Excessive Sweating (Hyperhidrosis)

Medically Reviewed by Jabeen Begum, MD on June 27, 2024
6 min read

Hyperhidrosis is a condition that causes excessive sweating. If left untreated, these problems may continue throughout your life.

Excessive sweating can cause embarrassment and social isolation. Severe cases can also have serious practical consequences, making it hard for people who have it to hold a pen, grip a car steering wheel, or shake hands. But there are treatments to help with hyperhidrosis.

There are different types of hyperhidrosis, including:

Primary hyperhidrosis

This is excessive sweating that starts in adolescence or even younger and impacts your hands and feet. There's no known cause for the condition.

Secondary hyperhidrosis

This type of hyperhidrosis starts when you're an adult, and there's a root medical cause of the condition, such as an endocrine disorder, infection, or neurologic disease. Certain medications can also trigger it.

Focal hyperhidrosis

When excessive sweating affects specific parts of your body, it's known as focal hyperhidrosis. It typically impacts your palms, soles, armpits, and forehead.

Generalized hyperhidrosis

This is when you sweat from your whole body, usually your head, chest, abdomen, back, arms, legs, groin, and buttocks.

What is axillary hyperhidrosis?

This kind of hyperhidrosis affects your underarm area. Underarm problems tend to start in late adolescence.

What is palmoplantar hyperhidrosis?

This is excessive sweating on your palms and soles, and it usually starts around age 13 on average.

Sweat glands, like tiny water sprinklers, keep us cool. Normally, nerves turn them on with heat, exercise, or emotions. In hyperhidrosis, these nerves glitch, triggering excessive sweat even when not needed. Genetics might play a role in explaining why it can run in families.

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

To figure out if you have hyperhidrosis, your doctor will first talk to you about your symptoms and health history. They'll ask when and where you sweat the most, what seems to cause it, and how it impacts your day-to-day activities. The doctor will also examine you to see how much you sweat and suggest blood, urine, and other lab tests to check for any other health issues that could be causing your condition.

Sometimes, they might use other tools and tests, such as:

  • Starch-iodine test, which turns your sweat brown to show where you sweat too much
  • Vapometer, or a tool that checks how much water your skin loses and measures how much you sweat from your hands, underarms, feet, and head
  • Paper test, which is a special type of paper that soaks up sweat. Your doctor will then weigh it to figure out your amount of sweat.

First-line treatment for hyperhidrosis

The first treatment for excessive sweating usually involves daily creams that dry out the skin. The most common ingredients in these creams are aluminum chloride or aluminum chloride hexahydrate. You'll usually apply these creams at night and then cover the area to help the skin absorb them. Many people find that these creams work well, but you may have side effects such as burning and skin irritation.

Prescription medications

Your doctor may prescribe medication that blocks the nerves that trigger sweat glands or an antidepressant. Another type of drug, an anticholinergic, works throughout your whole body to create a drying reaction. It's for people who sweat in more than one part of their bodies. Doctors don't typically prescribe anticholinergic drugs because they cause dry mouth, dry eyes, blurred vision, and trouble emptying the bladder. Most people who take oral medication have tried other treatments and found they don't work.

Aluminum chloride hexahydrate for excessive sweating

When regular antiperspirants don't work on excessive sweating, most doctors suggest aluminum chloride hexahydrate (Drysol), a prescription-strength version of aluminum chloride. You apply it just before bedtime two to three nights in a row, then roughly once a week after that to maintain improvements. This treatment works well on excessive underarm sweating, but not palm and sole sweating. Be sure to use this treatment as directed by your doctor. 

The main side effect of Drysol is irritation, which you may be able to avoid by drying your skin before applying the antiperspirant and letting it completely dry after applying it. It may also help to use it less or apply a lotion containing a corticosteroid.

Botox for hyperhidrosis

Most people use Botox, a nerve toxin that can temporarily paralyze muscle, as a cosmetic treatment for wrinkles. But doctors also use it for excessive underarm sweating. Using a fine needle, they'll inject a small amount of Botox into about 20 to 25 spots in each armpit. The injections can be uncomfortable, but using a small needle helps make them bearable. Afterward, you may have up to 14 months of relief from sweating.

The FDA has only approved Botox for excessive underarm sweating, but some doctors use it in other areas such as the palms and soles. Palm injections can be more painful and require nerve blocks to numb your hands. Some doctors also use Botox for excessive head and face sweating. Many health insurers cover these injections when other treatments don't work.

miraDry treatment

This is a noninvasive treatment that uses electromagnetic energy to direct heat on sweat glands, destroying them. During this hour-long procedure, your doctor will apply a numbing medicine (local anesthesia) to the area and cool your skin. For it to work best, you may need the treatment two or three times.

Laser for hyperhidrosis

Lasers focus a narrow beam on underarm sweat glands to destroy them. This quick procedure has a fast recovery time.

Iontophoresis for excessive sweating

People with excessive sweating have used iontophoresis for more than 50 years. Doctors aren't exactly sure how it works, but it may temporarily block your sweat duct. The painless procedure uses water to conduct an electric current to the skin a few times each week, for about 10 to 20 minutes per session, followed by a maintenance program of treatments at 1- to 3-week intervals, depending on how you respond to the treatment. You can buy an iontophoresis device with a doctor's prescription, and medical insurance may cover the cost.

Thoracic sympathectomy for hyperhidrosis

Thoracic sympathectomy is a surgery that cuts certain nerves to reduce sweating. In this procedure, the surgeon aims to destroy the nerves that control sweat glands by using a special tool inserted through the chest near the armpit. While the surgery can work well, it can also trigger other health problems. These include more sweating in other areas of your body, as well as possible lung and nerve damage. Because of these serious and often permanent health problems, doctors usually consider this surgery as a last resort.

If you have hyperhidrosis, you might face higher rates of anxiety and depression because excessive sweating can make you feel embarrassed and avoid social situations. Sweating and anxiety can reinforce each other in a harmful cycle.

Therapy, such as cognitive-behavioral therapy (CBT) and antidepressant medications, can help break this cycle by addressing negative thoughts and improving your mood. Help from health care professionals is essential for managing both the physical symptoms and emotional impact of hyperhidrosis.

If you have hyperhidrosis, it can have a serious impact on your quality of life by causing constant worry about sweat stains, leading to social anxiety, limiting what you wear, and even causing physical discomfort like skin irritation.

There's no cure for the condition, but treatment, regular doctor visits, and lifestyle changes such as breathable clothes can help keep your symptoms under control.

Hyperhidrosis causes excessive sweating in areas such as your underarms, palms, and soles of the feet, leading to discomfort and disrupting your daily life. Treatments include over-the-counter and prescription-strength antiperspirants, medications, and procedures such as Botox injections. People with hyperhidrosis may have higher rates of anxiety and depression, which you can manage through therapy and antidepressant drugs. While there's no cure for hyperhidrosis, proper management can improve your quality of life. Regular follow-ups with your doctor are critical for tracking your progress and adjusting your treatment plan.