Hyperhidrosis and Sweating: When Should You See a Doctor?

Medically Reviewed by Poonam Sachdev on March 01, 2023
Written by Matthew Hoffman, MD
5 min read

Excessive sweating (hyperhidrosis) isn't life threatening, but it can threaten your quality of life. How do you know when it's time to see a doctor about excessive sweating?

How can you tell if your sweating is excessive?

No one can say how much sweat is "too much." There's really no effective and convenient way to measure the total amount of sweat.

Excessive sweating is instead defined as any amount of sweating that causes problems or distress. The exact causes aren't known, but up to 3% of people have hyperhidrosis.

Hyperhidrosis usually starts in adolescence or young adulthood. Sweating is worst in the palms, soles, or underarms. When excessive sweating is limited to these areas, it's called focal hyperhidrosis.

Most people with focal hyperhidrosis are otherwise completely healthy. Studies suggest that they are no more nervous or easily upset than people who sweat normally.

At the same time, hyperhidrosis can cause real problems. Most people feel extremely embarrassed by their excess sweating. They frequently report frustrations or problems with things most people take for granted:

  • Frequently changing clothing because of underarm sweating
  • Avoiding shaking hands
  • Missing out on social gatherings due to concern about sweating
  • Challenges with romantic relationships
  • Difficulty writing because the pen slips or sweat soaks through ink on the page

In fact, about one-third of people with focal hyperhidrosis describe their symptoms as significantly affecting their quality of life.

Despite the serious negative impact hyperhidrosis has on the lives of those who have it, most never seek treatment.

Generally, people with focal hyperhidrosis have been living with their problem since they were young. After learning to live with excessive sweating, they often don't recognize their problem is treatable.

That's too bad, because while hyperhydrosis can be difficult to control, there are treatments. Although no treatment is perfect, hyperhidrosis medications and procedures can help many people with the condition.

Some primary care doctors are familiar with the initial treatment of focal hyperhidrosis, which may include:

  • Over-the-counter (OTC) antiperspirants: these can be applied to the hands and feet, as well as the armpits. Hyperhidrosis that's controllable by OTC treatment doesn't need a doctor's visit. Antiperspirants should be used at bedtime for more time to work. People with focal hyperhidrosis don't sweat while they they sleep.
  • Prescription antiperspirants: Most people with hyperhidrosis will sweat through OTC antiperspirants. A doctor can prescribe a higher-strength, aluminum salt-based antiperspirant. This can be effective for mild cases of excessive sweating.

Dermatologists are generally the best doctors for treating excessive sweating that's not controlled by OTC products. They are usually more familiar with hyperhidrosis treatment, especially when sweating is severe. Depending on your insurance, you may need a referral to a dermatologist from your regular doctor.

Some more advanced treatments for hyperhidrosis include:

  • Iontophoresis: This involves soaking the hands or feet in a basin of water through which a mild electric current is passed. It requires frequent treatments, but it's often effective at reducing sweatingand can be done at home. 
  • Botulinum toxin type A (Botox): Injections of this anti-wrinkle drug turn off sweat glands of the underarms for months at a time. Botox is more than 90% effective as a hyperhidrosis medication. The injections can be painful, though, sometimes requiring local anesthesia.
  • miraDry system: This device uses electromagnetic thermal energy to permanently eliminate underarm sweat glands. It is not approved for use on other areas of the body.

Oral hyperhidrosis medications can also reduce excessive sweating, although side effects sometimes limit their use.

In extreme cases, referral to a surgeon is an option. Surgical procedures are available to treat hyperhidrosis and can be quite effective. They often have serious side effects, though, and are considered a last resort.

Focal hyperhidrosis isn't medically serious. Other forms of excessive sweating, though, can signal underlying medical problems.

Sweating all over the body at once is called generalized hyperhidrosis. It's frequently caused by diseases affecting the whole body. Infections, hormone problems, cancer, or nerve problems can be responsible. It often occurs during sleep, unlike focal hyperhidrosis, which occurs only when awake.

Anyone with all-over body sweating should see a doctor as soon as possible.

When you go in for your first doctor's visit, it helps to know a little bit about your sweating patterns and what seems to trigger heavy sweating. In the days or weeks before your appointment, keep a diary of the following information:

  • How many times a day do you have to change your clothes?
  • How many times a day do you bathe or shower, and what type of soap do you use?
  • What methods have you tried (such as antiperspirants or absorbent foot pads) to control excessive sweating?
  • How has heavy sweating affected your life -- for example, have you had to change social plans, lost friends, or been affected at work because of hyperhidrosis?
  • Do you experience any skin irritation at the site of the heavy sweating?
  • How does heavy sweating affect you emotionally? Do you ever get sad or angry because of it?

Your doctor will ask you about your sweating -- when it occurs, and what seems to trigger it. You'll also be asked about your medical history, including any medical conditions you have and medicines you are taking.

The doctor will do a medical exam, which may include:

  • Lab tests and other tests to check for conditions that can cause hyperhidrosis, such as heart disease, thyroid problems, and diabetes.
  • Tests for hyperhidrosis. The starch-iodine test uses a mixture of iodine and starch, which turns blue in areas where your body is sweating excessively. The paper test uses a special type of paper applied to the affected area to measure the volume of sweat you are producing.

Based on your health history and exam, your doctor will determine whether you have primary hyperhidrosis or secondary hyperhidrosis.

  • Primary hyperhidrosis is the most common cause of excessive sweating. It's not due to any medical condition -- it is the condition. Primary hyperhidrosis tends to start in childhood and run in families, and it usually causes heavy sweating on the palms of the hands, soles of the feet, and armpits.
  • Secondary hyperhidrosis is caused by a medical condition (such as cancer or an infection) or medication (which can include antidepressants and antipsychotic drugs). Sweating can occur over wider areas of your body.

Knowing which kind of sweating problem you have can help your doctor find the right treatment for it. That treatment may involve antiperspirants, iontophoresis (a technique that uses a low current passed through water to treat heavy sweating of the hands and feet), or Botox injections to block the nerve signals that trigger your sweat glands.

If sweating is due to another condition, then treating the primary condition may help with symptoms. Discuss all of your options with your doctor. Make sure you fully understand them, and their possible side effects before you begin hyperhidrosis treatment.

Also ask your doctor whether your health insurance will cover the cost of treatment. Some insurance companies and policies will pay for all or part of hyperhidrosis treatments, and it's important to know how much of your treatment you will need to cover yourself.

Keep in close touch with your doctor while you are undergoing treatment for excessive sweating. If your hyperhidrosis isn't responding to antiperspirants, iontophoresis, or Botox, the next step may be to try oral medication or surgery.