can cause a plethora of neurological issues. Sweating of the palms of the hand can also become an issue of productivity if your job requires you to use your hands often. Because excessive sweating tends to make people self-conscious, anxiety, depression, and other issues often stem from this symptom. Night sweats are another symptom that people suffer from. Not only are night sweats uncomfortable, but they can be particularly embarrassing if you share a bed with a romantic partner.

Treatments For Hyperhidrosis

There are many different treatments for hyperhidrosis based on the source of the sweating and its frequency. Surgery is typically considered a last resort treatment and is often only recommended to those with severe palmar (palm) and armpit sweating. Check out these doctor-recommended, non-surgical treatments for patients with hyperhidrosis :

Antiperspirants with Aluminum

If your sweating is minimal and more manageable, your doctor may recommend over-the-counter or prescription antiperspirants that contain aluminum to limit the amount of sweat your glands produce.

Anticholinergics Medicine

This kind of medication works by inhibiting the signals that your nervous system sends to your sweat glands. This can help inhibit the amount of sweat your glands produce.

Iontophoresis

Iontophoresis is an electromotive, non-invasive way to administer medicine without the use of a syringe. It administers a charged substance to the body with no trauma and can be very effective at treating hyperhidrosis.

Other Causes of Excessive Sweating

To a certain extent, excessive sweating can be normal and related to things that aren’t harmful. If you live in a humid or hot area, have recently started a new or more intense workout regimen, or generally spend a lot of time outside exerting yourself, the amount of sweat you are experiencing may be completely normal. The best thing for you to do is to see a health care provider for a physical examination . They can properly diagnose you and then walk you through potential treatment options.

Visit Beaumont Dermatology and Family Practice

At Beaumont Dermatology and Family Practice, we know skin. If you are looking for treatment for hyperhidrosis, acne, eczema, or other common skin ailments, you’ve come to the right place. Contact us today to learn more about us and our services.

Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.

Tyra Tennyson Francis, MD, is a board-certified family medicine physician and currently serves as the medical director of an outpatient clinic.

Verywell / Brianna Gilmartin

Sweating can sometimes seem annoying, but it is important to remember that it is through sweating that the body is able to cool itself when it gets too hot. Without the ability to sweat, a medical condition called anhidrosis , the body can overheat and even develop heatstroke, a life-threatening condition.  

That being said, in some individuals, excessive sweating—also known as hyperhidrosis —can be an issue. While it is not harmful, it can be embarrassing and frustrating to deal with, especially as a teen in school.  

Normal vs. Excessive Sweating

Sweaty underarms, foreheads, faces, palms, and feet are on the common side in teens and preteens. Sweating is normal in obvious situations—high heat and humidity, when eating spicy foods, exercising, in cases of fever, and when your teen is angry, panicking, anxious, or nervous.

If you notice anything out of the ordinary, particularly sweating when there's no obvious reason or if your child is soaking through his or her clothing, there may be something else at play.

Primary and Secondary Hyperhidrosis

Hyperhidrosis—excessive sweating—can be a condition in and of itself (primary hyperhidrosis) or a symptom of an underlying cause (secondary hyperhidrosis).

Primary Hyperhidrosis

Primary hyperhidrosis often begins in childhood. The cause is unknown, and most teens with excessive sweating and no other symptoms are thought to have it. In this condition, the excessive sweating is limited to just one or more areas of their bodies, and the sweating is bilateral and symmetric (for example, both hands or both armpits).   Sweaty palms, feet, underarms, and faces are most common. The sweating doesn't usually occur when sleeping.

All people with primary focal hyperhidrosis have a normal number of sweat glands that work just as they should—they just produce more sweat for some reason.

Sweat is produced by eccrine and apocrine glands in the skin. Eccrine sweat glands are found over most of the body and produce sweat without any odor. On the other hand, apocrine sweat glands are not as widespread and are typically just found in the underarms and groin area. They produce sweat that, once it has contact with bacteria, has a distinct body odor.

Secondary Hyperhidrosis

Secondary hyperhidrosis is usually generalized and caused by an underlying medical condition. These conditions can include:  

  • Hyperthyroidism (overactive thyroid gland), which may be accompanied by other symptoms like weight loss and changes in heartbeat
  • Various types of infections
  • Diabetes, often accompanied by other symptoms like increased thirst, urination, and weight loss
  • Other metabolic and hormonal disorders
  • High blood pressure in children

Know that the risk of secondary hyperhidrosis is small in younger individuals. Risk increases with age and is often accompanied by other symptoms outside of sweating.   Whether or not your teen complains about any additional symptoms, or if you notice something out of the ordinary yourself, it's important to go see a doctor to double check what's going on, especially if your teen's excessive sweating frequently interferes with daily activities or has become intolerable.

A physical examination, bloodwork, and other lab tests such as a sweat test, which tests how the body reacts to changes in temperature and air flow, can confirm a diagnosis.

If an underlying condition is involved, treatment will help reduce the sweating and get the condition under control.

If it turns out that your teen has primary hyperhidrosis, know that the condition isn't particularly harmful—just often times embarrassing and frustrating to deal with.   Luckily, there are treatment options available for coping with the excess sweat.

Treatments

Treatments that may help control excessive sweating in teens include:  

  • A regular over-the-counter antiperspirant—use it both in the morning and the evening for best results. There are also over-the-counter antiperspirants, such as Certain Dri, with 12 percent aluminum chloride, and prescription strength antiperspirants, such as DrySol, with 20 or 6.25 percent aluminum chloride.
  • Anticholinergic medications—because of their side effects, such as dry mouth, constipation, and drowsiness, they are more helpful for generalized hyperhidrosis and not teens who just have sweaty palms or excessive armpit sweating
  • Prescription medication such as Qbrexza (glycopyrronium) cloth, which is an anticholinergic drug infused in a pre-moistened disposable towelette. It is to be used on the underarms only and is approved for the treatment of excessive underarm sweating by the U.S. Food and Drug Administration (FDA) for adults and children 9 years of age and older.

When it comes to the antiperspirants, help your teen follow the directions closely when using antiperspirants with aluminum chloride, as they can be very irritating to your teen's skin.   To decrease any chances of irritation, apply the antiperspirant to dry skin at night, and then wash it off 6 to 8 hours later. Use a cool blow dryer (don't use a warm or hot setting) to help dry your skin if necessary before applying antiperspirant. Applying hydrocortisone cream or topical baking soda after you wash away the antiperspirant may also help to decrease the chances of skin irritation.

Antiperspirants are sometimes used on sweaty palms and sweaty feet, but talk to a pediatrician first, because there is a risk for skin irritation.

Other treatments for excessive sweating that are more commonly used in adults include surgical treatments like local sweat gland excision or endoscopic thoracic sympathectomy. Iontophoresis, in which low-level electrical current is applied to the skin's surface to reduce sweat production, is another option, as are Botox injections. Although the effect is only temporarily, Botox works to block a neurotransmitter that stimulates sweat glands, leading to a decrease in sweat production for 6 to 7 months.  

A dermatologist can help you further manage your teen's excessive sweating and explore the prescription medication options available.